Table 4 Descriptive statistics of barrier questionnaire items

1. Overall, our unit functions very well together as a team.

2. Our ICU team engages in joint decision-making in planning, coordinating and implementing nutrition therapy for our patients.

3. Overall, it is easy for me to openly talk with other members of the ICU team about matters related to the nutritional needs of my patient.

4. In our ICU, implementing best practices, as defined by clinical practice guidelines, is intrinsic to our culture.

5. Our ICU Managers/Directors are supportive of implementing nutrition guidelines.

6. Nutrition is very important for my critically ill patients.

7. I feel responsible for ensuring that my patients receive adequate nutrition while in the ICU.

8. I am familiar with our current national guidelines for nutrition in the ICU.

9. If the recommendations of the current national guidelines for nutrition are followed in our ICU, patient outcomes will improve.

1. Enteral nutrition should be used in preference to parenteral nutrition.

2. Enteral nutrition should be initiated early (24 – 48 hours following admission to ICU).

3. An evidence-based feeding protocol should be used.

4. If a feeding protocol is used, it should tolerate a higher gastric residual volume (i.e., >250 mls) before holding feeds.

5. In patients who have feed intolerance (i.e., high gastric residual volumes, emesis) a promotility agent should be used.

6. Small bowel feeding should be considered for those select patients who repeatedly demonstrate high gastric residual volumes and are not tolerating adequate amounts of enteral nutrition delivered into the stomach.

7. Patients receiving enteral nutrition should have the head of the bed elevated to 45 degrees.

8. In all critically ill patients, hyperglycemia (blood glucose >10 mmol/l or 180mg/dl) should be avoided by minimizing intravenous dextrose and using insulin administration when necessary.

1. Not enough nursing staff to deliver adequate nutrition.

2. Not enough dietitian time dedicated to the ICU during regular weekday hours.

3. No or not enough dietitian coverage during weekends and holidays.

4. Enteral formula not available on the unit.

5. No or not enough feeding pumps on the unit.

6. Current scientific evidence supporting some nutrition interventions is inadequate to inform practice.

7. The current national guidelines for nutrition are not readily accessible when I want to refer to them.

8. The language of the recommendations of the current national guidelines for nutrition are not easy to understand.

9. Not enough time dedicated to education and training on how to optimally feed patients.

10. No feeding protocol in place to guide the initiation and progression of enteral nutrition.

11. Current feeding protocol is outdated.

12. Delay in physicians ordering the initiation of EN.

13. Waiting for the dietitian to assess the patient.

14. Non-ICU physicians (i.e., surgeons, gastroenterologists) requesting patients not be fed enterally.

15. Nurses failing to progress feeds as per the feeding protocol.

16. Fear of adverse events due to aggressively feeding patients.

17. Feeding being held too far in advance of procedures or operating room visits.

18. No feeding tube in place to start feeding.

19. Delays in initiating motility agents in patients not tolerating enteral nutrition (i.e., high gastric residual volumes).

20. Delays and difficulties in obtaining small bowel access in patients not tolerating enteral nutrition (i.e., high gastric residual volumes).

21. In resuscitated, hemodynamically stable patients, other aspects of patient care still take priority over nutrition.

22. Lack of agreement among ICU team on the best nutrition plan of care for the patient.