We read the excellent article “Development of Evidence-Based Guidelines and Critical Care Nurses’ Knowledge of Enteral Feeding” by Bourgault and colleagues (August 2007:17–29). Their review provided a thorough, evidence-based approach to the topic. In our unit, a large number of patients develop diarrhea while receiving enteral feedings and we would like to share our approach to this commonly encountered clinical problem.

Recognizing that patients receiving enteral feeding may develop diarrhea for reasons unrelated to the feeding, we have adapted the guideline developed by Greenwood11 at Vancouver General Hospital, which provides a pathway to distinguish among the multiple causes of diarrhea. We are currently implementing this protocol in our unit by educating staff on its use and collecting data to assess the efficacy of this protocol.

Central to the protocol is collaboration with the dietician and physicians. This...

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