Article submitted by Sam Ousey, RD, HMC Vice President
 
Enteral Orders need to be consistent. Have you looked at the Tube feeding orders in your facilities lately to check if they have all these components: 

• Method of delivery (continuous, bolus or cyclic)
• Rate in ml.
• Duration in time with time on and time off
• Total volume infused
• Total kcal
• H20 Flush in ml. with times of flush  (not just q shift)
• Total volume of free water per day
• Site of infusion; NG, GT, JT

Refer to the "Worksheet for Enteral Feeding Orders" on page 192 of the HMC Policy and Procedure Manual for assistance with QA  of enteral feeding orders. When you follow this format it clarifies enteral feeding orders for your facilities.   

Do you know how to use the dose feature on pumps? Many times the total volume is not accomplished or the dose limit is not correct. Invite nursing staff to partner in the QA of enteral feedings. These are items to look for in a QA of enteral feedings:

• Oral Intake;
• Enteral order properly written (open bottles dated)
• Verify Tube Placement
• Checking Residuals
• Tube Flushing
• Intake & Output
• Elevation of Head of Bed
• Administration Sets & Syringes (dated and replaced)
• Pumps (clean and calibrated annually)
• Site Care
• Nursing Assessment
• Weight goals 
• Lab values

Enteral feeding is a great 'In Service'. Partner up with the Enteral Sales Representative. Did you know some of our HMC Dietitians do enteral feeding QA's for a Pharmaceutical company? Please feel free to contact Sam for more information about this service.