A scoping review of best practices in home enteral tube feeding

Abstract

Aims: To review the experiences of healthcare professionals (HCPs) and service users on the provision and receipt of home enteral nutrition (HEN) in primary care settings, respectively. Backgrounds: HEN supports the nutritional needs of service users in primary care settings who are unable to meet their nutritional requirements through oral intake alone. While HEN supports service users to remain in their home, the provision of HEN services can be variable. The prevalence of HEN is increasing as health systems shift delivery of care from acute to primary care settings, and therefore the evolving needs of HCPs and service users in relation to HEN deserve exploration. Methods: Quantitative and qualitative studies were included if they described (1) practices that support best outcomes in adults on HEN and residing in their own homes and/or (2) service user and HCP experiences of HEN. Studies on the economics of HEN were included. Databases searched included MEDLINE/PubMed, EMBASE, Web of Science, and CINAHL. Publications up to March 2021 were included. A descriptive analytical approach was used to summarise the findings. Findings: Key themes included the importance of initial education to enable service users to adapt to HEN and the need for support from knowledgeable HCPs. Access to support from HCPs in primary care was limited, and some HCPs felt their knowledge of HEN was inadequate. Service users highlighted the significant impact of HEN on daily living and emphasised the need for support from a HEN team. HEN services were also associated with reduced hospital admissions, lengths of stay in hospital, and costs of hospitalisation. Conclusions: A specialist HEN service can manage enteral nutrition-related complications, reduce unnecessary hospital admissions, and improve quality of care and patient satisfaction. Further education of HCPs is needed on the provision of HEN.

Enteral nutrition: An underappreciated source of patient safety events

“…These reports underscore the need for standardized protocols for protecting patients, monitoring medical line safety, and frequently and closely monitoring patients who have enteral tubes and use feeding sets 23,61 . A scoping review of the literature reported that most patients requiring EN can be safely and efficiently managed using standardized EN protocols 58 . To enhance the uptake and sustainability of system‐wide protocols, healthcare systems, interdisciplinary nutrition support teams, and EMR vendors can work collaboratively to build these standardized protocols into their organization‐wide policies and EMR workflows 14,58,62 …”

“…36 Solutions include ensuring that nurses in hospitals or patients in the home setting have current knowledge of how to use the equipment and appropriate supplies to administer EN so as to not damage the tubes or injure themselves. 58 Additionally, determining periodic automatic replenishment inventory levels and barcode scanning unit-stocked EN therapies or using standardized order sets that include ordering/delivering EN supplies for patients during the ordering process may help to improve the safety, resource use, and timeliness of care. 14,59,60 The third most common event type was patient protection events, which accounted for 14 (1%) of the reports.…”

“…23,61 A scoping review of the literature reported that most patients requiring EN can be safely and efficiently managed using standardized EN protocols. 58 To enhance the uptake and sustainability of system-wide protocols, healthcare systems, interdisciplinary nutrition support teams, and EMR vendors can work collaboratively to build these standardized protocols into their organization-wide policies and EMR workflows 14,58,62 Thematic analysis using the MUP After manually reviewing the 1030 narrative summaries within the top five event subtype categories, 691 events emerged as being directly related to EN therapy use, and our team identified 1229 MUP process errors within those 691 reported events. This demonstrates that a single EN safety event frequently crossed several MUP steps highlighting failures occurring at several steps in the process.…”

“…The importance of reporting these types of events to electronic reporting mechanisms, such as the MERP or JPSR, so that there can be improvements in the process or products design cannot be overemphasized 36 . Solutions include ensuring that nurses in hospitals or patients in the home setting have current knowledge of how to use the equipment and appropriate supplies to administer EN so as to not damage the tubes or injure themselves 58 . Additionally, determining periodic automatic replenishment inventory levels and barcode scanning unit–stocked EN therapies or using standardized order sets that include ordering/delivering EN supplies for patients during the ordering process may help to improve the safety, resource use, and timeliness of care 14,59,60 …”

“…A scoping review of the literature reported that most patients requiring EN can be safely and efficiently managed using standardized EN protocols 58 . To enhance the uptake and sustainability of system‐wide protocols, healthcare systems, interdisciplinary nutrition support teams, and EMR vendors can work collaboratively to build these standardized protocols into their organization‐wide policies and EMR workflows 14,58,62 …”