Objective To review the current status of clinical application of evidence-based prevention and management of enteral nutrition-related vomiting in mechanically ventilated patients，analyze the barriers and facilitating factors，and establish reform strategies to provide a reference for the clinical transformation of evidence. Methods Audit indicators were developed and audit methods were defined through the 26 best pieces of evidence summarized in the previous stage. The consolidated framework for implementation research（CFIR） was applied to conduct an analysis of the barriers and facilitators of the audit results from five dimensions：innovation，external factors，internal factors，individual characteristics，and the implementation process，and to formulate reform strategies. Results A total of 31 audit indicators were formulated. Among them，the implementation rate of 15 indicators was less than 60%，and the implementation rate of 4 indicators was 0. The main barriers were the lack of knowledge and training of RICU nurses in enteral nutrition management，fragmented processes，the lack of equipment and intelligent technology，insufficient multidisciplinary collaboration，and the subjective biases of medical staff. The main facilitators were the relatively good evidence transformation ability of the team，strong organizational leadership，the high enthusiasm of medical staff for reform，and the potential for multidisciplinary collaboration. Based on this，corresponding reform strategies were formulated，including carrying out stratified training and performance incentives，perfecting the processes and institutionalization，establishing multidisciplinary team collaboration and integrating intelligent tools，deploying dynamic quality control feedback mechanisms，encouraging medical staff to put forward improvement suggestions and continuously optimizing the processes. Conclusion There is a gap between the evidence and clinical practice regarding the prevention and management of enteral nutrition-related vomiting in mechanically ventilated patients. It is necessary to scientifically and comprehensively analyze the barriers and promoting factors，formulate targeted improvement strategies and action plans，and promote the clinical transformation of evidence.