A study of reasons for failure to administer prescribed volume of nasogastric enteral feeds in a district general hospital

Abstract

Background: A number of studies have demonstrated that the amount of enteral feed delivered is often significantly less than that prescribed (Park, 1992; Reid, 2006), which can impair nutritional status (National Institute for Health and Clinical Excellence, 2006). The aim of this survey was to establish the amount of feed administered versus that prescribed and identify the reasons for patients failing to receive the volume of feed prescribed.Methods: Data were collected prospectively on 20 consecutive patients on medical or surgical wards, who were commenced on nasogastric feeding (NGF). Feed requirements were determined by a clinical dietitian. The volume of feed administered versus that prescribed was calculated from the daily fluid balance charts. Medications and reasons for failure to administer prescribed feed were ascertained from medical, nursing and dietetic records and questioning staff. This was recorded on a data collection form.Results: Data were evaluated for 13 male and seven female patients, mean age 66 years (range 35–91 years) on gastroenterology, oncology and surgical wards. In total, 235 days of NGF were prescribed. Under‐delivery of feed occurred on 70 out of 235 (30%) days. Mean (SD) NGF delivered was 77% (39%) of feed prescribed. No feed was administered on 39 out of 235 days (17%). Fifty‐five percent of patients were on proton pump inhibitors (PPIs). Reasons for not administering feed or administering less than that prescribed are detailed in Fig. 1.Discussion: Inadvertent removal and inability to confirm correct positioning of nasogastric tubes (NGTs) accounted for significant interruptions to feeding resulting in under‐delivery of feed and lost feeding days (27%). Fifty‐five percent of patients were on PPIs because these are known to increase gut pH; this warrants further investigation of the possible cause of obtaining an unsuitable pH. The mean NGF delivered is similar to other studies mentioned. The limitations of this study include the small sample size and the possible inaccuracies of the fluid balance charts. image [ Reasons for failure to administer prescribed feed expressed as a percentage (n = 70). ]Conclusions: As a consequence, the nutrition support team is working on improving methods of securing NGTs, investigating aspiration practice, encouraging a review of PPIs and optimising radiography procedures. The study highlights the opportunities for improving practice to ensure that patients receive the feed prescribed.References National Institute of Health and Clinical Excellence (2006) Nutrition support in adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. NICE, Available at http://www.nice.org.uk/guidance/CG32 (accessed on 3 December 2008).Park, R.H.R., Allioson, M.C., Lang J., Spence E., Morris A.J., Danesh B.J.Z., Russell, R.I. & Mills P.R. (1992) Randomised comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with persisting neurological dysphagia. BMJ304, 1406–1409.Reid, C. (2006) Frequency of under and overfeeding in mechanically ventilated ICU patients: causes and possible consequences. J. Hum. Nutr. Diet.19, 13–22.