BAPEN Meeting/Delivering Excellence in Clinical Nutrition Dec 4 2012: New data presented today shows a serious shortfall in policies to ensure the provision of adequate fluids for vulnerable patients, particularly those on enteral tube feeding. The data from a BAPEN / PENG online survey, amongst 429 healthcare professionals, reveals an alarmingly low availability of hydration guidelines. Only 31% of the respondents’ Trusts had general hydration guidelines, whilst for patients on enteral tube feeding only 20% reported to have specific hydration guidelines.
“The provision of adequate fluid (and nutrition) is considered a core fundamental element of patient care, yet these results demonstrate improvements in hydration policies are required”, says Ailsa Brotherton, Honorary Secretary to BAPEN, who goes on to say, “The new data suggests a need for cross-disciplinary education and empowerment to encourage consideration of the enteral route as part of normal hydration practice where there is an over reliance on IV fluids.”
The findings suggest a lack of confidence or reluctance to share knowledge around the daily amount of fluid that should be given to patients receiving enteral tube feeding as only 32% of respondents actually answered this question. Interestingly, of those who answered, the majority stated the amount of fluid to be 30-35ml/kg per day, as outlined by PENG and other guidelines*.
Healthcare professionals should be aware of the dangers of dehydration yet these new findings question this as they show the provision of adequate fluid does not always translate into routine clinical practice. Dehydration has an enormous impact on avoidable harms, for example, pressure ulcers, falls and urinary tract infections in patients with catheters and mortality, therefore attention to improving the provision of fluid by the most acceptable method and looking for signs of dehydration are urgently required.
The findings go on to show that when water is administered through the enteral tube, by far the most common method of administration was via a manual flush (67%) which is usually pre or post medication, whilst the administering of water via an enteral feeding pump was much lower with only 16% of respondents stating that they used this method.
“I was surprised by the low response to the question asking about the quantity of fluids for patients dependent on enteral feeding, and also to see that in the acute setting virtually all (99%) respondents said they relied on the IV route to give their patients with enteral tubes additional fluids. This suggests that the enteral feeding tube is not seen as a route to provide hydration even when it is in place for feeding. PENG are keen to explore this finding further and identify the barriers that prevent health professionals using the enteral feeding tube for hydration.” says Anne Holdoway, Chair of PENG.
NB: It is worth noting that the respondents, as well as being members of BAPEN and PENG, were an experienced group of health practitioners, with over half (57%) being qualified for ten years or longer and nearly half (41%) were members of their local nutrition team.
*For more information about the PENG Pocket Guide to Clinical Nutrition 4th Edition 2011 visit www.peng.org.uk
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