U.S. flag

An official website of the United States government

Talk to the Veterans Crisis Line now
Skip to main content

Last updated

Tube Feeding Safety

Share Print

The mission of our innovation was to support a culture of safety by employing existing technology of bar code scanning to enhance the safety, administration, communication and quality of nutrition care to prevent and treat malnutrition.

This innovation is replicating across multiple facilities as its impact continues to be validated. See more replicating innovations.

Adoptions:

1 successful

Tags:

High Reliability Hospital Medicine Information Technology Inpatient Care Nursing Nutrition & Food Pharmacy

Overview

Problem

Malnutrition is common in hospitalized patients leading to increased patient complications and costs. Nutrition support therapies, including prescribed nutrition therapy through a tube in the stomach or enteral nutrition (EN), are effective in preventing and treating complications and reducing costs. Unfortunately, poor coordination of nutrition support care ... See more

Images

A magenta circle is surrounded by 5 smaller blue circles. The magenta circle states "1 in 3 hospitalized patients is at risk for malnutrition leading to:" The blue circles state "Increased medical complications" "Higher readmission rates" "Increased mortality" "Higher costs" "Increased length of stay"

The consequences of malnutrition

    Files

    Links

    • Chew, Mary M. MS, RDN∗; Rivas, Salvador PharmD∗; Chesser, Michael MD, FACP∗; Landas, Noel MSN, RN, RRT∗; Schaefer, Stephanie MS, RDN∗; Enright, Amy RDN∗; Olsen, Jamie MS, RDN, CDCES∗; Meacci, Katie MSN, RN, CCRN∗; Luevano, Victor RN, CCRN∗; Harraway, Doristeen RN∗; Citty, Sandra W. PhD, APRN-BC†. Improving Administration and Documentation of Enteral Nutrition Support Therapy in a Veteran Affairs Health Care System: Use of Medication Administration Record and Bar Code Scanning Technology. Journal of Patient Safety 19(1):p 23-28, January 2023. | DOI: 10.1097/PTS.0000000000001076 Journal of Patient Safety January 2023

Solution

Based on a review of the literature and best practices from other VA and non-VA hospitals, utilizing the existing Medication Administration Record (MAR) and Bar Code Medication Administration (BCMA) technology to optimize nutrition support therapy can lead to improved administration, communication, monitoring and safety of nutrition support therapy. Includin ... See more

Images

This is a process flow diagram with blue boxes showing the pre-implementation steps including "EN ordered" "EN product delivered the ward" and "EN administered to the patient" with magenta color boxes inserted between the blue to show the safety checks that the EHR optimization added inluding "EN automatically appears on the MAR alerting nursing and pharmacy for review and verification" "EN bar-code scanned and verified by nurse for correct patient, product, dose, route, frequency, time" and "Documentation of EN administration or non-administration is automated.

Process flow diagram showing the optimization of EHR with safety checks and automated documentation of EN.

    Files

    • Chew, Mary M. MS, RDN∗; Rivas, Salvador PharmD∗; Chesser, Michael MD, FACP∗; Landas, Noel MSN, RN, RRT∗; Schaefer, Stephanie MS, RDN∗; Enright, Amy RDN∗; Olsen, Jamie MS, RDN, CDCES∗; Meacci, Katie MSN, RN, CCRN∗; Luevano, Victor RN, CCRN∗; Harraway, Doristeen RN∗; Citty, Sandra W. PhD, APRN-BC†. Improving Administration and Documentation of Enteral Nutrition Support Therapy in a Veteran Affairs Health Care System: Use of Medication Administration Record and Bar Code Scanning Technology. Journal of Patient Safety 19(1):p 23-28, January 2023. | DOI: 10.1097/PTS.0000000000001076 Journal of Patient Safety

Results

Improved nutrition practices lead to improved outcomes for Veterans. Having a limited number of enteral nutrition support therapies to be able to be ordered in the electronic health record's medication administration record (MAR) and using bar code scanning using BCMA allows for the right product to be delivered to the right patient, at the right time, in th ... See more

Metrics

  • After a year of implementation, outcome data were collected that showed 100% of patients with EN ordered were bar code scanned and documented. 3106/3807 products (82%) were documented as given, 447/3807 (12%) were documented as held, 12/3,807 (<1%) were documented as missing or unavailable, 242/3807 (6%) were documented as refused. There were no further safety events reported in our local facility.

Diffusion tracker

Does not include Clinical Resource Hubs (CRH)

Statuses

NC: Charles George Department of Veterans Affairs Medical Center (Asheville)

There are no in-progress adoptions for this innovation.

There are no unsuccessful adoptions for this innovation.

Implementation

Timeline

  • Step 1
    Leadership Committee Approvals through Pharmacy, Medical Center Nutrition Committee, Nursing Clinical Practice Council, Food Service (Phoenix VAHCS). This may include baseline data of current practices that showcase safety issues, documentation issues, patient outcomes, ect.
  • Step 2
    Determine which products will be entered into the drug file to be scanned. These will be your local VA formulary tube feeding products, oral nutrition supplements (optional), modulars such as protein powders.
  • Step 3
    Add the products determined in step 2 to the drug file in VISTA by scanning the barcodes.
  • Step 4
    Create order sets in CPRS through informatics. This order set will automatically populate the order into the MAR and populate into the PRN section of BCMA. Include all feeding regimens: Bolus, continuous, volume based feedings.
  • Step 5
    Create VISTA report for Food Service tracking on drug file orders of tube feeding, modulars and oral nutrition supplements to be correctly delivered to patients ward for administration.
  • Step 6
    Collaborate with all disciplines to educate staff across all department stakeholders including nurse education, pharmacy, dietitians, food service, BCMA coordinators, and providers.

Departments

  • Pharmacy
  • Hospital medicine
  • Information technology
  • Nutrition, food, and dietary

Core Resources

Resource type Resource description
PEOPLE
  • Project lead from nutrition, pharmacy or nursing will need to obtain committee approval from all stakeholders.
  • Nutrition Support Team members or dietitians determine which products on the formulary will be included.
  • Pharmacy informatics team member will scan the bar codes on the products determined and add these to the inpatient drug file. Once the products have been identified the scanning of bar codes takes less than 5 minutes. A report will need to be created in VISTA for the Food Service staff to track these orders for delivery to ward.
  • Clinical Application Coordinator will create order sets in CPRS. This order set will automatically populate the order into the MAR and populate into the PRN section of BCMA. Include all feeding regimens: Bolus, continuous, volume based feedings.
  • Nurse education will provide practice alerts and notification to all inpatient nursing staff.
PROCESSES
  • Lean training can be useful to gather baseline data of current practice, identify barriers, solutions and return on investment

Support Resources

Resource type Resource description
PEOPLE
  • Project lead with experience in implementation and sustainment to mentor other leaders
TOOLS
  • Educational materials use to create stakeholder buy in and show examples of successful implementation
  • Order Set Examples
  • Publication explaining the benefits of implementation

Files

Contact

Comment

Comments and replies are disabled for retired innovations and non-VA users.

About

Origin story

As a critical are dietitian, I was passionate about providing optimal nutrition support to the highest risk patients who were being fed through feeding tubes. It was obvious that what I was prescribing was not being delivered when one day a nurse showed me all the protein packets piled up in the nourishment room. We conducted a study which showed less than 3 ... As a critical are dietitian, I was passionate about providing optimal nutrition support to the highest risk patients who were being fed through feeding tubes. It was obvious that what I was prescribing was not being delivered when one day a nurse showed me all the protein packets piled up in the nourishment room. We conducted a study which showed less than 30% of what was prescribed for nutrition was being delivered and administered to patients. Documentation was inconsistent, haphazard and difficult to find. A patient was given an incorrect formula that had higher amounts of fiber right after a surgery with a different amount of fluid and carbohydrate than what was intended. A patient safety error was reported which sparked the project to make a change. The interdisciplinary group was highly engaged and shared a passion for continuous process improvement to enhance patient outcomes and our leadership stakeholders were committed to listening to concerns of front line staff and removing barriers to support a culture of safety.

Original team

Mary Chew

Clinical Nutrition Manager

Salvatore Rivas

Pharmacy Informatacist

Stephanie Schaefer

Registered Dietitian

Amy Enright

Chief of Food and Nutrition Services

Kate Meacci

Nurse Educator

Doris Harraway

BCMA Coordinator

Noel Landas

Clinical Application Coordinator

Michael Chesser

Hospitalist

Jamie Olsen

Inpatient Dietitian Supervisor

Victor Leuvano

Critical Care RN

Sandra Citty

Clinical Nurse Investigator

Search tags

High Reliability Hospital Medicine Information Technology Inpatient Care Nursing Nutrition & Food Pharmacy