https://doi.org/10.1177/0148607117692751 Journal of Parenteral and Enteral Nutrition Volume XX Number X Month 201X 1–8 © 2017 American Society for Parenteral and Enteral Nutrition DOI: 10.1177/0148607117692751 jpen.sagepub.com Original Communication Clinical Relevancy Statement A previous study 1 found that critically ill children were spend- ing over 40% of their pediatric intensive care unit (PICU) admission time without any form of nutrition. A nurse-driven feeding protocol was implemented in this specific PICU in 2013, and this study performed an audit to determine compli- ance to the protocol. This study observed a 95% adherence rate to the feeding protocol, and reasons for noncompliance were identified. These findings provide justification for the use of standardized evidence-based feeding protocols in the PICU. It is important to advocate for this vulnerable population, to ensure that critically ill children receive adequate nutrition support in the PICU. Introduction Patients admitted to pediatric intensive care units (PICUs) often experience prolonged periods without nutrition support. 1 Hospital-induced malnutrition can negatively affect clinical outcomes such as 60-day mortality, PICU length of stay (LOS), hospital LOS, number of ventilator days, and infection rates. 2 Moderate to severe malnutrition at admission has been reported at a prevalence of 53% in a tertiary care children’s hospital. 3 Nutrition support is crucial for critically ill children, to prevent further deterioration from suboptimal energy intake. 4,5 Consistent feeding practices, driven by protocols, are neces- sary to try to overcome these barriers. Patients receive signifi- cantly more nutrition support when feeding protocols are followed; however, difficulties with protocol adherence have 692751PEN XX X 10.1177/0148607117692751Journal of Parenteral and Enteral NutritionCunningham et al research-article 2017 From 1 Division of Human Nutrition, Faculty of Agriculture, Life, and Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada; 2 Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; 3 Department of Epidemiology, School of Public Health, University of Alberta, Edmonton, Alberta, Canada; and 4 Nutrition Services, Alberta Health Services, Edmonton, Alberta, Canada. Financial disclosure: None declared. Conflicts of interest: None declared. Corresponding Author: Bodil M. K. Larsen, PhD, RD, Stollery Children’s Hospital, 3G1.23 Walter Mackenzie Centre, 8440 112 St, Edmonton AB, T6G 2B7, Canada. Email: bodil.larsen@albertahealthservices.ca Adherence to a Nurse-Driven Feeding Protocol in a Pediatric Intensive Care Unit Carmen A. Cunningham, BSc 1 ; Lindsay B. Gervais, BSc 1 ; Vera C. Mazurak, PhD 1 ; Vijay Anand, MD 2 ; Daniel Garros, MD 2 ; Katelynn Crick, BSc 3 ; and Bodil M. K. Larsen, PhD, RD 1,2,4 Abstract Background: Patients admitted to pediatric intensive care units (PICUs) often experience prolonged periods without nutrition support, which may result in hospital-induced malnutrition and longer length of stay. Nurse-driven feeding protocols have been developed to prevent unnecessary interruptions or delays to nutrition support. The primary objective of this study was to identify compliance and reasons for noncompliance to a feeding protocol at a tertiary care hospital PICU in Canada. The secondary aim was to determine the mean time (hours) spent without any form of nutrition and to identify reasons for time spent without nutrition. Materials and Methods: This was a prospective cohort audit, consisting of 150 consecutive PICU admissions (January–February 2016). Exclusion criteria consisted of patient mortality within 48 hours (n = 1) and patients who were still admitted at the end of the data collection timeframe (n = 7). The remaining cohort consisted of 142 consecutive admissions. Data collection took place in real time and included patient demographics, diagnostic categories, time spent without nutrition, reasons for interruptions to nutrition support, and reasons for noncompliance to the protocol. Observations were obtained through paper and computer charts and conversing with clinicians. Results: There was a 95% compliance rate to the protocol and an average of 25.6 hours spent without nutrition per patient. The most prevalent reason for noncompliance was an avoidable delay to restart feeds before/after procedures or after surgery. Conclusions: A nurse-driven feeding protocol may reduce time spent without nutrition. Future research is required to examine the relationship between adherence to feeding protocols and clinical outcomes. (JPEN J Parenter Enteral Nutr. XXXX;xx:xx-xx) Keywords pediatrics; feeding protocol; adherence; critical care; intensive care unit; enteral nutrition