Development of a Clinical Pathway for Enteral Nutrition

Abstract

Clinical pathways illustrate, sequentially, the most efficient interventions for reaching desired outcomes for various disease states or treatment modalities. With the increasing demand for high-quality, costeffective nutrition care, the Enteral Nutrition Service developed a clinical pathway for enteral feedings. The purpose was to coordinate multidisciplinary efforts to ensure comprehensive, goal-oriented nutrition care. The pathway has two phases. Phase one focuses on initiating and optimizing inpatient enteral nutrition support. Phase two addresses the transition to oral diet and discharge planning. This pathway was designed to augment disease specific pathways already in place. In the model developed at William Beaumont Hospital, the Registered Dietitian is designated as the case manager to monitor compliance and record variances. Corresponding continuous quality improvement indicators include nutritional adequacy, complications, compliance to hospital policies, and trial of the proposed home regimen before discharge. The variances and outcomes are presented routinely to the Hospital Nutrition Committee for review and adaptation of the pathway. From both a legal and quality perspective, clinical pathways allow a proactive, multidisciplinary approach to designing the optimal treatment course.