Errors in emergency feeds in inherited metabolic disorders: a randomised controlled trial of three preparation methods.
OBJECTIVE
Glucose polymer-based emergency feeds (EF), used during illness to prevent metabolic decompensation and encephalopathy in inherited metabolic disorders, should be produced accurately and safely.


METHODS
In a randomised, prospective, controlled study, the aim was to investigate if when preparing age-appropriate EF, a pre-measured sachet of glucose polymer, compared with scoops and weighing (using digital scales), decreased carer errors.


METHODS
47 carers (3 men, 44 women) of 52 inherited metabolic disorders patients were recruited.


METHODS
The carers made EF using all three techniques (weighing, scoops and pre-measured sachets) under supervision in controlled and home conditions. A 100-ml aliquot of each EF was analysed for carbohydrate concentration.


RESULTS
Under controlled preparation conditions, with 1 litre EFs, the % median glucose polymer concentration closest to target amounts was (1) pre-measured sachets (105%), (2) weighing (107%) and (3) scoops (118%; p<0.001). Similarly, under home conditions, the closest method was (1) pre-measured sachets (111%), (2) weighing (112%) and (3) scoops (118%; p<0.05). Under home preparation conditions, with 200 ml EFs, the pre-measured sachets were more likely to be within 20% of target weight than weighing (p<0.05), but there was no difference with scoops. Common errors observed were inaccurate water measurements (40% controlled and home conditions), incorrect scoop measurements and difficulty using digital scales. CONCLUSIONS; Overall, using pre-measured sachets was more accurate in EF production. Pre-measured sachets are likely to decrease preparation error and, therefore, reduce the risk of feed intolerance, particularly osmotic diarrhoea and consequential metabolic decompensation and encephalopathy.
Research Dietitian in Inherited Metabolic Disorders, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK. hgokmen@hacettepe.edu.tr
H
H
Gokmen-Ozel
A
A
Daly
P
P
Davies
S
S
Chahal
A
A
MacDonald
D000293:Adolescent; D017028:Caregivers / Q000592:standards; D002648:Child; D002675:Child, Preschool; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004630:Emergencies; D004750:Enteral Nutrition / Q000379:methods / Q000592:standards*; D005260:Female; D005936:Glucans / Q000008:administration & dosage; D006701:Home Nursing / Q000379:methods / Q000592:standards*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008508:Medication Errors / Q000517:prevention & control / Q000706:statistics & numerical data; D008661:Metabolism, Inborn Errors / Q000628:therapy*; D055815:Young Adult
D004040:Dietary Carbohydrates; D005936:Glucans