Documentation of Tube Feeds

[icuedu]

Howdy all....I am looking for some advice/info....

A few years back our facility was "dinged" by CMS for not accurately recording our enteral nutrition. (What nurses were doing is setting their TF pumps at say 65cc/hr and then documenting 65cc/hr across the 24 hr flowsheet) For a while, nurses were zeroing their pumps and recording the ACTUAL amount infused over the previous hour, NOT what the pump was set at.

Over the past few years since the CMS visit, some units have become more lax than others with regard to zeroing out their pumps every hour....We have gotten to a point where nurses from units that are zeroing every hour are being "yelled at" by nurses/physicians in other units when they have to float.

My question is this.....

What do most of you out there do in the ICU setting? Accurately record hourly tube feeding intakes? Or just document what the pump is set at?

Any help is greatly appreciated...

[AtlantaRN, RN]

document what the hourly rate is set at, also another documentation for flushes and meds in liquid form, etc.

linda

[hrtprncss]

What we do is record let's say 65 on the I/O per hour on the intake part, and we don't reset the TF to zero every hour. We do it at the end of the shift just like the IV's. Even though we record IV's q 1 hour. I mean if you have six to ten IV pumps, it makes it harder to reset it every hour. And your flowsheet would look kind of out of whack, with different numbers....If someone looks at your flowsheet it might look like you have different orders for IV and TF qhr if you record different numbers.

[icuedu]

So documenting that the intake is 65 (just because that is what the pump) per hour is as accurate as zeroing the pump frequently? I'm sorry, I'm not trying to be sarcastic or anything....But what if the TF is stopped for a short time, maybe going to CT or getting the pt OOB or bathing, etc, do you still record 65 cc?

And just as a side....This is assuming that you DONT have 6-10 patients....I posted in the Critical Care/Med Surg ICU forum (1, 2, 3 at the most patients)

[hrtprncss]

Oh no, didn't take it as a sarcastic remark whatsoever. When a person goes to MRI/CT, we put a comment of pt is ''off the unit''...I mean how many times do we usually go to CT...And I'm an ICU nurse. Let's even say the pt is a neuro patient, maybe twice, or if ur unlucky three times in a shift. Let's say that I need to give meds with flushes, then there's another box where you put in your flushes. But if you do go to CT let's say max of 15 minutes, MRI bout an hour including taking down everything and setting all back up again, then yes of course you'd make an adjustment. I mean it would be nice to zero everything every hour I agree, but you'd almost have to do it on the dot, or else the numbers would be different. Although at the end of the shift it really won't make a difference anyways because the total net should be the same. I guess what I'm saying is that it just makes it easier for the nurse, especially if you're handling multiple pumps, it would be difficult to zero everything every hour. I mean if you do zero it every hour, I applaud you for being meticulous, but at the same time I kinda understand why someone who would look at your flowsheet be a little confused with numbers that fluctuates(let's say that you don't get to zero it at the exact minute like you're supposed to). I guess your unit would just have to create a policy where every nurse would have to zero every hour and record whatever cc it is that you see. :)