Enteral feeding barriers in the intensive care unit of a tertiary hospital in Ghana.

Background: Enteral nutrition (EN) is an important aspect of patient management in the intensive care unit (ICU). However, various barriers have been reported that limit the provision of EN, with implications for patient care and outcomes. Objectives: To evaluate the perceived barriers to the provision of EN among ICU healthcare professionals in our resource-limited setting, as a preliminary step toward developing tailored quality improvement interventions in our unit. Methods: A cross-sectional survey of 21 ICU healthcare professionals (17 nurses and 4 doctors) was conducted. The Revised Barriers to Feeding Critically Ill Patients questionnaire was used to evaluate barriers to the provision of EN in our ICU. A Likert scale was used to assess perceived barriers, with each factor rated from 0 to 6; 0 indicating 'not at all' and 6 indicating 'an extreme amount'. Descriptive statistics were used to describe the data as medians, interquartile ranges, counts and proportions. The Wilcoxon-Mann-Whitney test was used to evaluate differences in medians between doctors and nurses, given the skewed distribution of data. Likert-based responses were used to generate a stacked bar chart. Statistical significance was set at p<0.05. Results: The main barriers to the provision of EN were related to dietitian support, ICU resources and EN delivery. Dietitian-related barriers included insufficient coverage on weekends, evenings and holidays (median 5), delayed nutritional assessments (median 3) and limited time dedicated to education and training on optimal feeding (median 3). ICU resource constraints included the absence or shortage of feeding pumps and the unavailability of enteral formulas (median 3 for both). Barriers to EN delivery included delayed initiation of motility agents in patients with feeding intolerance (median 3). Conclusion: These findings underscored the importance of developing context-specific quality improvement initiatives to address local barriers to the provision of EN. Contribution of the study: This study describes the perceived barriers to the provision of enteral nutrition in an intensive care unit (ICU) in Ghana, adding to the limited data available from African ICUs on this topic. The study provides insights into the systemic, operational, and workforce-related challenges that affect enteral feeding in resource-constrained critical care settings, including limited dietitian coverage, shortage of feeding pumps, and enteral formulas. These challenges highlight the needs and opportunities for strengthening nutrition support through context-specific quality improvement initiatives. As such, this work contributes valuable locally generated evidence to support enhanced care for critically ill patients as well as inform professional development strategies for ICU healthcare professionals in similar low-resource environments.