These are important factors to consider when assessing the feasibility of adopting a tailored approach. Finally, there are several components of our intervention that may limit its generalizability to the real world. The external research team played an active role in the intervention. the presenting at grand rounds, facilitating the action plan development meetings, and coaching the local guideline implementation team through the implementation phase. Furthermore, all participating sites were affiliated with a registered dietitian who was a part of the guideline implementation team. It may be difficult for ICUs without a dietitian or local nutrition expert to develop and implement a nutrition focused intervention such as this one.

These roles could be completed by individuals with training in quality Inhibitors,Modulators,Libraries improvement employed Inhibitors,Modulators,Libraries at the hospitals, or through networks or shared exchanges whereby teams, including dietitians, from different sites support each other. In addition, our resource intense methods of assessing barriers and tailoring were classified as high. Given that many of the identified barriers were common across participating sites Inhibitors,Modulators,Libraries and that the subsequently selected change strategies were also similar. an intervention tailored to these common barriers may be as effective as one that includes the additional steps of a local barriers assessment and tailoring to these site specific barriers. Finally, the five participating sites were a highly selective subgroup of ICUs. Further investigation Inhibitors,Modulators,Libraries is required to clarify the optimal tailoring method in ICUs with different characteristics, organizational cultures, and healthcare systems.

Conclusion The results of the PERFECTIS study are promising, indicating that a multifaceted, interdisciplinary tailored approach to improving adherence to critical care nutrition guidelines is feasible, and may decrease barriers to enterally Inhibitors,Modulators,Libraries feeding critically patients. However, the complexity of this approach may attenuate its application in practice. Potential refinements to the intervention based on the lessons learned from this preliminary study include incorporating common components of the action plans as standard facets of the intervention, a readiness to change assessment at baseline to evaluate the ICUs ability to manage and accept the proposed changes, training for the guideline implementation team on leadership, teamwork, and quality improvement, and a longer implementation period or assessment of change in practice after several time intervals. These modified components will ensure a more parsimonious those intervention. The proposed changes will need to be piloted prior to proceeding to designing and conducting a large interventional study to formally evaluate the effectiveness of the approach.