Factors leading to discrepancies between prescription and intake of enteral nutrition therapy in hospitalized patients

Abstract

ObjectiveWe investigated factors leading to a reduction in enteral nutrition (EN) prescribed by a nutritional support team (NST) at a general hospital in Brazil. MethodsIn this prospective, observational study, hospitalized adults receiving only EN therapy via tube feeding were followed for up to 21 d from July to October 2008. ResultsThe 152 subjects analyzed included 38 (23.5%) ward patients and 124 (76.5%) intensive care unit (ICU) patients. Eighty percent of the targeted feeding volume was achieved on day 4 by 80% of the patients. Reasons for not receiving the total amount of EN prescribed included delay in EN administration (3.1%), abdominal distention (5.6%), patient refusal of treatment (6.8%), feeding tube obstruction (8.6%), vomiting (10.5%), diarrhea (17.9%), unknown causes (17.9%), interference by a non-NST physician (25.9%), accidental feeding tube loss (34%), presence of high gastric residual (34%), and operational logistics at the hospital's Nutrition and Dietetics Service (99.4%). There was a significant association between patients who received <60% of the prescribed EN and external physician interference (P < 0.016). ICU patients also received inadequate EN (P < 0.025). Neurologic patients had a greater chance of receiving >81% of the prescribed EN amount than cardiac patients (odds ratio 3.75, P < 0.01). ConclusionMajor reasons for inadequate EN intake are (in decreasing order) operational logistical problems, gastric stasis, accidental loss of enteral feeding tube, and interference by an external physician (not an NST member). Cardiologic patients and ICU patients are at a higher risk for inadequacy than neurologic patients.