Feasibility of Implementing Automatic Dual feed-flush Pump Set

Nicholas P. Patanus, Dietetic Intern Kathryn Chiles RD, LD, CNSC

Aramark Distance Learning Dietetic Internship
INTRODUCTION
The proper devices used to administer enteral
nutrition and flushes cycles is essential for the
patient to receive the correct amount and rate of
formula that is prescribed by the dietitian. Nurses
should be familiar with the importance of enteral
nutrition support recommendations established by
the American Society of Parenteral and Enteral
Nutrition (A.S.P.E.N.) or policies their hospitals have
adopted. A study concluded that up to 57% of
nurses do not flush before administering
medications. The recommendations established by
A.S.P.E.N. states to adhere to protocols that call for
proper flushing of tubes before and after medication
administration.

Purpose of the Study

Determine the efficacy of implementing a dual
spike flush set for free water administration for
patients with enteral nutrition support at Baylor St.
Lukes Medical Center

Currently, the hospital system does not utilize

automatic enteral feeding pump sets in the neuro
ICUs and the neuro floor. There are many
advantages for the implementation of automatic
enteral feeding pumps, yet not all of the hospital is
utilizing the opportunity to offer patients and staff
with automatic free water administration.

Advantages to utilizing Dual Feed-Flush PumpSet

More accuracy with formula and fluid
administration.
Decreased risk in clogged feed lines
Higher predicted compliance with nursing staff
Reduce the reliance on nursing staying compliant
with flush policies.

METHODOLOGY
The design of the study will be intended to discover
the feasibility of implementing free water administration
via dual-spike flush set for enteral nutrition support. This
research targets the opinions and point of view of
particular subjects to determine if the introduction of a
newly designed policy can be successful. To capture the
opinions of the particular subjects, an evaluative research
design including a survey will have the best potential.

Pre-trial Survey
Identified barriers to tube feed flushes and free water administration
Lack of supplies
Avoid disturbing the pt

Difficulty remembering
Other
10%

Lack of time

12%

The results of the study show that there was an

overall increase in enteral support patients meeting
their fluid needs with the utilization of a dual-spike,
feed-flush pump set. Additionally, nursing staff of the
covered units preferred the automatic feed-flush sets,
as they were found to be convenient and resolved
some perceived barriers of free water administration.
limitations in the study
The inability to survey and provide the educations of
the in-service to all of the nurses covering the
studied areas.
Nurses continuing to use feed only pump sets during
the pilot and unaware of the study.
Nurses unaware of flush pump set location for use in
respective floor/unit.
No documentations of clogged feeding lines during
the dual feed flush pilot.
Lack of properly documenting policy required
medication flushes, tube patency flushes as well as
MD ordered flushes.

24%
30%

Survey Population
Nursing staff on 22nd tower floor and neuro ICU 7S4 and
7S5.
Excluded participants are all other health professionals
on these listed hospital areas.
A pre-trial survey will ask questions designed to
determine the subjectivity of the nursing staff on
automatic free water administration, test their knowledge
of hospital water flush policies, and assess their
compliance to current water flush policies.
The clinical nutrition manager will provide an inservice to the nursing staff so that nursing will have the
proper education to set-up a dual spike flush set. The trial
run for the implementation of the dual spike flush set will
run for three weeks starting at the end of January. During
this time the nurses will utilize the new enteral feeding
set-up on patients that are in need of enteral nutrition
support. At the conclusion of the trial period a second
survey will be given to the same nursing staff. This time,
the survey will seek to find the compliance of this new
enteral nutrition administration, determine how many
patients were seen utilizing the dual spike flush set,
expected compliance to the new enteral nutrition support
administration, and conclude with seeking any barriers
involved during the trial.

Post-trial Survey

Computer paper and ink

Printer
Feed-Flush Bag
There will be no need for funding, as this is a very
inexpensive study. If there is a serious interest in utilizing
the dual spike flush set, there will need to be a cost
evaluation to determine if this will be covered within the
hospital budget.
The data collected from the pre and post-trial
surveys will be reviewed and each response will be
analyzed for the frequency of each selected answer. This
will provide an average for responses that are not a
written evaluation. Once all of the data is collected and
analyzed, further interpretation of the results will
determine if the implementation of a dual feed- flush set
is feasible for the selected areas in the hospital.

Percent perceived level of compliance to free water administration/feed flush policy

Frequency of Responses

15
10

11

5
3

0
50 Percent

75 Percent

90 Percent

100 Percent

Comparison of Feed Only and Dual FeedFlush Pilot Study

PRE POST

44.8 % compliance with policy required flushes for patency (ALL)

39.0

56.3 % compliance with policy required flushes for patency (ICU)

30.0

34.2 % compliance with policy required flushes for patency (NON-ICU)

Description

10.5

21.2 % compliance with MD ordered water flushes (ALL)

13.3

15.4 % compliance with MD ordered water flushes (ICU)

0.0

25.0 % compliance with MD ordered water flushes (NON-ICU)

35.0

46.0 Average % of ordered flushes provided (ALL)

38

30.2 Average % of ordered flushes provided (ICU)

36

56.3 Average % of ordered flushes provided (NON-ICU)

Description

8.3

38.5 % compliance with medication flushes (ALL)

25.0

88.0 % compliance with medication flushes (ICU)

0.0
7

16.7 % compliance with medication flushes (NON-ICU)

4

PRE POST
49.4
2.9
13.3
61.6
7

Number of patients with recorded med flushes but no meds via tube

CONCLUSIONS
Results are indicative of visible improvements
in the amount of water each enterally fed patient
received according to their calculated water needs
per day
77% of nursing preferring to use the dual feed
flush pump set for policy required flushes
88% of nursing preferring the pump set for MD
ordered flushes
It can be concluded that the dual feed flush
pump set for enterally fed patients are not only
preferred by nursing, but evidence suggests that
patients are also receiving more water per day than
patients receiving water with manual water
administration.

Description

59.3 Average % of estimated water needs met

1.7

The post-pilot survey uncovered that only half of

the nurses admitted to honestly charting all water
flushes provided by the automatic pump set.
48% of whom cited difficulty of remembering to
chart the flushes
20% stating they were unsure of were to properly
chart flushes
12% saying they do not have enough time to chart
20% mentioning other perceived

Description

36.7

PRE POST

Materials

24%

PRE POST

Projected results obtained form the planned

survey will conclude that the nursing staff as well as
physicians will be compliant to implementing
automatic free water administration on patients that
will need enteral nutrition. If the projected results
are favored, there will be further evaluation by the
nutrition services department, including a cost
analysis to determine if the implementation is
financially feasible.

DISCUSSION

RESULTS

% of patients met of their estimated minimum water needs

25.0 % of patients that met >80% of their est. minimum water needs
30

% of patients that met <50% of their est. minimum water needs

Room for Improvement

A cost analysis would be important to determine if
the dual feed-flush is feasible financially for the
studied areas of the hospital.
An in-service for nursing about documenting all
flushes, feed given and medication administration
ahead of the study will certainly help ensure that
nursing will be more compliant to proper
documentation.
Nicholas Patanus
patsnus-nicholas@aramark.com