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

Abstract

Background It has been reported that many hospitals in the United States have fragmented and ineffective ordering, administration, documentation, and evaluation/monitoring of nutrition therapies. This paper reports on a project to investigate if perceived hospital staff awareness and documentation of nutrition support therapies (NSTs) improves by including them as part of the medication administration record (MAR). Methods Surveys were conducted with nursing staff, physicians, and dietitians before and after adding NSTs to the MAR to evaluate the perceived impact on the outcome of interest. The outcomes of interest include nurses’ perception of ease of finding information, awareness of an order, and ability to assess administration and documentation and dietitian, nurse, and physician staff perceptions of impact of intervention on aspects of the nutrition care process. Results After adding NST to the MAR, nursing staff perceived improvement in knowing that their patient had an oral nutritional supplement (ONS) order (P = .01), when and how much product was last administered (P = .01), and documentation of the type of product consumed (P = .01) and volume of product consumed (P = .01). The majority of dietitian and nurses surveyed reported perceived improvement in placing and finding ONS orders, in administration of ONS, in ability to evaluate patient nutrition status, and in ONS intake and a positive impact on clinical practice. Conclusion Inclusion of NST in the MAR presents an innovative solution to enhance staff awareness of ordered therapies and perception of improved documentation of nutrition interventions for hospitalized patients.

Improving Administration and Documentation of Enteral Nutrition Support Therapy in a Veteran Affairs Health Care System: Use of Medication Administration Record and Bar Code Scanning Technology

“…Information about missing products can be relayed to food service staff for service correction. As providers become more aware of the status of administration (or nonadministration) of therapies, they can make decisions and provide timely adjustments in care plans 28,29,32 …”

“…Worldwide, EN delivery is notoriously underdelivered, underdocumented, and underconsumed. 13,19,26,[28][29][30] In fact, Costello et al 31 (2018) conducted a recent survey across federal agencies and found nutrition supplements are inconsistently reconciled, documented, and tracked within the federal facility's EHR systems. In our process improvement project, the addition of nutrition therapies on the MAR/BCMA seeks to meet this unmet need by capturing these products within the MAR and requiring safer nursing administration and documentation practices.…”

“…Worldwide, EN delivery is notoriously underdelivered, underdocumented, and underconsumed 13,19,26,28–30 . In fact, Costello et al 31 (2018) conducted a recent survey across federal agencies and found nutrition supplements are inconsistently reconciled, documented, and tracked within the federal facility’s EHR systems.…”

“…This type of functionality is available and used in commercially available EHRs in the United States. 28,29 Lastly, this quality improvement project did not have the resources to evaluate changes in patient outcomes related to malnutrition and improved nutritional delivery.…”

Pharmacotherapeutic prophylaxis and post-operative outcomes within an Enhanced Recovery After Surgery (ERAS®) program: A randomized retrospective cohort study

“…These factors are known to affect patient comfort (especially nausea), insulin resistance, and LOS, since a “diet as tolerated” (DAT) assessment is needed for discharge. Recording ONS on the Medication Administration Record or a separate Nutrition Administration Record may facilitate POI reduction, early post-operative enteral feeding, and DAT evaluation [ 41 ]. Finally, a recent report provides a useful conceptual framework for studying the relationships of core elements bundled in ERAS colorectal programs based on variations in the primary outcomes of three sub-populations [ 42 ].…”