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Improving the percentage of inpatients receiving Enteral Nutrition Product (ENP) within 24 hours of dietitians’ prescription in Serdang Hospital
Irne Jumat1, Siah, Pek Jia2, Nurliyana Naharudin3, Siti Zafirah Md Redza4, Halimatun Saadiah Sohami5, Normawati Ab Wahab6, Fatimah Salleh7, Roslinda M Safri8.
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
Affiliation:
- Serdang Hospital, Selangor State Health Department, Ministry of Health Malaysia, Malaysia
- Serdang Hospital, Selangor State Health Department, Ministry of Health Malaysia, Malaysia
- Universiti Putra Malaysia, Serdang, Malaysia
- Serdang Hospital, Selangor State Health Department, Ministry of Health Malaysia, Malaysia
- Serdang Hospital, Selangor State Health Department, Ministry of Health Malaysia, Malaysia
- Serdang Hospital, Selangor State Health Department, Ministry of Health Malaysia, Malaysia
- Serdang Hospital, Selangor State Health Department, Ministry of Health Malaysia, Malaysia
- Serdang Hospital, Selangor State Health Department, Ministry of Health Malaysia, Malaysia
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