A practitioner, using a tablet computer, assists a patient with tube feeding therapy.

Home care dietitians improve tube feeding patient outcomes

Coram’s research highlights the critical role home care dietitians play in decreasing tube feeding intolerance and improving nutrition outcomes

Home-based health care continues to gain traction as an option for people living with a variety of chronic conditions. In fact, home infusion care can be a safe and cost-effective treatment alternative when compared to the same care provided in an in-patient or hospital setting. Coram CVS Specialty Infusion Services (Coram) is leading the way in home infusion care and parenteral (intravenous) and enteral (tube feeding) nutrition with a team of skilled home care Registered Dietitians, who can address nutrition intolerance, assess adequacy of hydration in feeding regimens, and address associated patient questions.

To advance the knowledge of health care practitioners and improve care for patients, Coram is actively involved in home nutrition care research. This research includes evaluating the impact of transitioning nutrition care from the hospital to the home and the benefits of home-based parenteral and enteral nutrition in certain populations.

Coram dietitians Nicki Bray, MS, RD, LDN; Sarah Allen MS, RD, LDN; and Caitlin Wendecker, RD, CNSC, recently conducted research to evaluate the efficacy of home care dietitian recommendations in addressing reported enteral nutrition intolerances, and the critical role home care dietitians play in creating interventions to improve nutrition outcomes. They shared their findings in their abstract, Home Care Dietitian Intervention Effectiveness to Reported Intolerance.

When patients are sent home from the hospital with little additional support and potentially poor tolerance to tube feedings, their outlook and compliance with their home tube feeding regimen may be impacted. Identifying and effectively addressing intolerance will increase a patient’s compliance and improve nutrition outcomes.

Coram conducted a retrospective review of adult patient records that reported intolerance within 48 hours of start of care. This retrospective review supported the important role of home care dietitians in evaluating and managing tube feeding intolerance, with dietitian interventions effective for 72% of patients by day 30 and 91% of patients by day 60. Without appropriate intervention by a dietitian, patients may be at risk for poor nutrition outcomes such as gastrointestinal distress, malnutrition, weight loss or underfeeding.

Home enteral nutrition patients are also at increased risk for dehydration due to inadequate fluid administration, and Coram dietitians explored this in an additional abstract, Adequacy of Flushing Orders in Home Enteral Nutrition Patients, by Katrina Sesler, MS, RD, CNSC; Rebecca Caldwell, MS, RD, LDN; and Laura Kashtan, RD, which reviewed patients’ water flushing orders at discharge from facility to home care. From a retrospective chart review of adult patients, Coram dietitians noted that discharge flush orders are missing or are inadequate for a considerable number of home enteral nutrition patients. Individualized recommendations and early patient contact by a dietitian may be important to prevent dehydration in these patients.

Early intervention by home care dietitians can help patients address tube feeding intolerance, assess hydration levels, improve therapy compliance and address patient questions and concerns. This support can help improve patient outcomes, potentially preventing hospital readmission at a time when hospital resources are stretched due to the increasing rate of COVID-19 admissions. Measures to help patients remain home and avoid hospital readmission are always valuable, but today they are critical.

04.23.20