Tube Feedings and IV Fluid Administration Documentation for the EMR

[steph2311]

Hello,

Looking for all input from Nurses that are working with EMR's in their facilities. I am in the process of formatting a MAR for Tube Feedings and IV Fluid Administration. The Mar for Tube Feedings would contain the Physician Orders for the: Formula, MOA-Pump, Bolus, or Gravity, Rate of Flow, Dose Volume, and Route-Naso, Jej, or Gastro.

The Nurses would then need to use their Electronic Tablets to fill in what is applicable to each Order on the rest of the MAR:

Tube Placement Checked: YES/NO

Tube Patent: YES/NO

H2O Flush before Feeding ___ml

H2O Flush after Feeding ___ml

Tubing Changed YES/NO

Is there anything that needs to be added that a Nurse would have to do and document for this? I would also need a similar format related for IV Administration. Any help would be greatly appreciated! Thanks fellow Nurses!

[Inquisitive one]

Just a few things off the top of my head. You may want to add residual checked, amount of residual, MD orders to hold TF for whatever time presecribed if residual is greater than____ (whatever the order states), TF intake if it's not recorded somewhere else, HOB elevated. Some facilities pH test the residual to check correct placement. Hope this helps.

[steph2311]

This was a Tremendous help, thank you so much! I will be adding that info to the format. Any other essential things you can think of let me know...

I have not worked in a Hospital/Nursing Home setting in quite some time. So I am trying to visualize the Nursing Mar and Progress Note I would chart that would contain all essential information for Tube Feedings and IV Administration. Thanks again!

[Inquisitive one]

Your welcome. Sometimes free water is ordered in between feedings so you may want to include that. Also there is one medication, Tegretol or Dilantin I believe, which the TF needs to be held for a certain amt of time before administering. I'd have to look that one up.

[Inquisitive one]

My DPH survey manual is about 5 years old but there is a section under Medication Errors, F332 and F333 that talks about med errors with enteral formulas and enteral formulas with dilantin administration. You may want to check this out.

[TonyaM73, ASN, RN]

It is Dilantin that you need to hold the tube feeding for 1 hr before and 1 hr afterwards. I was just reading this yesterday. Good luck! Those written MARS are a bugger.

[ChristineN, BSN, RN]

You might want to inlude a spot for checking the last time the tube feed bag was changed. It can very greatly by facilty, but I've worked places where it needs to be changed anywhere from every 4 hours to every 24 hours.

[GRAB1]

Vital 1.5 started at 8P -- infusing via pump at 65 mL/hr. X 13 hrs. (845 mL total feed to be received). H2O flushes provided at 72 mL/hr. X 13 hrs. (936 mL to be instilled via pump). All meds received via peg tube without difficulty. Peg tube patent and flushing without resistance. No residual prior to start of feeding. Peg placement verified by auscultation. + BS all 4 quadrants. HOB kept elevated. New gauze dressing placed to peg tube site.