Enteral Nutrition Delivery Is Overestimated in Provider Documentation

Burn-injured patients have the highest metabolic demand of all critically ill patients and are vulnerable to complications of malnutrition. Many burn centers have challenges in achieving prescribed rates of nutrition, despite aggressive algorithms. One possible reason for the discrepancy is inaccurate documentation of volumes. This is a retrospective review of patients requiring tube feeding admitted to a regional burn center between June and August 2015. Demographics were abstracted including gender, type of injury, TBSA, and age. The total feeding volume was recorded from the feeding pump every 24 hours. The values were compared with the enteral nutrition volume charted by the nursing staff and rate prescribed by the physician team. Repeated measures analysis of variance was used to compare continuous variables. Twenty-five patients were observed during the study period providing a total of 105 patient days. The average age was 44 years with 42% TBSA mean burn size. The average volume prescribed by providers was 1,598 ml/d. According to documentation, the average volume given was 1,448 ml/d, a significant difference (P = <.001). The average volume delivered as recorded on the feeding pump was less at 1,287 ml/d. The nourishment provided was significantly less than documented and even more so when compared with the prescribed rate (P < .001 and P < .001, respectively). Overall, 19% of ordered enteral nutrition was not provided. There was a significant discrepancy between ordered, recorded, and delivered volume of enteral nutrition. Potential reasons for the discrepancy may be frequent interruption for repositioning, wound care, linen changes, or other nursing workflow. Burn providers should be aware of the potential for underfeeding patients.