Date of Award

Spring 5-1-2020

Document Type


Degree Name

Doctor of Nursing Practice (DNP)

First Advisor

Sterling Roberts, DNP, RN, CHSE

Second Advisor

Deborah MacMillan, PhD, RNC, CNM

Third Advisor

Leslie Culpepper, MSN, CNS, CCRN


This evidence-based project sought to evaluate the practice change of routine GRV elimination within a 14 bed adult intensive care unit (ICU) at a large teaching hospital in the southeastern United States. For decades, the gold standard to determine tolerance to enteral nutrition (EN) has been routine GRV assessments via aspiration. However, recent studies have concluded the practice ineffective. Critical Care guidelines published in 2016 now recommend cessation of routine GRV assessments (Ozen, et. al, 2018). In-servicing, education, and implementation of a validated protocol from the University of Virginia Medical Center was used to enact the practice change. A 30-day pre-and post-implementation data collection design was conducted to determine effects on total volume of EN received as well as rate of adverse events. There was a significant difference in percentage of EN delivered between the routine group (M = .60, SD = .17733) and cessation group (M = .81, SD = .12167); t (45) = -4.77, p = .00, CI = - 0.305 to -0.1238, with no increase in adverse events (emesis, aspiration pneumonia). This data indicates that the elimination of routine GRV assessment is safe and results in improved nutrition provision. Additionally, it indicates use of a protocol for practice change as well as mandatory in-servicing can effectively change nursing practice. This is useful for implementing the practice change across various other units, patient populations, and facilities.