Improving the Percentage of Inpatients Receiving Enteral Nutrition Product (ENP) within 24 Hours of Dietitians’ Prescription in Serdang Hospital

Abstract

Enteral nutrition product (ENP) is a product that contains dietary ingredients to further add nutritional value to one’s diet. Dietitians prescribe ENP to ensure patients with malnutrition receive sufficient nutrients to improve their clinical status during the hospital stay. Delay in nutrition support may pose patients to a higher risk of disease complications, and increase mortality rate and length of hospital stay. This study aimed to achieve 90% of patients receiving ENP within 24 hours of dietitians’ prescription. Verification study showed only 59.3% achievement against the current standard. A quality improvement study was conducted using universal sampling in three selected wards with 140 subjects in two consecutive phases by using an audit form. Pre-remedial study showed that 40.7% (n=57) patients did not receive ENP within 24 hours of dietitians’ prescription. Products are not served to patients (67%, n=38), ENP not indented (23%, n=13), products not collected from dietetic department (5%, n=3), indent not processed (4%, n=2), and wrongly indented by staff (2%, n=1) were identified as contributing factors in delayed nutritional support. The improvement strategies included the establishment of a dietetic chart, provision of a formatted dietetic board, updating standards of work procedures, and conducting continuous nursing education. Additional strategies included updating the formatted nursing report, empowering hospital attendants to prepare ENP, conducting bedside teaching for nurses and providing bedside tagging. The percentage of patients receiving ENP within 24 hours of dietitians’ prescription had improved from 59.3% to 85.4% in Cycle 1 and increased to 95.0% in Cycle 2. The interventions successfully reduced the duration of patients receiving the ENP from the time ENP was prescribed, from an average of 34 hours to 20 hours. This study has been expanded to all wards in the Serdang Hospital and replicated in all Ministry of Health (MOH) Hospitals in Selangor.