Improving patient safety in enteral feed and fluid prescription and administration in community care settings

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Background

Within the Home Enteral Feeding Team (that sits within the Nutrition and Dietetics Department) we wanted to focus on preventing community care settings from transcribing and incorrectly implementing tube feeding regimens. Our feeding regimens are prescriptions of ACBS approved products but our team would often come across rewritten versions due to staff finding our versions unclear. These transcribed regimens often contain multiple errors resulting in inappropriate products / volumes of feed / water being given to tube-fed patients.

Aim

To have 80% of five community care settings with tube- fed patients not transcribing feed regimens by August 2019, thereby reducing prescription and administration errors.

Method

Five care settings were identified and baseline data on transcribing and confidence of using their current regimens were collected. We provided each care setting with a new version of their patients’ feeding regimens. Contact was made with each of the care settings on a monthly basis to determine: 1. whether they were still using the new version of the feeding regimen or had transcribed it, and 2. how confident they felt with using the new feeding regimen (on a scale of 1 - 4).

Results

All five of the selected care settings were transcribing at the start of our project. After the new regimen was implemented we found it was easier for staff to understand and staff felt more confident in using it therefore didn’t need to transcribe. After six months of monitoring, 100% of the care settings no longer transcribe these regimens.

Implications

It was important to explain to the care settings why we are changing the regimens in order for them to agree to it, and then taking their feedback on board. We have also found it is making all the Dietitians write regimens in a consistent format. We want to roll out the new regimen to all care settings and consider amending the template to use with patients in their own homes.