A service evaluation to assess the dietary management of hospitalised patients with diabetes receiving enteral nutrition
Published Date: 13th April 2021
Publication Authors: Gallagher CG, Langan E, Blakeman S, Love J
Background
Hospitalised patients with diabetes receiving enteral nutrition (EN), require a management plan from an established multidisciplinary team, including dietitians and diabetes specialist nurses(1). Optimizing glucose control in these patients is associated with better outcomes(2). However, EN may increase the risk of complications such as hyper/hypoglycaemia events(2). There is limited local and national evidence to guide dietetic practice in the area of EN in this patient group; therefore, the aim is to review dietetic practice for patients with diabetes also receiving EN in secondary care. The following variables were investigated: enteral feeding regime, diabetes specialist nurse (DSN) input, diabetes treatments and EN rationale; to inform dietetic practice.
Methods
A retrospective service evaluation was carried out on the wards and patients were identified via the Trust’s scanning and documentation system. The inclusion criteria for patients included; all types of established diabetes (Type 1, 2 and 3c diabetes), seen by a dietitian within 12 months, enterally fed (bolus or continuous). The exclusion criteria included patients prediabetes or patients on oral nutritional supplements. A total of 13 subjects met the criteria and the following variables were analysed; enteral feeding regime (including rate, time, volume and pump vs bolus), DSN, diabetes treatment and rationale for EN. The project was approved by the Trust’s Quality Improvement and Clinical Audit (QICA) team. Ethics was considered, however was deemed unnecessary for this service evaluation.
Results
Different results were found across all the variables analysed. Results showed that each of the participants received different feeding plans from the dietitian. Some patient’s diabetes medication was altered during hospital stay. For example, changes in dietary controlled treatments during hospital admission (39% and 16% patients before and during hospital admission respectively) and more insulin therapies during admission (0% and 15% patients before and during hospital admission respectively). In addition, there were a variety of rationales for commencing patients on EN; ‘Nill by mouth’ (46.2%), ‘swallowing difficulties’ (23.1%), ‘inadequate oral intake’ (15.4%), ‘poor wound healing’ (7.7%) and ‘ICU stepdown’ (7.7%). The majority of patients (77%) received EN via a pump and (23%) were bolus fed. It was also identified that 38% of the sample did not have input from a DSN during their admission.
Discussion
The above results indicate that ward dietitians are currently using a variety of feeding regimes for this patient group. This may create complications for the DSNs, as they will need to prescribe a variety of insulin regimes for different patients. Subsequently, inconsistencies and potential miscommunication in prescribing insulin regimes could lead to hypoglycaemic or hyperglycaemic events. This suggests that there is a need for the dietetic service to be more consistent when implementing care plans for patients with diabetes receiving EN. To encourage consistent EN feeding regimes, the team created a ‘Diabetes and Enteral Feeding Flow Chart’ for dietetic team to use on the wards.
Conclusion
There are inconsistencies in the types of EN feeding regimes used for patients with diabetes in the Trust. This indicates a need to educate the dietetic team and to encourage consistent feeding plans on the wards. We will assess the use of ‘Diabetes and Enteral Feeding Flow Chart’ to see if it has improved dietetic practice in this patient group.
Gallagher, C; Langan, E; Blakeman, S; Love, J. (2021). A service evaluation to assess the dietary management of hospitalised patients with diabetes receiving enteral nutrition. Journal of Human Nutrition and Dietetics. 34 (S1), 62-63