Care Coordination to Enhance Management of Long‐Term Enteral Tube Feeding

Majka, Andrew J.; Wang, Zhen; Schmitz, Kristine R.; Niesen, Cynthia R.; Larsen, Ruth A.; Kinsey, Gail C.; Murad, Angela L.; Prokop, Larry J.; Murad, Mohammad Hassan

doi:10.1177/0148607113482000

Cited by 38 publications

(54 citation statements)

References 34 publications

(30 reference statements)

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“…Advance practice nurse care [136], quality improvement strategies [137, 148–152], case management [138], collaborative care [140], evidence-based medicine practice strategies [144], midwife-led continuity services [145], comprehensive asthma care [146], and patient-centered medical home [125, 147] have all been evaluated. Moderate- to high-quality reviews demonstrated improved safety, quality care, increased vaccination rate, and improved management of patient with depression and anxiety in primary healthcare settings [135–137, 139–142, 144, 147, 148, 150, 151]. Few reviews failed to provide any conclusive outcomes [122, 126, 129, 131, 134, 143, 154, 155].…”

Section: Resultsmentioning

confidence: 99%

Behavior change interventions and policies influencing primary healthcare professionals’ practice—an overview of reviews

et al. 2017

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BackgroundThere is a plethora of interventions and policies aimed at changing practice habits of primary healthcare professionals, but it is unclear which are the most appropriate, sustainable, and effective. We aimed to evaluate the evidence on behavior change interventions and policies directed at healthcare professionals working in primary healthcare centers.MethodsStudy design: overview of reviews.Data source: MEDLINE (Ovid), Embase (Ovid), The Cochrane Library (Wiley), CINAHL (EbscoHost), and grey literature (January 2005 to July 2015).Study selection: two reviewers independently, and in duplicate, identified systematic reviews, overviews of reviews, scoping reviews, rapid reviews, and relevant health technology reports published in full-text in the English language.Data extraction and synthesis: two reviewers extracted data pertaining to the types of reviews, study designs, number of studies, demographics of the professionals enrolled, interventions, outcomes, and authors’ conclusions for the included studies. We evaluated the methodological quality of the included studies using the AMSTAR scale. For the comparative evaluation, we classified interventions according to the behavior change wheel (Michie et al.).ResultsOf 2771 citations retrieved, we included 138 reviews representing 3502 individual studies. The majority of systematic reviews (91%) investigated behavior and practice changes among family physicians. Interactive and multifaceted continuous medical education programs, training with audit and feedback, and clinical decision support systems were found to be beneficial in improving knowledge, optimizing screening rate and prescriptions, enhancing patient outcomes, and reducing adverse events. Collaborative team-based policies involving primarily family physicians, nurses, and pharmacists were found to be most effective. Available evidence on environmental restructuring and modeling was found to be effective in improving collaboration and adherence to treatment guidelines. Limited evidence on nurse-led care approaches were found to be as effective as general practitioners in patient satisfaction in settings like asthma, cardiovascular, and diabetes clinics, although this needs further evaluation. Evidence does not support the use of financial incentives to family physicians, especially for long-term behavior change.ConclusionsBehavior change interventions including education, training, and enablement in the context of collaborative team-based approaches are effective to change practice of primary healthcare professionals. Environmental restructuring approaches including nurse-led care and modeling need further evaluation. Financial incentives to family physicians do not influence long-term practice change.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0538-8) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Behavior change interventions and policies influencing primary healthcare professionals’ practice—an overview of reviews

et al. 2017

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“…Essential components of the education process include training on feeding tube and access site care, preparation and administration of formula, medication administration, enteral pump operation, monitoring and troubleshooting complications, and emergency care plan and contact information 6 , 8 . ‐ 12 Thompson et al 13 have emphasized the need for clinicians to evaluate the effectiveness of their EN education process, provide comprehensive EN education and patient resources, proceed over more than 1 educational session, and prepare patients and caregivers to resolve foreseeable problems, such as tube occlusion and dislodgement, skin care issues, and psychosocial challenges.…”

Section: Section 11 Transition Of Carementioning

confidence: 99%

ASPEN Safe Practices for Enteral Nutrition Therapy

Boullata

Carrera²,

Harvey

et al. 2016

J Parenter Enteral Nutr

334

531

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Enteral nutrition (EN) is a valuable clinical intervention for patients of all ages in a variety of care settings. Along with its many outcome benefits come the potential for adverse effects. These safety issues are the result of clinical complications and of process-related errors. The latter can occur at any step from patient assessment, prescribing, and order review, to product selection, labeling, and administration. To maximize the benefits of EN while minimizing adverse events requires that a systematic approach of care be in place. This includes open communication, standardization, and incorporation of best practices into the EN process. This document provides recommendations based on the available evidence and expert consensus for safe practices, across each step of the process, for all those involved in caring for patients receiving EN.

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“…Enteral nutrition is a safe and cost-effective intervention to feed patients who cannot cover all requirements from food or oral nutritional supplements, or who cannot swallow safely (9).…”

Section: Discussionmentioning

confidence: 99%

“…Enteral nutrition (EN) has been found to be beneficial in patients with a wide range of conditions, including burns, chronic obstructive pulmonary disease, gastrointestinal surgery or liver diseases (7,8). In addition, it has been shown to be safe and cost-effective and, since its introduction, it has become an established procedure (9).…”

Section: Introductionmentioning

confidence: 99%

The effects on nutritional status, bowel habits and tolerance of a high- protein, high-calorie, fiber- and fructo-oligosaccharide-enriched enteral formula: Safety and Effectiveness of Enteral Nutrition in Spanish patients (SENS Study).

et al. 2017

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on behalf of the SENS Working Group. The effects of a high-protein, high-calorie, fiber-and fructooligosaccharide-enriched enteral formula on nutritional status, bowel habits and tolerance: Safety and Effectiveness of Enteral Nutrition in elderly Spanish patients (SENS Study ResumenIntroducción: la nutrición enteral es una intervención efectiva para pacientes desnutridos o en riesgo de sufrir desnutrición. Sin embargo, puede desencadenar complicaciones como intolerancia gastrointestinal, hiperglicemia o síndrome de realimentación. Objetivo: investigar los efectos de una fórmula de nutrición enteral por sonda en el estado nutricional y bioquímico, hábitos gastrointestinales y seguridad de los pacientes. Metodología: estudio observacional, prospectivo y multicéntrico. Se incluyeron pacientes ≥ 18 años, desnutridos o en riesgo de desnutrición, tributarios de recibir una fórmula de nutrición enteral hipercalórica, hiperproteica, y rica en fibra y fructooligosacáridos. Los pacientes fueron evaluados durante 8 semanas en 3 visitas (V1, inicial; V2, 4 semanas; V3, 8 semanas). Resultados: entre V1 y V2 se observó un incremento estadísticamente significativo en peso (1,5 kg), índice de masa corporal (0,6 kg/m 2 ) e ingesta calórica (59,7 kcal/día). Entre V1 y V3, existió un descenso en el porcentaje de pacientes con valores anormales de glucosa, potasio, proteína total y albúmina. Los hábitos intestinales se mantuvieron estables durante el estudio (1,1 deposiciones diarias de media). Conclusión: la fórmula fue segura, tolerada, y mejoró el estado nutricional del paciente sin alterar los hábitos intestinales. AbstractBackground: Enteral nutrition (EN) is an effective nutritional intervention for patients at risk of malnutrition or malnourished. However, complications such as gastrointestinal intolerance, hyperglycemia or refeeding syndrome can be triggered by EN. Aim: To investigate the effects of a tube feeding formula (TFF) on patients' nutritional status, biochemical status, bowel habits and safety. Methodology: Observational, prospective and multicenter study. Patients ≥ 18 years, undernourished or at nutritional risk, who were prescribed a high-calorie, high-protein, fiber-fortified TFF were included. Patients were evaluated over a period of eight weeks (baseline [V1], four weeks [V2] and eight weeks [V3]). Results: A statistically significant increase in weight (1.5 kg), body mass index (0.6 kg/m 2 ) and nutritional intake (59.7 kcal/day) was observed between V1 and V2. Between V1 and V3, there was a statistically significant decrease in the percentage of individuals with abnormal biochemical markers for glucose, potassium, total protein and albumin. The number of patients' bowel movements remained stable throughout the study with a mean of 1.1 daily bowel movements. Conclusion: The TFF was safe and well tolerated, improving patients' nutritional status without altering patients' bowel habits.

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Care Coordination to Enhance Management of Long‐Term Enteral Tube Feeding

Cited by 38 publications

References 34 publications

Behavior change interventions and policies influencing primary healthcare professionals’ practice—an overview of reviews

Behavior change interventions and policies influencing primary healthcare professionals’ practice—an overview of reviews

ASPEN Safe Practices for Enteral Nutrition Therapy

The effects on nutritional status, bowel habits and tolerance of a high- protein, high-calorie, fiber- and fructo-oligosaccharide-enriched enteral formula: Safety and Effectiveness of Enteral Nutrition in Spanish patients (SENS Study).

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