Drug therapy may be complicated in hospitalized patients receiving nutrition via enteral feeding tubes. Dosage form selection and appropriate administration methods are crucial in patients with feeding tubes. Although hospitalized patients receive nutritional support through various routes, oral nutrition is preferred. Enteral or parenteral nutrition may be used if oral intake is inadequate or inadvisable. Patients with functional gastrointestinal tracts usually receive enteral nutrition. Administering oral medications through the enteral feeding tube can lead to complications like tube clogging or decreased drug activity. However, drug therapy need not be compromised in patients receiving enteral nutrition. Careful selection and preparation of dosage forms reduces the complications of medication administration. Flushing the feeding tube and screening for drug incompatibilities decreases the incidence of tube clogging and replacement.

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In 1989, Williamson published a survey of nutrition care practices in burn centers. Nutrition practices have evolved since then; we conducted a study to determine the current scope of nutrition care in burn centers. With IRB approval, a 64 question survey was emailed to 103 burn centers listed in the Burn Care Resources in North America. Follow-up emails were sent to those who did not respond within 2 weeks. Sixty-five centers (63%) responded and included 66% of currently verified burn centers. Due to incomplete surveys, most questions had 45 to 50 responses. The centers averaged 246 annual admissions and all admitted non-burn patients. Eighty percent of dietitians had >5 years burn experience (vs 17% in 1989) and 90% also worked in other intensive care settings. Most dietitians reported advanced training or education (83%). Nutrition assessment, support and monitoring methods have changed though most centers continue to use serum proteins for assessment. Indirect calorimetry use has increased with most centers (78%) adding a 'stress factor' of 10 to 30% above measured energy needs. More centers provided specialized formulas including high-protein (82 vs 8.8%) and immune-enhancing (53 vs 12.3%) than in 1989. All gave a variety of vitamin and mineral supplements. Anabolic steroid and glutamine use was common (92 and 69%). Eighty percent of centers used glucose protocols with 54% having a goal of

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