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PEPuP Canada symbol

PEP uP initially started as a collaborative designed to foster a network of clinicians committed to the optimal delivery of enteral nutrition therapy in the ICU. The aim of PEP uP continues to be to provide practical tools and strategies to improve the delivery of enteral nutrition, including a volume-based feeding protocol (The PEP uP Protocol), along with additional resources and education materials for the multidisciplinary team. This quality improvement initiative provides dietitians, nurses, and physicians the opportunity to improve current nutrition practices, resulting in better patient outcomes. It will also enable these practitioners to further their role as nutrition educators in the ICU. 

You will find the PEP uP Tools below. We hope you will take the time to also learn about the initiative from PEP uP sites and read PEP uP publications.

PEP uP Discussion Group

The PEP uP google group is for you to discuss any of your experiences using the tools/education materials provided below. We also encourage you to share any new or adapted tools you come up with along the way.


Bedside Tools

Enteral Feeding Orders

This form is a paper based template that your site can adapt to use as the initial order form for enteral nutrition. The protocols differ in the initial order for voume based feeds due to the differences in kcal/ml of the formulas. If the use of a Peptamen or semi-elemental product is a barrier to your site implementing the PEP uP protocol, you may use a different formula.


Gastric Feeding Flowchart

This flow diagram illustrates the procedure for management of gastric residual volumes.


Volume Based Feeding Schedule

This table is a quick reference for determining goal rates of enteral feeding based on the volume of feed that needs to be delivered and the number of hours left in a 24 hr period. An example calculation is provided at the bottom.


Volume Based Feeding Calculations

This one-page document will help you quickly determine the volume-based goals and feeding rate when using an enteral formula that is 1.0 kcal/ml, 1.2 kcal/ml or 1.5 kcal/ml


Nurses' Guideline for the Management of Diarrhea

Reference sheet providing a guideline for potential causes of diarrhea and factors to consider in its management.


EN Guidelines for Surgical Procedures

Guideline to assist with the management of enteral feeding in critically ill patients that are going the operating room.


PEP uP Pocket Guide

Intended to be a quick overview of the PEP uP Protocol, and to direct nurses at the bedside to appropriate tools should they require further information


Bedside Nutrition Monitoring Tool

Web-based application used to monitor the progress of enteral nutrition in real time..


Information Sheets

PEP uP Summary



A small brochure summarizing PEP uP and use of Peptamen (specifically Peptamen 1.5) and Beneprotein.


Information Sheet for Nurses

Provides general information about the protocol rationale and guidelines for implementation of the protocol.



Also known as Nutrition Information Bytes, NIBBLES provide quick information about a popular nutrition topic. Issue 7 discusses trophic feeds, Issue 8 introduces the PEP uP protocol.


Implementation Tools

Educational Video

This MUST SEE 11 minute video made in collaboration with Nestle Health Sciences features the nurse and dietitian from the Credit Valley ICU, Mississauga, a PEP UP Canadian site that received a Best of the Best Award in the International Nutrition Survey 2013. Use this video for educating those working on implementing the PEP uP Protocol.


Webinar May 2014

You can follow along with the recorded webinar audio using the two PowerPoints: #1 was presented by Dr. Heyland and introduces the PEP uP Collaborative, reviews the Canadian PEP uP Collaborative results and discusses barriers to protocol implementation. PowerPoint #2 was presented by Rupinder Dhaliwal and reviews the PEP uP tools and INS 2014.



Hang posters on bulletin boards in the ICU, staff room, research boards, or any other medium for communication.



The long version, a lecture style inservice, is designed for educational sessions of 30-40 minutes, with cases. The short version, a bedside style inservices, is designed for short 10 – 15 min sessions with a few nurses at the bedside.


Grand Rounds Presentation

This is the PowerPoint Dr. Heyland has presented internationally at conferences and at site visits.


Slideshow of PEP uP pointers

This format of reminder messages is used to maintain awareness about the protocol. Play the slideshow on a large screen in a central area of the ICU or display these messages on bedside terminals.


Self Learning Module

This Word file provides an opportunity for staff to work through several cases after reading some basic information about the PEP uP protocol.



This FAQ document has been designed to address some common questions about the PEP uP Protocol, and to offer solutions to issues that might be encountered.
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