Enteral Nutrition Administration Record Prescribing Process Using Computerized Order Entry: A New Paradigm and Opportunities to Improve Outcomes in Critically Ill Patients

Abstract

Background Prevalence of malnutrition has been reported in 60% of hospitalized and up to 78% of patients admitted to intensive care units. Malnutrition has been associated with complications, such as infection, increased hospital length of stay, morbidity, and mortality. Nutritional support has been shown to reduce avoidable readmissions, pressure ulcers, malpractice claims, and hospital costs. Creating a new electronic nutrition administration record (ENAR) with a linked nutrition tab within the electronic health record (EHR) would promote enhanced patient outcomes by improving adherence to established institutional enteral nutrition (EN) protocols and achieving early energy goals. Additionally, it would enable a clear and standardized method for documentation and administration of EN therapy. Methods The multidisciplinary nutrition support team was established and met on a weekly basis to discuss strategies and barriers, identify stakeholders, evaluate the current state, and establish a process and workflow from the point of order entry, delivery, administration, and electronic documentation of orders of EN supplements. The aim of this article is to describe a systematic approach and process of creating a new ENAR with a linked nutrition tab in the EHR, and to illustrate the order panel built and lessons learned from the process. Results A separate nutrition tab was created in the EHR with minimal disruption in patient care and end‐users’ positive feedback for the new order panel. Conclusion ENAR allows for easier data collection and promotes nutrition‐related research that may result in enhanced patient care. Utilizing technology to build a full ENAR would result in optimized patient care and safety.

Nutrition Support Therapies on the Medication Administration Record: Impacts on Staff Perception of Nutrition Care

“…The Meehan study reported that the use of MAR for ONS streamlined the process for administration and documentation of ONS and allowed for better monitoring, reduced length of hospital stay, reduced prevalence of pressure ulcer, reduced 30‐day readmissions, and reduced costs of care 8 . Another report found that after inclusion of ONS on the MAR, more patients reported being offered the ONS product ( P = .01), and more patients (5% before and 86% after) reported being offered the correct type, amount, and frequency of nutritional products ( P = .01) 25,26 . van den Berg and colleagues (2015) reported on a randomized controlled trial assessing ONS consumption if patients were given ONS during medication administration.…”

“…There are limited studies on the use of MAR for administration and documentation ONS. Of the few published studies, benefits such as improved administration and documentation, reduced waste, and improved patient outcomes have been reported; however, all had methodological limitations (small sample size, 1 cohort) 8,25–27 . Meehan et al (2016) reports on a nurse‐led quality improvement study related to use of MAR systems to administer and document ONS for hospital patients 8 .…”

“…Implementation of the nutrition care process using a standardized, streamlined approach that accommodates ordering, documenting, and monitoring nutrition interventions in the EHR is recommended 24,30,31 . In addition to this institution, other US hospital systems have reported utilizing MAR and BCMA to order, administer, and document NST, including the Phoenix VAMC and Tampa General Hospital, among others 8,25,26,35,36 . There may be other interventions or process modifications that improve a system's ability to administer and track NST.…”

“…Not all NSTs are able to be reconciled at transitions of care 8,15 . Most NSTs are not ordered, administered, and documented in a standardized manner, although there are reported cases of errors, errors of omission, near‐misses, and cases that involved death of patients 15,16,22–26 . These safety issues highlight the need for hospitals to fully integrate EHR and bar code medication administration (BCMA) systems with EN support therapies, avoid manual transcription of orders, and match prescribing labels with bedside barcode scanning of patients 27–29 …”

The Age of Artificial Intelligence: Use of Digital Technology in Clinical Nutrition

“…In addition, capturing the EN product used as well as documenting the amount used is important for the overall care of patients. To address these issues, Kamel et al demonstrated the steps for development of an electronic nutrition administration record (ENAR) with a linked nutrition tab in their EHR [61]. Working with the EHR vendor, they were able to create order panels that standardized the EN ordering process.…”