title: Delivered volumes of enteral nutrition exceed prescribed volumes.
abstract: BACKGROUND
  Enteral nutrition (EN) provisions are typically calculated based on a 24-hour infusion period. However, feedings are often interrupted for daily activities, procedures, or gastrointestinal intolerance. The study's objective was to determine the delivered EN quantities provided to stable hospitalized patients, using cellular time and measured volumes to verify our EN calculation adjustment.
  
  
  METHODS
  A supply of consecutively numbered ready-to-hang (RTH) EN product was delivered to the bedside of 26 inpatients with established EN tolerance at goal rates on various types of nursing units. The dietitian weighed the volume remaining in the infusing product and recorded the measurement time. On the following days, the dietitian continued to weigh the infusing RTH product and the empty RTH bottles saved by nursing. The primary outcome was the difference between the prescribed and delivered EN provisions, which was calculated with a paired t test.
  
  
  RESULTS
  Patients received significantly more calories in the delivered enteral feeding (mean [SD], 1678 [385] kcal) than prescribed calories in the EN order (1489 [246 kcal]; t = 3.736, P = .001), adjusting for observed time. No significant differences were found between nursing units, product, and rate.
  
  
  CONCLUSIONS
  EN delivered may actually exceed ordered amounts by 5%–21% (mean, 12%) with feeding pump inaccuracy as the primary contributing factor. This differs from what others have found. Our findings support using a volume-based ordering system vs a rate-based ordering system for more accurate EN delivery.
authors.affiliation: Michael E. DeBakey Medical Center, 2002 Holcombe Blvd, Rm 4a-340, Houston, TX 77030, USA. Email: RNEW00@aol.com
authors.forename: Renee Nichole
authors.initials: RN
authors.lastname: Walker
authors.forename: Anne
authors.initials: A
authors.lastname: Utech
authors.forename: Maria Eugenia
authors.initials: ME
authors.lastname: Velez
authors.forename: Katie
authors.initials: K
authors.lastname: Schwartz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002149:Energy Intake; D004750:Enteral Nutrition / Q000379:methods / Q000592:standards*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009751:Nutritional Requirements; D055656:Prescriptions; D011446:Prospective Studies