TY - JOUR
T1 - Improving Administration and Documentation of Enteral Nutrition Support Therapy in a Veteran Affairs Health Care System
T2 - Use of Medication Administration Record and Bar Code Scanning Technology
AU - Chew, Mary M.
AU - Rivas, Salvador
AU - Chesser, Michael
AU - Landas, Noel
AU - Schaefer, Stephanie
AU - Enright, Amy
AU - Olsen, Jamie
AU - Meacci, Katie
AU - Luevano, Victor
AU - Harraway, Doristeen
AU - Citty, Sandra W.
N1 - Funding Information:
The authors thank the Phoenix Veterans Affairs Healthcare System and the North Florida South Georgia Geriatric Research Education and Clinical Center for the support of this project.
Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.
PY - 2023/1/1
Y1 - 2023/1/1
N2 - Objectives The goal of this project was to evaluate and improve the ordering, administration, documentation, and monitoring of enteral nutrition therapies within the inpatient setting in a Veteran's Health Administration system. Methods An interdisciplinary team of clinicians reviewed the literature for best practices and revised the process for enteral nutrition support for hospitalized veterans. Interventions included training staff, revising workflows to include scanning patients and products, including enteral nutrition orders within the medication administration record (MAR), and using the existing bar code medication administration system for administration, documentation, and monitoring. Baseline and postprocess improvement outcomes over a year period were collected and analyzed for quality improvement opportunities. Results Before process change, only 60% (33/55) of reviewed enteral nutrition orders were documented and 40% (22/55) were not documented in the intake flowsheet of the electronic health record. In the year after adding enteral nutrition therapies to the MAR and using bar code scanning, a total of 3807 enteral nutrition products were evaluated. One hundred percent of patients were bar code scanned, 3106/3807 (82%) products were documented as given, 447/3807 (12%) were documented as held (with comments), 12/3807 (<1%) were documented as missing/unavailable, and 242/3807 (6%) were documented as refused. Conclusions Inclusion of enteral nutrition order sets on the MAR and using bar code scanning technology resulted in sustained improvements in safety, administration, and documentation of enteral therapies for hospitalized veterans.
AB - Objectives The goal of this project was to evaluate and improve the ordering, administration, documentation, and monitoring of enteral nutrition therapies within the inpatient setting in a Veteran's Health Administration system. Methods An interdisciplinary team of clinicians reviewed the literature for best practices and revised the process for enteral nutrition support for hospitalized veterans. Interventions included training staff, revising workflows to include scanning patients and products, including enteral nutrition orders within the medication administration record (MAR), and using the existing bar code medication administration system for administration, documentation, and monitoring. Baseline and postprocess improvement outcomes over a year period were collected and analyzed for quality improvement opportunities. Results Before process change, only 60% (33/55) of reviewed enteral nutrition orders were documented and 40% (22/55) were not documented in the intake flowsheet of the electronic health record. In the year after adding enteral nutrition therapies to the MAR and using bar code scanning, a total of 3807 enteral nutrition products were evaluated. One hundred percent of patients were bar code scanned, 3106/3807 (82%) products were documented as given, 447/3807 (12%) were documented as held (with comments), 12/3807 (<1%) were documented as missing/unavailable, and 242/3807 (6%) were documented as refused. Conclusions Inclusion of enteral nutrition order sets on the MAR and using bar code scanning technology resulted in sustained improvements in safety, administration, and documentation of enteral therapies for hospitalized veterans.
KW - bar code scanning
KW - electronic health record
KW - enteral nutrition
KW - malnutrition
KW - medication administration record
KW - nutrition support
KW - nutrition therapy
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U2 - 10.1097/PTS.0000000000001076
DO - 10.1097/PTS.0000000000001076
M3 - Article
C2 - 36538338
AN - SCOPUS:85144589865
SN - 1549-8417
VL - 19
SP - 23
EP - 28
JO - Journal of Patient Safety
JF - Journal of Patient Safety
IS - 1
ER -