A multidisciplinary QA program for enteral nutrition in high-risk patients.
An increase in elderly patients and severity of illness rates means greater use of nasogastric feeding tubes for both high-risk acutely ill and chronically ill patients. When the QA screening process at Booth Memorial Medical Center revealed a certain percentage of complications with small bore, weight-tipped feeding tubes inserted through the nares, a multidisciplinary peer review committee (MPRC) was formed to review the enteral nutrition program. After a literature review to determine possible complications, the MPRC identified lung perforations due to tube misplacement, tube feeding aspiration into the lungs leading to possible aspiration pneumonia, and an internal tip separation from the tube product failure. Unconscious incubated patients on ventilators were shown as at high risk for feeding tube misplacement in an initial MPRC patient study. A second study evaluated several different feeding tube products in the medical, respiratory and surgical ICU. The MPRC established a credentialing process for physician assistants, interns and residents in feeding tube placement. The MPRC proceedings were presented to the hospital-wide QA committee for review, endorsement and recommendations on all policy and procedure changes. The conclusions were that a more concerted effort must be made to improve medical management and encourage ongoing education in the administration of enteral feedings to high-risk patients.
D'Addario
V
V
Booth Memorial Medical Center, Flushing, NY.
Danek
M
M
D003362:Cost-Benefit Analysis; D004282:Documentation; D004750:Enteral Nutrition / Q000592:standards*; D005568:Forms and Records Control; D006745:Hospital Bed Capacity, 300 to 499; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D009519:New York City; D010348:Patient Care Team / Q000592:standards*; D011367:Professional Staff Committees; D011785:Quality Assurance, Health Care / Q000458:organization & administration*