Frustration!

You said they had a trial so the dietician and MD should know what that trial revealed.

Stand your ground because if something is amiss it will surely fall on you. I would not set my own trial unless I had orders from the MD to titrate until the agreed amount is over 14 hours. Then I would speak to my supervisor and let my supervisor know I will need to be going back into the home several times throughout the next 28 hours to determine this patient need for nutritional support from the titration.

Make sure you document well so the reimbursement can be made using time increments of 15 mins.

That doesn't make sense. The thickness of the formula does not prevent orders being written. What is more likely is that they are not sure how at what rate your patient will tolerate this thicker feeding. Sometimes feeding rates have to be changed depending on how patient's tolerate them, especially when their consistencies change. They should have given you an order with parameters.

That's what I have dealt with in the past with patients.

I don't really see the big deal. Everywhere I've ever worked, nurses adjust the rate of tube feeds all the time. If the patient needs 3 pouches of formula (I'm going to take a wild guess and say this is Nourish which is around 330 mL/pouch), divide the total amount (990 mL) by 14 hours, start at 71 mL/hr and titrate to how the patient tolerates it. I have plenty of patients whose nurses adjust their feeding rates up and down throughout the day depending on what's going on with them clinically and when I was a home infusion liaison, formula orders almost never included a rate because the MD wrote the prescription with 11 refills/for 1 year and they knew that was going to change constantly.