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Sabaghnejad E, Nikvarz N, Nematollahi M. Effect of Virtual Education on Knowledge and Practice of Critical Care Nurses Regarding the Administration of Drugs Through Enteral Feeding Tubes: A Prospective Randomized Pre-Post Intervention Study. Crit Care Nurs Q 2024; 47:286-295. [PMID: 39265110 DOI: 10.1097/cnq.0000000000000524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2024]
Abstract
A study was conducted to evaluate the effect of virtual education on knowledge and practice of nurses regarding administration of drugs through enteral feeding tubes (EFTs). Sixty nurses working in 4 intensive care units were enrolled. A questionnaire evaluating knowledge and practice of nurses regarding drug administration through EFTs was used. At the pre-intervention stage, all nurses responded to the questionnaire. Then an educational videoclip was provided to the intervention group. One month later, post-intervention stage, both groups answered to the questionnaire again. At the end of the study, the scores of all items in the knowledge domain including medication preparation (mean difference [MD] [95% CI]: 1.11 [0.57; 1.66]), tube flushing (MD [95% CI]: 2.15 [1.59; 2.79]), recognizing drug-drug/drug-feed interactions (MD [95% CI]: 0.57 [0.05; 1.09]), and recognizing dosage forms (MD [95% CI]: 1.51 [0.94; 2.10]) and practice domain including medication preparation (MD [95% CI]: 1.63 [1.04; 2.21]), tube flushing (MD [95% CI]: 1.19 [0.64; 1.74]), and recognizing drug-drug/drug-feed interactions [MD (95% CI): 2.16 (1.53; 2.80)] in the intervention group were significantly higher than those in the control group (P < .05). Education of proper technics of preparation and administration of drugs through EFTs improved knowledge and practice of the participants.
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Affiliation(s)
- Elnaz Sabaghnejad
- Author Affiliations: Department of Clinical Pharmacy, Faculty of Pharmacy (Ms Sabaghnejad), Herbal and Traditional Medicines Research Center (Dr Nikvarz), Nursing Research Center (Ms Nematollahi), Kerman University of Medical Sciences, Kerman, Iran
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2
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Karkossa F, Bading A, Klein S. What to consider for successful administration of oral liquids via enteral feeding tubes? a case study with paediatric ibuprofen suspensions. Int J Pharm 2024; 649:123628. [PMID: 37984617 DOI: 10.1016/j.ijpharm.2023.123628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 11/22/2023]
Abstract
Administration of medications via enteral feeding tubes (EFTs) is a common practice for children who cannot swallow properly. Although liquid formulations are the preferred dosage forms for this route of administration, little attention has been paid to the amount of drug that reaches the site of absorption after administration via an EFT. This systematic in vitro study aimed to identify formulation parameters and administration approaches that are critical for successful dose delivery via EFTs. For this purpose, drug recovery after administration of three different paediatric ibuprofen suspensions via different types of EFTs was studied using derivative UV spectrophotometry for quantification. Study results indicate that in addition to formulation parameters, feeding tube characteristics and the administration process can have a significant impact on the administered dose. The ratio between the total administered fluid volume (TAV), represented by the sum of dose- and flushing volume, and the feeding tube volume (FTV) proved to be a valuable indicator for assessing successful administration. Incorrect dosing and complications could be avoided if the TAV/FTV ratio was greater than 4. This and other knowledge gained in the study will help to make the administration of liquid paediatric medicines via EFTs both more effective and safer.
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Affiliation(s)
- Frank Karkossa
- University of Greifswald, Department of Pharmacy, Institute of Biopharmaceutics and Pharmaceutical Technology, Center of Drug Absorption and Transport (C_DAT), Felix-Hausdorff-Straße 3, 17489 Greifswald, Germany
| | - Annelie Bading
- University of Greifswald, Department of Pharmacy, Institute of Biopharmaceutics and Pharmaceutical Technology, Center of Drug Absorption and Transport (C_DAT), Felix-Hausdorff-Straße 3, 17489 Greifswald, Germany
| | - Sandra Klein
- University of Greifswald, Department of Pharmacy, Institute of Biopharmaceutics and Pharmaceutical Technology, Center of Drug Absorption and Transport (C_DAT), Felix-Hausdorff-Straße 3, 17489 Greifswald, Germany.
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Karkossa F, Lehmann N, Klein S. A systematic approach for assessing the suitability of enteral feeding tubes for the administration of controlled-release pellet formulations. Int J Pharm 2022; 612:121286. [PMID: 34775043 DOI: 10.1016/j.ijpharm.2021.121286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 11/04/2021] [Accepted: 11/07/2021] [Indexed: 10/19/2022]
Abstract
Enteral nutrition plays an important role for patients who are unable to properly swallow food. In such patients, enteral feeding tubes are often used, through which food, but often also oral medications, are administered. However, this can pose the risk of tube clogging. Compared to the administration of crushed tablets, multiparticulate dosage forms are often considered easier to administer and furthermore have the advantage of enabling the administration of even controlled-release preparations. The objective of this systematic study was to identify tube- and formulation-related factors that contribute to successful administration of coated pellet formulations via a variety of commercially available feeding tube devices. The suitability of enteral feeding tubes for the administration of controlled-release pellet formulations that differed in size and type of starter core and functional coating was investigated in a stepwise approach using a novel in vitro setup. Results of the study indicate that pellet diameter and inner diameter of the feeding tube are by no means reliable parameters for estimating the tube's suitability for pellet administration, but that many other tube and formulation-related factors and combinations thereof must be considered to ensure safe and effective drug administration via enteral feeding tubes.
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Affiliation(s)
- Frank Karkossa
- University of Greifswald, Department of Pharmacy, Institute of Biopharmaceutics and Pharmaceutical Technology, Center of Drug Absorption and Transport, 3 Felix Hausdorff Street, Greifswald 17489, Germany
| | - Nicole Lehmann
- University of Greifswald, Department of Pharmacy, Institute of Biopharmaceutics and Pharmaceutical Technology, Center of Drug Absorption and Transport, 3 Felix Hausdorff Street, Greifswald 17489, Germany
| | - Sandra Klein
- University of Greifswald, Department of Pharmacy, Institute of Biopharmaceutics and Pharmaceutical Technology, Center of Drug Absorption and Transport, 3 Felix Hausdorff Street, Greifswald 17489, Germany.
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Abu Hdaib N, Albsoul-Younes A, Wazaify M. Oral medications administration through enteral feeding tube: Clinical pharmacist-led educational intervention to improve knowledge of Intensive care units' nurses at Jordan University Hospital. Saudi Pharm J 2021; 29:134-142. [PMID: 33679176 PMCID: PMC7910138 DOI: 10.1016/j.jsps.2020.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/31/2020] [Indexed: 01/10/2023] Open
Abstract
Introduction Medication administration through enteral feeding tubes is a practice that is commonly encountered in hospital settings, particularly in critically ill patients. This study aims to evaluate the knowledge of intensive care unit nurses regarding enteral medication administration and evaluate the effect of an educational intervention led by a clinical pharmacist that would improve nurses’ knowledge regarding the subject. Methods A pre/post interventional study was conducted. Improvement in nurses’ knowledge regarding medication administration through an enteral feeding tube was assessed using a validated questionnaire. Results Data were coded, entered, and analyzed using the Statistical Package for Social Sciences (IBM SPSS statistics 22). Independent samples t-test and paired t-test were used to detect any statistically significant differences in the mean total knowledge scores both between and within each group respectively. A P-value of <0.05 was considered statistically significant. The mean total knowledge score for nurses in the intervention and control group at the pre-interventional phase of the study was inadequate. There was a statistically significant improvement in the mean total knowledge score for the interventional group at the post-interventional phase of the study, while that of the control group remained inadequate (Intervention group total mean knowledge score at baseline 12.11 ± 3.75, post-intervention 21.50 ± 2.36, p-value <0.001; Control group total mean knowledge score at baseline 12.05 ± 3.12, post-intervention 12.60 ± 3.76, p-value 0.96). Conclusion Incorrect drug preparation and administration for patients with feeding tubes can affect patients. The knowledge of nurses regarding the subject can be improved significantly via an educational intervention. The activation of clinical pharmacists’ role and collaboration between pharmacists, physicians, and nurses is highly recommended in this clinical setting.
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Affiliation(s)
- N. Abu Hdaib
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Jordan
- Department of Pharmacy, Faculty of Pharmacy, Middle East University, Amman, Jordan
| | - A. Albsoul-Younes
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Jordan
| | - M. Wazaify
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Jordan
- Corresponding author at: Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman 11942, Jordan.
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Boullata JI. Enteral Medication for the Tube-Fed Patient: Making This Route Safe and Effective. Nutr Clin Pract 2020; 36:111-132. [PMID: 33373487 DOI: 10.1002/ncp.10615] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/15/2020] [Indexed: 12/26/2022] Open
Abstract
The administration of medication through an enteral access device requires important forethought. Meeting a patient's therapeutic needs requires achieving expected drug bioavailability without increasing the risk for toxicity, therapeutic failure, or feeding tube occlusion. Superimposing gut dysfunction, critical illness, or enteral nutrition-drug interaction further increases the need for a systematic approach to prescribing, evaluating, and preparing a drug for administration through an enteral access device. This review will explain the fundamental factors involved in drug bioavailability through the gut, address the influencing considerations for the enterally fed patient, and describe best practices for enteral drug preparation and administration.
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Affiliation(s)
- Joseph I Boullata
- Department of Clinical Nutrition Support Services, Penn Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Tillott H, Barrett D, Ruan J, Li V, Merrick S, Steed H, Morrissey H, Anthony Ball P. Survey of nurses' knowledge and practice regarding medication administration using enteral tubes. J Clin Nurs 2020; 29:4614-4622. [PMID: 32954598 DOI: 10.1111/jocn.15498] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 01/07/2023]
Abstract
AIM AND OBJECTIVES To identify the practice variation of the individual practitioners in medications' formulation modification for patients using enteral feeding tubing and to support health practitioners involved in this process. BACKGROUND Blockage of enteral tubes is a common problem that can sometimes be resolved but may require replacement of the tube. Medications are a common culprit. DESIGN A survey of 73 registered nurses' practices around medication administration via enteral feeding tubes. METHODS A questionnaire study was undertaken within a district general hospital across a broad variety of wards to explore nurses' experiences of medication administration via enteral tubes. The study is reported in accordance with the squire 2.0 guidelines from the EQUATOR network. RESULTS Seventy-three nurses responded. Twenty-six per cent reported never checking about drug modification for administration via a tube, 12% check every time and 61% when unsure about a new drug. The volume of fluid flushes administered after medication ranged from 7.5-150 ml. Seventy-one per cent of participants reported stopping feed when medications are required, varying from 1-60 min. Sixty per cent had experienced a blocked tube and 52% the tube being removed for these reasons. The clinical nurse specialist was the commonest first point of call to help. Staff named 15 medications as the most problematic to administer, lactulose and omeprazole were the top two. CONCLUSIONS Practice varies significantly amongst nurses around medication administration. Theoretically, this may contribute to blocked tubes and excessive fluid administration to some patients. Barriers to medication administration were thematically grouped into: time, difficulty modifying medication, medication interactions and knowledge. Areas identified to support staff include training, devices to crush medications, medication suitability, multidisciplinary approach to streamline care and quick reference guides. RELEVANCE TO CLINICAL PRACTICE Health professionals may use these results to reduce and ultimately avoid problems with administering medications through feeding tubes. Organisations may use these results to develop their local practice pathways for prescribing, dispensing and training around administration of medications through enteral tubes. In a community setting, this paper may improve the awareness of patients, caregivers and prescribers of the possible implications of tubing blockages.
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Affiliation(s)
| | - Diane Barrett
- The Royal Wolverhampton National Health Service Trust, Wolverhampton, UK
| | - Jingjing Ruan
- The Royal Wolverhampton National Health Service Trust, Wolverhampton, UK
| | - Vincent Li
- The Royal Wolverhampton National Health Service Trust, Wolverhampton, UK
| | - Susan Merrick
- The Royal Wolverhampton National Health Service Trust, Wolverhampton, UK
| | - Helen Steed
- University of Wolverhampton, Wolverhampton, UK.,The Royal Wolverhampton National Health Service Trust, Wolverhampton, UK
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Bandy KS, Albrecht S, Parag B, McClave SA. Practices Involved in the Enteral Delivery of Drugs. Curr Nutr Rep 2020; 8:356-362. [PMID: 31606851 DOI: 10.1007/s13668-019-00290-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW While the delivery of medications through enteral tubes is common in critically ill patients, there are complications and a lack of unified practices between institutions. The purpose of this review is to evaluate current practices and literature evidence regarding this administration route. The effect of this administration on the medication's efficacy, safety, tolerability, and pharmacokinetics was examined, as well as other considerations to ensure that this route of delivery is both safe and effective for patients. RECENT FINDINGS Studies have found crushed oral tablets are the most frequent cause of obstructed feeding tubes. Complications such as this are primarily due to inadequate personnel training and failure to properly access medications before enteral administration. There are many factors that should be considered in order to effectively administer drugs via enteral tubes. Formal training and use of a multi-disciplinary approach that includes pharmacists and dieticians has been shown to reduce tube obstructions and administration errors.
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Affiliation(s)
- Kathryn S Bandy
- Department of Pharmacy, University of Louisville Hospital, 530 S Jackson St., Louisville, KY, 40202, USA.
| | - Stephanie Albrecht
- Department of Pharmacy, University of Louisville Hospital, 530 S Jackson St., Louisville, KY, 40202, USA
| | - Bhavyata Parag
- Department of Pharmacy, Houston Methodist Clear Lake Hospital, 18300 Houston Methodist Dr, Houston, TX, 77058, USA
| | - Stephen A McClave
- Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville Hospital, 530 S Jackson St., Louisville, KY, 40202, USA.,Department of Digestive and Liver Health, University of Louisville Physicians Outpatient Center, 401 E. Chestnut St., Louisville, KY, 40202, USA
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8
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Wasylewicz ATM, van Grinsven RJB, Bikker JMW, Korsten HHM, Egberts TCG, Kerskes CHM, Grouls RJE. Clinical Decision Support System-Assisted Pharmacy Intervention Reduces Feeding Tube-Related Medication Errors in Hospitalized Patients: A Focus on Medication Suitable for Feeding-Tube Administration. JPEN J Parenter Enteral Nutr 2020; 45:625-632. [PMID: 32384187 PMCID: PMC8048796 DOI: 10.1002/jpen.1869] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/20/2020] [Accepted: 04/29/2020] [Indexed: 11/29/2022]
Abstract
Background Administering medication through an enteral feeding tube (FT) is a frequent cause of errors resulting in increased morbidity and cost. Studies on interventions to prevent these errors in hospitalized patients, however, are limited. Objective The objective was to study the effect of a clinical decision support system (CDSS)–assisted pharmacy intervention on the incidence of FT‐related medication errors (FTRMEs) in hospitalized patients. Methods A pre‐post intervention study was conducted between October 2014 and May 2015 in Catharina Hospital, the Netherlands. Patients who were admitted to the wards of bowel and liver disease, oncology, or neurology; using oral medication; and had an enteral FT were included. Preintervention patients were given care as usual. The intervention consisted of implementing a CDSS‐assisted pharmacy check while also implementing standard operating procedures and educating personnel. An FTRME was defined as the administration of inappropriate medication through an enteral FT. The incidence was expressed as the number of FTRMEs per medication administration. Multivariate Poisson regression was used to calculate the incidence ratio (IR) comparing both phases. Results Eighty‐one patients were included, 38 during preintervention and 43 during the intervention phase. Incidence of FTRMEs in the preintervention phase was 0.15 (95% CI, 0.07–0.23) vs 0.02 (95% CI, 0.00–0.04) in the intervention phase, resulting in an adjusted IR of 0.13 (95% CI, 0.10–0.18). Discussion Incidence of FTRMEs, as well as the IR, is comparable to previous studies. Conclusion The intervention resulted in a substantial reduction in the incidence of FTRMEs.
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Affiliation(s)
| | | | | | - Hendrikus H M Korsten
- Department of Signal Processing Systems, Faculty of Electronic Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Toine C G Egberts
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands.,Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Rene J E Grouls
- Department of Clinical Pharmacy, Catharina Hospital, Eindhoven, the Netherlands
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Beckwith MC, Feddema SS, Barton RG, Graves C. A Guide to Drug Therapy in Patients with Enteral Feeding Tubes: Dosage Form Selection and Administration Methods. Hosp Pharm 2017. [DOI: 10.1177/001857870403900308] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- M. Christina Beckwith
- Drug Information Service, University of Utah Hospitals and Clinics, Salt Lake City, Utah
| | - Sarah S. Feddema
- Drug Information Service, University of Utah Hospitals and Clinics, Salt Lake City, Utah
| | - Richard G. Barton
- Department of Surgery, University of Utah Hospitals and Clinics, Salt Lake City, Utah
| | - Caran Graves
- Nutrition Care Services: University of Utah Hospitals and Clinics, Salt Lake City, Utah
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10
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Elhassan AO, Tran LB, Clarke RC, Singh S, Kaye AD. Total Parenteral and Enteral Nutrition in the ICU: Evolving Concepts. Anesthesiol Clin 2017; 35:181-190. [PMID: 28526141 DOI: 10.1016/j.anclin.2017.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Appropriate nutrition in the hospital setting, particularly in critically ill patients, has long been tied to improving clinical outcomes. During critical illness, inflammatory mediators and cytokines lead to the creation of a catabolic state to facilitate the use of endogenous energy sources to meet increased energy demands. This process results in increasing the likelihood of overfeeding. The literature has revealed exponential advances in understanding the molecular basis of nutritional support and evolution of clinical protocols aimed at treating artificial nutritional support as a therapeutic intervention, preventing loss of lean body mass and metabolic deterioration to improve clinical outcomes in the critically ill.
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Affiliation(s)
- Amir O Elhassan
- Department of Anesthesiology, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA 70112, USA
| | - Lien B Tran
- Department of Anesthesiology, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA 70112, USA
| | - Richard C Clarke
- Department of Anesthesiology, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA 70112, USA
| | - Sumit Singh
- Department of Anesthesiology, David Geffen UCLA School of Medicine, 757 Westwood Plaza, Los Angeles, CA 90095, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA 70112, USA.
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11
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Seifert CF, Johnston BA. A Nationwide Survey of Long-Term Care Facilities to Determine the Characteristics of Medication Administration through Enteral Feeding Catheters. Nutr Clin Pract 2017; 20:354-62. [PMID: 16207674 DOI: 10.1177/0115426505020003354] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Previous data clearly showed profound differences in nursing practices and techniques within the state of Texas regarding the administration of medications through enteral feeding catheters (EFCs) between long-term care (LTC) facilities that predominantly serve a rural vs an urban population. This study aims to determine the incidence and characteristics of medication administration through EFCs in the LTC setting in the United States with particular emphasis on the delineation between practices in facilities that predominantly serve a rural vs an urban population. A 36-item validated survey was mailed to the Directors of Nursing of the 16,400 LTC facilities registered with the U.S. Medicare LTC facility database registry. In all, 1278 (7.8%) surveys were included in this analysis. The majority of nurses responding were RNs (93%), with extensive years of experience (19 years), working in facilities predominantly serving a rural area (58%). There were significant differences between rural and urban facilities with regard to the percent of patients receiving medications through EFCs (6.6% vs 9.0%, p < .0001), number of oral medications/day (8.3 vs 9.4, p = .0003), amount of flush before and after administering medications (64 mL vs 59 mL, p = .0127), those attending a seminar/in-service on medication administration through EFCs (45% vs 56%, p < .0001), and medication obstruction rate (6.4% vs 3.9%, p = .0227). Medication obstruction rate was significantly increased when nurses used 3 or more inappropriate techniques (8.1% vs 4.8%, p = .0171), particularly crushing enteric-coated (8.9% vs 4.6%, p = .0003) and sustained-release dosage forms (8.5% vs 4.7%, p < .0001). Medication obstruction through EFCs is significantly increased when 3 or more inappropriate techniques are utilized. Techniques, complications, and sources of information vary significantly from rural to urban facilities and various parts of the country. A universal set of guidelines to administer medications through EFCs should be adopted and widely disseminated particularly to LTC facilities in rural areas.
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Affiliation(s)
- Charles F Seifert
- School of Pharmacy, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA.
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12
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Hanssens Y, Woods D, Alsulaiti A, Adheir F, Al-Meer N, Obaidan N. Improving Oral Medicine Administration in Patients with Swallowing Problems and Feeding Tubes. Ann Pharmacother 2016; 40:2142-7. [PMID: 17132805 DOI: 10.1345/aph.1h342] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Correct administration of oral medicines in patients with swallowing problems and feeding tubes remains a challenge. Objective: To improve drug administration in patients with swallowing problems and feeding tubes in a 1600 bed tertiary referral center in the State of Qatar. Methods: A questionnaire was used to evaluate the knowledge and practice of nursing staff from 6 different intensive care units (ICU). Questions assessed the respondents' knowledge of the purpose of controlled-release (CR) preparations, codes used for CR medication, the consequences of crushing these preparations, and their interactions with enteral feeds and feeding tubes. Based on the results of the questionnaire, a 2 day training program was conducted for a core group of 34 staff nurses from all units (ICU and non-ICU) and 3 nursing instructors. Following the principle of “training the trainers,” the core group and the nursing instructors would widen the scope of education by running programs in the future. Lecture sessions for pharmacy staff and a monitoring tool to evaluate the practice were also developed. Results: Overall knowledge of CR codes increased from 0% to 40%, correct crushing of solid preparations from 35% to 90%, and knowledge of possible interactions with the enteral feed or feeding tubes from 51% to 88%. Correct administration of medication in patients with feeding tubes improved from 32% to 83%. The quality and value of the 2 day training course received a mean score of 96%. Conclusions: While most nurses were aware of the purpose of CR formulations, little was known about the different codes used by drug companies and the consequences of crushing these preparations. Interactions with enteral feeds and feeding tubes were mostly overlooked. A 2 day training course followed by continuous in-service training, a lecture to pharmacy staff, and provision of supportive educational material greatly improved the overall medicine administration process in patients with swallowing problems and feeding tubes.
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Affiliation(s)
- Yolande Hanssens
- Pharmacy Department, Clinical Pharmacy Services, Hamad Medical Corporation, Doha, State of Qatar.
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Sivén M, Kovanen S, Siirola O, Hepojoki T, Isokirmo S, Laihanen N, Eränen T, Pellinen J, Juppo AM. Challenge of paediatric compounding to solid dosage forms sachets and hard capsules – Finnish perspective. J Pharm Pharmacol 2016; 69:593-602. [DOI: 10.1111/jphp.12648] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 09/04/2016] [Indexed: 11/29/2022]
Abstract
Abstract
Objectives
The study evaluated the quality of compounded sachets and hard gelatine capsules and their feasibility in paediatric drug administration.
Methods
Commercial tablets were compounded to sachets and capsules in hospital environment, and the uniformity of content and simulated drug dose were determined.
Key findings
Compounded formulations were successfully obtained for a range of drug substances; dipyridamole, spironolactone, warfarin and sotalol formulations were within acceptable limits for uniformity of content, in most cases. However, some loss of drug was seen. The type and amount of excipients were found to affect uniformity of content; good conformity of capsules was obtained using lactose monohydrate as filler, whereas microcrystalline cellulose was a better choice in sachets. In capsules, content uniformity was obtained for a range of drug doses. If the drug is aimed to be administered through a nasogastric tube, solubility of the drug and excipients should be considered, as they were found to affect the simulated drug dose in administration.
Conclusions
Compounded sachets and capsules fulfilled the quality requirements in most cases. In compounding, the choice of excipients should be considered as they can affect conformity of the dosage form or its usability in practice. Quality assurance of compounded formulations should be taken into consideration in hospital pharmacies.
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Affiliation(s)
- Mia Sivén
- Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Satu Kovanen
- Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Outi Siirola
- Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Tuomas Hepojoki
- Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | | | | | | | - Jukka Pellinen
- Department of Environmental Sciences, Faculty of Biological and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | - Anne M Juppo
- Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
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15
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Development and evaluation of an algorithm to facilitate drug prescription for inpatients with feeding tubes. Eur J Clin Pharmacol 2015; 71:489-97. [PMID: 25690983 DOI: 10.1007/s00228-015-1817-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 02/03/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE We aimed to develop and evaluate an algorithm to facilitate drug switching between primary and tertiary care for patients with feeding tubes. METHODS An expert consortium developed an algorithm and applied it manually to 267 preadmission drugs of 46 patients admitted to a surgical ward of a tertiary care university hospital between June 12 and December 2, 2013, and requiring a feeding tube during their inpatient stay. RESULTS The new algorithm considered the following principles: Drugs should be ideally listed on the hospital drug formulary (HDF). Additionally, drugs should include the same ingredient instead of a therapeutic equivalent. Preferred dosage forms were appropriate liquids, followed by solid drugs with liquid administration form, and solid drugs that could be crushed and/or suspended. Of all evaluated drugs, 83.5% could be switched to suitable drugs listed on the HDF and another 6.0% to drugs available on the German drug market. Additionally, for 4.1% of the drugs, the integration of individual switching rules allowed the switch from enteric-coated to immediate-release drugs. Consequently, 6.4% of the drugs could not be automatically switched and required case-to-case decision by a clinical professional (e.g., from sustained-release to immediate-release). CONCLUSIONS The predefined principles were successfully integrated in the new algorithm. Thus, the algorithm switched more than 90% of the evaluated preadmission drugs to suitable drugs for inpatients with feeding tubes. This finding suggests that the algorithm can readily be transferred to an electronic format and integrated into a clinical decision support system.
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Lohmann K, Ferber J, Send AFJ, Haefeli WE, Seidling HM. Inappropriate crushing information on ward lists: cytotoxic drugs, capsules, and modified release formulations are gravely neglected. Eur J Clin Pharmacol 2014; 70:565-73. [DOI: 10.1007/s00228-013-1638-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 12/29/2013] [Indexed: 01/07/2023]
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Stumpf JL, Kurian RM, Vuong J, Dang K, Kraft MD. Efficacy of a Creon delayed-release pancreatic enzyme protocol for clearing occluded enteral feeding tubes. Ann Pharmacother 2014; 48:483-7. [PMID: 24436458 DOI: 10.1177/1060028013515435] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Alkalinized Viokase pancreatic enzyme tablets restored patency to 71.9% of occluded Dobhoff tubes in a prospective study. After removal of Viokase tablets from the US market, the hospital protocol for unclogging enteral feeding tubes was adapted to use Creon pancreatic enzyme delayed-release capsules, despite the lack of published data. OBJECTIVE To evaluate the effectiveness of a Creon-based protocol to clear occluded enteral feeding tubes. METHODS This retrospective study included all adult and pediatric patients seen in the emergency department or in an inpatient setting who received Creon 12 000 units lipase delayed-release capsule dissolved in a solution of sodium bicarbonate 650 mg and sterile water for clearing occluded enteral feeding tubes between May 1 and November 30, 2010. The Creon protocol was deemed effective if tube clearance was documented in the medical record or if enteral feedings were resumed with no note regarding tube replacement. RESULTS Alkalinized Creon delayed-release capsules were administered to 83 patients with a total of 118 clogged tubes. Three poorly documented cases and 5 tubes with mechanical clogs were excluded from data analysis. Patency was restored to 53 of 110 (48.2%) occluded tubes. More than 1 treatment course was attempted in 5 cases, with success in 3. CONCLUSION An alkalinized Creon pancreatic enzyme protocol was effective in clearing approximately half of the occluded enteral feeding tubes in this retrospective study, an efficacy rate much less than that previously reported in the literature with a Viokase-based protocol.
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Affiliation(s)
- Janice L Stumpf
- University of Michigan Health System Department of Pharmacy Services, Ann Arbor, MI, USA
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Mafiana RN, Taqi A, Al-Zakwani I. Evaluation of nurses' knowledge of oral solid dosage forms that should not be crushed at a university hospital in Oman. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2013. [DOI: 10.1111/jphs.12046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Aqeela Taqi
- Department of Pharmacy; Sultan Qaboos University Hospital; Muscat Oman
| | - Ibrahim Al-Zakwani
- Department of Pharmacology and Clinical Pharmacy; College of Medicine; Sultan Qaboos University; Muscat Oman
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Affiliation(s)
- Peggi Guenter
- Peggi Guenter is the Senior Director for Clinical Practice, Advocacy, and Research Affairs for the American Society for Parenteral and Enteral Nutrition, Silver Spring, Md. Joseph Boullata is Professor of Pharmacology & Therapeutics at the University of Pennsylvania School of Nursing, and Clinical Pharmacy Specialist in Nutrition, Hospital of the University of Pennsylvania's Clinical Nutrition Support Services, Philadelphia, Pa
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Stuijt CCM, Klopotowska JE, van Driel CK, Le N, Binnekade J, van der Kleij B, van der Schors T, van den Bemt P, Lie-A-Huen L. Improving medication administration in nursing home residents with swallowing difficulties: sustainability of the effect of a multifaceted medication safety programme. Pharmacoepidemiol Drug Saf 2012. [DOI: 10.1002/pds.3373] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Joanna E. Klopotowska
- Academic Medical Centre; Department of Hospital Pharmacy; Amsterdam; the Netherlands
| | | | - Nhut Le
- University of Utrecht; Faculty of Pharmacy; Utrecht; the Netherlands
| | - Jan Binnekade
- Academic Medical Centre; Department of Intensive Care; Amsterdam; the Netherlands
| | - Bea van der Kleij
- Westfriesgasthuis; Department of Hospital Pharmacy; Hoorn; the Netherlands
| | | | | | - Loraine Lie-A-Huen
- Academic Medical Centre; Department of Hospital Pharmacy; Amsterdam; the Netherlands
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Phillips NM, Nay R. Nursing administration of medication via enteral tubes in adults: a systematic review. INT J EVID-BASED HEA 2012; 5:324-53. [PMID: 21631795 DOI: 10.1111/j.1479-6988.2007.00072.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Enteral tubes are frequently inserted as part of medical treatment in a wide range of patient situations. Patients with an enteral tube are cared for by nurses in a variety of settings, including general and specialised acute care areas, aged care facilities and at home. Regardless of the setting, nurses have the primary responsibility for administering medication through enteral tubes. Medication administration via an enteral tube is a reasonably common nursing intervention that entails a number of skills, including preparing the medication, verifying the tube position, flushing the tube and assessing for potential complications. If medications are not given effectively through an enteral tube, harmful consequences may result leading to increased morbidity, for example, tube occlusion, diarrhoea and aspiration pneumonia. There are resultant costs for the health-care system related to possible increased length of stay and increased use of equipment. Presently what is considered to be best practice to give medications through enteral tubes is unknown. Objectives The objective of this systematic review was to determine the best available evidence on which nursing interventions are effective in minimising the complications associated with the administration of medications via enteral tubes in adults. Nursing interventions and considerations related to medication administration included form of medication, verifying tube placement before administration, methods used to give medication, methods used to flush tubes, maintenance of tube patency and specific practices to prevent possible complications related to the administration of enteral medications. Search strategy The following databases were searched for literature reported in English only: CINAHL, MEDLINE, The Cochrane Library, Current Contents/All Editions, EMBASE, Australasian Medical Index and PsychINFO. There was no date restriction applied. In addition, the reference lists of all included studies were scrutinised for other potentially relevant studies. Selection criteria Systematic reviews of randomised controlled trials (RCTs) and RCTs that compared the effectiveness of nursing interventions and considerations used in the administration of medications via enteral tubes. Other research methods, such as non-randomised controlled trials, longitudinal studies, cohort and case control studies, were also included. Exclusion criteria included studies investigating drug-nutrient interactions or the bioavailability of specific medications. Data collection and analysis Initial consideration of potential relevance to the review was carried out by the primary author (NP). Two reviewers independently assessed study eligibility for inclusion. A meta-analysis could not be undertaken, as there were no comparable RCTs identified. All data were presented in a narrative summary. Results There is very limited evidence regarding the effectiveness of nursing interventions in minimising the complications associated with enteral tube medication administration in adults. The review highlights a lack of high quality research on many important nursing issues relating to enteral medication administration. There is huge scope for further research. Some of the evidence that was identified included that nurses should consider the use of liquid form medications as there may be fewer tube occlusions than with solid forms in nasoenteral tubes and silicone percutaneous endoscopic gastronomy tubes. Nurses may need to consider the sorbitol content of some liquid medications, for example, elixirs, as diarrhoea has been attributed to the sorbitol content of the elixir, not the drug itself. In addition, the use of 30 mL of water for irrigation when administering medications or flushing small-diameter nasoenteral tubes may reduce the number of tube occlusions.
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Affiliation(s)
- Nicole M Phillips
- Division of Nursing and Midwifery and Gerontic Nursing Clinical School, Australian Centre for Evidence Based Aged Care, La Trobe University, Bundoora, Victonia, Australia
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The role of clinical pharmacist to improve medication administration through enteral feeding tubes by nurses. Int J Clin Pharm 2012; 34:757-64. [DOI: 10.1007/s11096-012-9673-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Accepted: 07/02/2012] [Indexed: 11/27/2022]
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Kelly J, Wright D, Wood J. Medicine administration errors in patients with dysphagia in secondary care: a multi-centre observational study. J Adv Nurs 2011; 67:2615-27. [PMID: 21615463 DOI: 10.1111/j.1365-2648.2011.05700.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
AIM The aim of this study was to describe the interventions used by nurses when administering oral medicines to patients with and without dysphagia, to quantify the appropriateness of these interventions and the medicine administration error rate. BACKGROUND The administration of medicines to patients with dysphagia is complex and potentially more error prone because of the need to match the medication's formulation to the swallowing ability of the patient. METHOD Data was collected on the preparation and administration of oral medicines to patients with and without dysphagia, including those with enteral feeding tubes, using undisguised direct observation of 65 nurse-led medicine administration rounds on stroke and care-of-the-elderly wards at four acute general hospitals in East of England between 1 March and 30 June 2008. RESULTS Of the 2129 medicine administrations observed, 817 involved an error, and of these 313 involved patients with dysphagia. Excluding time errors, the normalized frequency of medicine administration errors for patients with dysphagia was 21.1% compared with 5.9% for patients without. Using a mixed effects model and excluding time errors, there is a higher risk of errors for patients with dysphagia (excluding patients with enteral tubes) compared with those without (P < 0.001) and a further increase in risk of error for patients with enteral tubes compared with dysphagic patients without tubes (P < 0.001). CONCLUSION The increased medicine administration error rate in patients with dysphagia requires healthcare professionals to take extra care when prescribing, dispensing and administering medicines to this group.
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Phillips NM, Endacott R. Medication administration via enteral tubes: a survey of nurses' practices. J Adv Nurs 2011; 67:2586-92. [PMID: 21592191 DOI: 10.1111/j.1365-2648.2011.05688.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This article is a report of a study examining the practices of acute care nurses when administering medication via enteral tubes. BACKGROUND Administering medication via enteral tubes is predominantly a nursing responsibility across countries. It is important to establish what nurses actually do when giving enteral medication to inform policy and continuing education development. METHOD In 2007, a survey was conducted using a random sample of acute care nurses at two large metropolitan hospitals in Melbourne, Australia. There were 181 Registered Nurses who participated in the study; 92 (50.8%) practised in intensive care units, 52 (28.7%) in surgical areas, 30 (16.6%) in medical areas and 7 (3.9%) were from combined medical-surgical areas. The questionnaire was developed by the researchers and a pilot study was conducted in August 2006 to test reliability, face validity and user-friendliness of the tool. RESULTS Nurses reported using a range of methods to verify enteral tube position prior to administering enteral medication; some were unreliable methods. A majority reported administering enteric-coated and slow or extended release forms of medication, and giving solid forms of medication when liquid form was available. Nearly all (96%) reported flushing a tube after giving medication, 28% before, and 12% always flushed between each medication. CONCLUSION Enteral medication administration practices are inconsistent. Some nurses are using unsafe practices and may therefore compromise patient care.
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Affiliation(s)
- Nicole Margaret Phillips
- The Deakin Centre for Quality and Risk Management in Health: A Joanna Briggs Collaborating Centre, School of Nursing and Midwifery, Faculty of Health, Deakin University, Burwood, Victoria, Australia.
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Palese A, Bello A, Magee J. Triturating drugs for administration in patients with difficulties in swallowing: evaluation of the drug lost. J Clin Nurs 2011; 20:587-90. [PMID: 21219531 DOI: 10.1111/j.1365-2702.2010.03577.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Alvisa Palese
- School of Nursing, University of Udine, Udine, Italy.
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Guenter P. Safe practices for enteral nutrition in critically ill patients. Crit Care Nurs Clin North Am 2010; 22:197-208. [PMID: 20541068 DOI: 10.1016/j.ccell.2010.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Promoting patient safety in the enterally fed critically ill patient is dependent on nursing surveillance and recognition of potential areas of patient harm and medical errors. Identifying areas for potential human error, administrative and organizational conditions that are conducive to error, and the patient's own tolerance to EN need to be recognized by the critical care nurse if the risk for EN complications is to be minimized.
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Affiliation(s)
- Peggi Guenter
- Clinical Practice, Advocacy, and Research Affairs, American Society for Parenteral and Enteral Nutrition, 8630 Fenton Street, Suite 412 Silver Spring, MD 20910, USA.
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Phenytoin Blood Concentrations in Hospitalized Geriatric Patients: Oral Versus Nasogastric Feeding Tube Administration. Ther Drug Monit 2010; 32:185-8. [DOI: 10.1097/ftd.0b013e3181d3fa3e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Idzinga JC, de Jong AL, van den Bemt PMLA. The effect of an intervention aimed at reducing errors when administering medication through enteral feeding tubes in an institution for individuals with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2009; 53:932-938. [PMID: 19744260 DOI: 10.1111/j.1365-2788.2009.01212.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Previous studies, both in hospitals and in institutions for clients with an intellectual disability (ID), have shown that medication errors at the administration stage are frequent, especially when medication has to be administered through an enteral feeding tube. In hospitals a specially designed intervention programme has proven to be effective in reducing these feeding tube-related medication errors, but the effect of such a programme within an institution for clients with an ID is unknown. Therefore, a study was designed to measure the influence of such an intervention programme on the number of medication administration errors in clients with an ID who also have enteral feeding tubes. METHODS A before-after study design with disguised observation to document administration errors was used. The study was conducted from February to June 2008 within an institution for individuals with an ID in the Western part of The Netherlands. Included were clients with enteral feeding tubes. The intervention consisted of advice on medication administration through enteral feeding tubes by the pharmacist, a training programme and introduction of a 'medication through tube' box containing proper materials for crushing and suspending tablets. The outcome measure was the frequency of medication administration errors, comparing the pre-intervention period with the post-intervention period. RESULTS A total of 245 medication administrations in six clients (by 23 nurse attendants) have been observed in the pre-intervention measurement period and 229 medication administrations in five clients (by 20 nurse attendants) have been observed in the post-intervention period. Before the intervention, 158 (64.5%) medication administration errors were observed, and after the intervention, this decreased to 69 (30.1%). Of all potential confounders and effect modifiers, only 'medication dispensed in automated dispensing system ("robot") packaging' contributed to the multivariate model; effect modification was shown for this determinant. Multilevel analysis using this multivariate model resulted in an odds ratio of 0.33 (95% confidence interval 0.13-0.71) for the error percentage in the post-intervention period compared with the pre-intervention period. CONCLUSIONS The intervention was found to be effective in an institution for clients with an ID. However, additional efforts are needed to reduce the proportion of administration errors which is still high after the intervention.
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Affiliation(s)
- J C Idzinga
- Hogeschool Utrecht, Institute for Applied Pharmaceutical Sciences, Utrecht, The Netherlands
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Heydrich J, Heineck I, Bueno D. Observation of preparation and administration of drugs by nursing assistants in patients with enteral feeding tube. BRAZ J PHARM SCI 2009. [DOI: 10.1590/s1984-82502009000100014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study aimed to know the standard of preparation and administration of medicines to patients using probes of enteral nutrition (SNE) hospitalized in a university hospital in Porto Alegre. Were accompanied sixty nursing auxiliaries, in two units of hospital, in their routine work and observed their techniques. The practice was compared with procedures that are part of the rules for administration of medicines to patients on enteral therapy. The auxiliary held a grinding in 90% of cases of solid pharmaceutical preparation. For this procedure they used preferably the mortar and pistil (63.3%). The dilution of the drugs was made mainly with tap water (78.3%). Most professionals (91.1%) prepare and administer together all medications that were prescribed to the patient. Only four assistants performed the procedure separately. The washing of the SNE after administration of drugs was made for 75% of assistants. It was observed a great diversity of working methods used at the derivation, dilution and administration of medicines by nursing auxiliaries.
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Williams NT. Medication administration through enteral feeding tubes. Am J Health Syst Pharm 2008; 65:2347-57. [DOI: 10.2146/ajhp080155] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Nancy Toedter Williams
- Pharmacy Practice, College of Pharmacy, Southwestern Oklahoma State University, c/o Norman Regional Health System, Pharmacy Services, 901 North Porter, Box 1308, Norman, OK 73070
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Phillips NM, Nay R. A systematic review of nursing administration of medication via enteral tubes in adults. J Clin Nurs 2008; 17:2257-65. [PMID: 18705702 DOI: 10.1111/j.1365-2702.2008.02407.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
AIM This systematic review aimed to determine the best available evidence regarding the effectiveness of nursing interventions in minimising the complications associated with administering medication via enteral tubes in adults. BACKGROUND Giving enteral medication is a fairly common nursing intervention entailing several skills: verifying tube position, preparing medication, flushing the tube and assessing for potential complications. If not carried out effectively harmful consequences may result leading to increased morbidity and even mortality. Until now, what was considered to be best practice in this area was unknown. DESIGN Systematic review. METHODS CINAHL, MEDLINE, The Cochrane Library, Current Contents/All Editions, EMBASE, Australasian Medical Index and PsychINFO databases were searched up to September 2005. Reference lists of included studies were appraised. Two reviewers independently assessed study eligibility for inclusion. There were no comparable randomised-controlled trials; data were presented in a narrative summary. RESULTS Identified evidence included using 30 ml of water for irrigation when giving medication or flushing small-diameter nasoenteral tubes may reduce tube occlusion. Using liquid medication should be considered as there may be less tube occlusions than with solid forms in nasoenteral tubes and silicone percutaneous endoscopic gastrostomy tubes. In addition, nurses may need to consider the sorbitol content of some liquid medications, for example elixirs, as diarrhoea has been attributed to the sorbitol content of the elixir, not the drug itself. CONCLUSION The evidence was limited. There was a lack of high-quality research on many important issues relating to giving enteral medication. RELEVANCE TO CLINICAL PRACTICE Nurses have the primary responsibility for giving medication through enteral tubes and need knowledge of the best available evidence. Some of the nursing considerations and interventions relating to this skill have been researched in the clinical area and have implications for practice. There is a need for further studies to strengthen these findings.
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Affiliation(s)
- Nicole M Phillips
- Division of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia.
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Kelly J, D'Cruz G, Wright D. A qualitative study of the problems surrounding medicine administration to patients with dysphagia. Dysphagia 2008; 24:49-56. [PMID: 18688675 DOI: 10.1007/s00455-008-9170-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2007] [Accepted: 05/01/2008] [Indexed: 10/21/2022]
Abstract
Swallowing dysfunction in the elderly is common and affects not only nutrition but also the ingestion of medicines. This qualitative study used a focus group to collect data from ten healthcare professionals who are involved in the care of people with swallowing difficulties. The group discussed their experiences of the problems associated with and solutions to the administration of medicines to patients with dysphagia. The focus group was audiotaped, and the data analysed using Colaizzi's technique. Six themes were identified, three main ones: (1) the wide spectrum of dysphagia; (2) medicine formulation, which affects how drugs can be administered; (3) problems with data flow, i.e., the correct information being with the right person at the right time and in the right place; and three minor ones which arose from the major themes: (4) the primary function of swallowing is nutrition rather than taking medication; (5) cost of medicines; and (6) therapeutic dilemmas. The study concludes that improvements in interprofessional communication are needed to improve medicine administration to dysphagic patients.
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Matsuba CS, De Gutiérrez MG, Whitaker IY. Development and evaluation of standardized protocol to prevent nasoenteral tube obstruction in cardiac patients requiring enteral nutrition with restricted fluid volumes. J Clin Nurs 2007; 16:1872-7. [PMID: 17880476 DOI: 10.1111/j.1365-2702.2007.01793.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES This study sought to assess the impact of a standardized protocol to maintain nasoenteral tube (NET) patency in patients requiring fluid restriction and identify factors associated with tube patency. BACKGROUND Nasoenteral tube obstruction may interrupt nutritional support and prohibit drug administration. Balancing NET patency in the context of fluid restriction can be a challenge. DESIGN AND METHODS The impact of the standardized protocol was assessed by using a quasi-experimental design and an historical control. RESULTS Sixty patients receiving nasoenteral feeding as part of their clinical management were enrolled in the study. Nasoenteral obstruction was 8.3%, showing a reduction from the 17.4% observed in the baseline data collection. A key factor associated with tube obstruction was sounding of an infusion pump alarm reflecting the tube patency issues. CONCLUSIONS While mindful of the limitations of probability sampling, the implementation of a standardized protocol accompanied by staff training reduced the rates of NET obstruction. RELEVANCE TO CLINICAL PRACTICE On the basis of these findings, we conclude that it is possible to maintain the patency of small bore tubes, even in the presence of fluid restriction, with a standardized protocol to guide clinical management.
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Affiliation(s)
- Claudia St Matsuba
- Intensive Care Unit, Federal University of São Paulo, Hospital do Coração/Associação do Sanatório Sírio, São Paulo, Brazil.
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Ech-chaouy A, Giesenfeld A, Ziegler O, Quilliot D. Médicaments et nutrition entérale: audit sur la galénique, le pilage et le mode d'administration. NUTR CLIN METAB 2007. [DOI: 10.1016/j.nupar.2007.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Phillips NM, Nay R. Nursing administration of medication via enteral tubes in adults: a systematic review. JBI LIBRARY OF SYSTEMATIC REVIEWS 2007; 5:344-406. [PMID: 27820220 DOI: 10.11124/01938924-200705060-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Enteral tubes are frequently inserted as part of medical treatment in a wide range of patient situations. Patients with an enteral tube are cared for by nurses in a variety of settings, including general and specialised acute care areas, aged care facilities and at home. Regardless of the setting, nurses have the primary responsibility for administering medication through enteral tubes. Medication administration via an enteral tube is a reasonably common nursing intervention that entails a number of skills, including preparing the medication, verifying the tube position, flushing the tube and assessing for potential complications. If medications are not given effectively through an enteral tube, harmful consequences may result leading to increased morbidity, for example, tube occlusion, diarrhoea and aspiration pneumonia. There are resultant costs for the health-care system related to possible increased length of stay and increased use of equipment. Presently what is considered to be best practice to give medications through enteral tubes is unknown. OBJECTIVES The objective of this systematic review was to determine the best available evidence on which nursing interventions are effective in minimising the complications associated with the administration of medications via enteral tubes in adults. Nursing interventions and considerations related to medication administration included form of medication, verifying tube placement before administration, methods used to give medication, methods used to flush tubes, maintenance of tube patency and specific practices to prevent possible complications related to the administration of enteral medications. SEARCH STRATEGY The following databases were searched for literature reported in English only: CINAHL, MEDLINE, The Cochrane Library, Current Contents/All Editions, EMBASE, Australasian Medical Index and PsychINFO. There was no date restriction applied. In addition, the reference lists of all included studies were scrutinised for other potentially relevant studies. SELECTION CRITERIA Systematic reviews of randomised controlled trials (RCTs) and RCTs that compared the effectiveness of nursing interventions and considerations used in the administration of medications via enteral tubes. Other research methods, such as non-randomised controlled trials, longitudinal studies, cohort and case control studies, were also included. Exclusion criteria included studies investigating drug-nutrient interactions or the bioavailability of specific medications. DATA COLLECTION AND ANALYSIS Initial consideration of potential relevance to the review was carried out by the primary author (NP). Two reviewers independently assessed study eligibility for inclusion. A meta-analysis could not be undertaken, as there were no comparable RCTs identified. All data were presented in a narrative summary. RESULTS There is very limited evidence regarding the effectiveness of nursing interventions in minimising the complications associated with enteral tube medication administration in adults. The review highlights a lack of high quality research on many important nursing issues relating to enteral medication administration. There is huge scope for further research. Some of the evidence that was identified included that nurses should consider the use of liquid form medications as there may be fewer tube occlusions than with solid forms in nasoenteral tubes and silicone percutaneous endoscopic gastronomy tubes. Nurses may need to consider the sorbitol content of some liquid medications, for example, elixirs, as diarrhoea has been attributed to the sorbitol content of the elixir, not the drug itself. In addition, the use of 30 mL of water for irrigation when administering medications or flushing small-diameter nasoenteral tubes may reduce the number of tube occlusions.
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Affiliation(s)
- Nicole M Phillips
- 1 Division of Nursing and Midwifery and 2 Gerontic Nursing Clinical School, Australian Centre for Evidence Based Aged Care, La Trobe University, Bundoora, Victonia, Australia
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Marshall AP, West SH. Enteral feeding in the critically ill: are nursing practices contributing to hypocaloric feeding? Intensive Crit Care Nurs 2005; 22:95-105. [PMID: 16289652 DOI: 10.1016/j.iccn.2005.09.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Revised: 08/31/2005] [Accepted: 09/05/2005] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Enteral feeding is the preferred method of nutritional support for the critically ill; however, a significant number of these patients are under-fed. It is possible that common nursing practices associated with the delivery of enteral feeding may contribute to under-feeding although there is little data available describing nursing practice in this area. METHOD A descriptive survey-based design was used to explore the enteral feeding practices of 376 critical care nurses (response rate 50.5%). Participants completed a 57-item survey that focused on general enteral feeding practice and the management of feeding intolerance and complications. RESULTS The enteral feeding practice of critical care nurses varied widely and included some practices that could contribute to under-feeding in the critically ill. Practices associated with the measurement of gastric residual volumes (GRV) were identified as the most significant potential contributor to under-feeding. GRV measurements were commonly used to assess feeding tolerance (n = 338; 89.9%) and identified as a reason to delay feeding (n = 246; 65.4%). Delayed gastric emptying was frequently managed by prokinetic agents (n = 237; 63%) and decreasing the rate of feeding (n = 247; 65.7%) while nursing measures, such as changing patient position (n = 81; 21.5%) or checking tube placement (n = 94; 25%) were less frequently reported. CONCLUSION The findings of this survey support the contention that nursing practices associated with the delivery of enteral feeds may contribute to under-feeding in the critically ill patient population.
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Affiliation(s)
- Andrea P Marshall
- Critical Care Nursing Professorial Unit, The University of Technology, Sydney, Level 6 Royal North Shore Hospital, St Leonards, NSW 2065, Australia.
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Abstract
Because the current drive towards evidence-based critical care nursing practice is based firmly within the positivist paradigm, experimentally derived research tends to be regarded as 'high level' evidence, whereas other forms of evidence, for example qualitative research or personal knowing, carry less weight. This poses something of a problem for nursing, as the type of knowledge nurses use most in their practice is often at the so-called 'soft' end of science. Thus, the 'Catch 22' situation is that the evidence base for nursing practice is considered to be weak. Furthermore, it is argued in this paper that there are several forms of nursing knowledge, which critical care nurses employ, that are difficult to articulate. The way forward requires a pragmatic approach to evidence, in which all forms of knowledge are considered equal in abstract but are assigned value according to the context of a particular situation. It is proposed that this can be achieved by adopting an approach to nursing in which practice development is the driving force for change.
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Affiliation(s)
- Paul Fulbrook
- Institute of Health & Community Studies, Bournemouth University, Royal London House, Bournemouth.
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42
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Abstract
In patients hospitalized in intensive care units (ICUs) nasogastric tubes are used for enteral feeding and solid pharmaceutical preparations are commonly administered. These drugs must be crushed before administration, which may alter their pharmacokinetic properties and consequently their therapeutic effects and adverse reactions, etc. The aim of this study was to review the orally-administered drugs used in our unit that should not be crushed, to propose alternative measures and to make recommendations for their correct administration. Their descriptive study was performed in the ICU of a University Hospital with 12 general-purpose beds. We reviewed all the oral medication currently administered in our unit and its form of administration through the nasogastric tube. Oral pharmaceutical preparations that should not be crushed were identified through a review of articles in MEDLINE published between 1991 and 2000 and through consultations with various pharmacy departments. Alternatives to these drugs were sought. Of the 115 drugs used in our unit, 50 could not be crushed. The pharmaceutical preparation of this group of drugs should not be modified because crushing would alter their characteristics, pharmacokinetic properties, etc. We present alternatives and make recommendations for their correct administration. In conclusion, a practical guide for the administration of drugs through nasogastric tubes is required. In our unit, such a guide would increase the efficacy and safety of the pharmacological treatment administered in this way. Collaboration with the pharmacy department is also advisable.
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Affiliation(s)
- E Catalán
- Diplomada en enfermería. Master en Ciencias de Enfermería. Universidad de Puerto Rico
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Goñi Viguria R, Sánchez Sanz L, Asiain Erro M, Baztán Indave A. [Drug administration through enteral feeding catheters]. ENFERMERIA INTENSIVA 2001; 12:66-79. [PMID: 11459545 DOI: 10.1016/s1130-2399(01)78019-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Because of easiness and accessibility, the oral route of administration is usually the route of choice for medication delivery, as long as the oral drug form is available and the patients' circumstances allow it.In patients admitted to the intensive care unit this route is frequently altered. This provokes difficulties in swallowing and consequently an enteral feeding catheter must be inserted to supply the patient's nutritional requirements. This catheter is also used for the drug administration, which necessitates opening capsules or crushing pills before dilution. When added to drug-nutrient interactions, this process alters the drug's properties and modifies its pharmacokinetic profile, its pharmacological effect and the intensity of side effects. It can also provoke catheter obstruction. The aim of this study was to establish guidelines for drug administration through enteral feeding catheters. We provide a thorough review of the literature, describe oral drug forms, present a protocol for correct drug administration and provide a guide to the most commonly used drugs in our unit. For each of these drugs we include recommendations on administration and possible alternatives.
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Affiliation(s)
- R Goñi Viguria
- Diplomadas en Enfermería, Unidad de Cuidados Intensivos, Clínica Universitaria, Universidad de Navarra, Spain
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Thomson P, Angus NJ, Scott J. Building a framework for getting evidence into critical care education and practice. Intensive Crit Care Nurs 2000; 16:164-74. [PMID: 10859625 DOI: 10.1054/iccn.2000.1483] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
One challenge for nurse educators is how best to enhance the integration of theory and practice elements in relation to critical care nursing. Practice should be evidence-based, i.e. the best available empirical evidence, including recent research findings, should be applied in practice in order to aid clinical decision-making. Barriers to the implementation of research exist at many levels including the individual practitioner, the clinical team, the practice setting and wider organizational factors. The authors propose that clinical guidelines can provide a vital link between theory and practice. At varying levels the use of care protocols, clinical pathways and algorithmic guidelines (provided they are rigorously reviewed and evidence-based) can help infuse research into practice, thereby promoting quality and standardization of care. The purpose of this paper is to discuss the value and use of these frameworks in promoting and raising awareness of the need for and use of evidence-based approaches to critical care education and practice. In this paper, we present outline information relating to an assessment method, adopted for continuing education courses in critical care within our department. This approach is designed to combine the best available evidence with reflective practice through the assessment process.
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Affiliation(s)
- P Thomson
- Department of Nursing & Midwifery, University of Stirling, UK
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45
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Taylor-Piliae RE. Establishing evidence-based practice: issues and implications in critical care nursing. Intensive Crit Care Nurs 1998; 14:30-7. [PMID: 9652259 DOI: 10.1016/s0964-3397(98)80085-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Evidence-based practice is the application of the best available empirical evidence, including recent research findings to clinical practice in order to aid clinical decision-making. The implementation of these findings is vital for optimizing patient outcomes, improving clinical practice, providing cost-effective high quality care and enhancing the credibility of nurses. The use of research findings to improve practice has been discussed and promoted for the last 20 years. The author argues that Rogers' theoretical model of the Diffusion of Innovations may prove useful in understanding the problem of the slow diffusion of the application of research evidence in clinical nursing practice. Many authors have discussed potential barriers to using research in clinical practice in order to facilitate utilization of findings. However, recent studies all document that a gap between research findings and their implementation in clinical practice still exists. This appears to hold true across a variety of practice settings, including nurses working in critical care. The diffusion of innovations in current critical care nursing practice at each stage of Rogers' theory will be examined, with recommendations given to facilitate the establishment of evidence-based practice (EBP).
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