Registered Dietitians and Nurses Integrate for Better Patient Outcomes when Enteral Nutrition Is Indicated

Significance/background: Oncology patients are at risk for malnutrition due to their diagnosis and treatment-related toxicities, which may prevent adequate calorie-protein intake for weight maintenance and require enteral nutrition (EN) support. Our NCI-designated cancer center uses a multidisciplinary, patient-centered team approach to provide oncology care for blood and marrow transplant (BMT) and general oncology (GO) patients, which is primarily delivered in the outpatient setting. Proactive medical nutrition therapy management and support is essential to keep patients successfully on treatment and prevent complications related to malnutrition.

With specialized training and privileges, registered dietitians (RDs) may place nasoenteric feeding tubes. A working group formed to create institutional practice to integrate RDs placing feeding tubes. Developing formalized institutional practice keeps staff trained and competent to place nasoenteric feeding tubes and minimizes barriers to timely referral and care coordination.

Purpose: To create a standardized workflow, which ensures RDs work to the top of their license to provide evidence-based nutrition support to oncology patients at risk for malnutrition and requiring nasoenteric feeding tube placement for EN support.

Intervention: After a historical chart review, our interdisciplinary team determined feeding tube placement incidence by disease group. The working group consensus was that the clinic-wide discipline responsible for feeding tube placement will be the RDs. Institutional policies, scope of service, and competency and training guidelines were created based on national recommendations. Education was instituted and implementation was jointly led by Nutrition (certified nutrition support clinician and RD manager) and nursing shared governance teams (clinical practice council and professional development council).

Discussion: Use of feeding tubes as a necessary component of oncology care is infrequent, yet essential for specific patients. The best practice model for delivery of services requires cross-professional analysis and delineation of roles/responsibilities. Nutrition support is foundational to the success of oncologic interventions and multidisciplinary teams are mandatory for the realization of efficacious implementation of clinical services. Routine referral to nutrition, orders for nasoenteric feeding tube placement, formula delivery, and follow-up will facilitate best patient care with each member of the multidisciplinary team functioning to the full of scope of licensure and practice.

Innovation/learning outcome: Staff practicing to the full scope of licensure resulted in RDs assuming responsibility for nasoenteric feeding tube placement with consistency in competency and confidence for best oncology patient outcomes.