Nil by mouth in intensive care - A qualitative, multiformat survey exploring the impact of mandatory oral restriction, from the health care providers perspective.

Introduction and objectives: Nil by mouth (NBM) is a frequent imposition for patients recovering from critical illness. Its impact on patients' wellbeing and rehabilitation is under researched. We sought ICU multidisciplinary opinion to primarily assess the relevance of taste deprivation on patient care and recovery, and to identify future opportunities for innovation and research.

Methodology: A descriptive, multiformat, observational, online survey investigated the experiences of specialist multidisciplinary healthcare professionals (HCP) from two academic hospitals regarding working with NBM patients. An e-survey containing 16 multiformat questions was developed by an experienced multidisciplinary HCP team and distributed over a 3-month period in 2023. The CHERRIES guidelines were followed for reporting of results.

Results: 58 HCPs completed the study. 97% of HCPs reported witnessing patient discomfort or distress when NBM. 91% believed felt that it impacted negatively on patients' engagement in their own recovery. 59% did not discuss food and taste with patients when prolonged NBM was anticipated because there was no solution on offer. 41% of HCPs did discuss flavour and food, to build rapport and help motivate recovery. 57% of HCPs often felt pressure to give oral food/liquid to a NBM patient. 90% of participants reported that a safe taste product could enhance a patient's ICU experience. Concerns regarding safety and a need for guidelines to enable implementation were common.

Conclusion: HCPs recognise the psychological sequalae on the patient and the impact on their relationship with the patient, that taste deprivation creates in recovering critically ill patients. Safe alternatives to oral intake that can enhance the ICU experience are considered desirable; this needs further research and innovation. Furthermore, with training and support HCPs should feel empowered to discuss NBM associated distress and challenge NBM recommendations.

Implications for clinical practice: There is demand for safe alternatives to oral flavour intake and belief this could enhance the ICU experience with downstream positive impact on ICU morbidity.