Hospitals fall short on enteral nutrition safety: ISMP

The prevalence of incorrect and expired enteral nutrition feedings is likely underreported in hospitals, according to the Institute for Safe Medication Practices. 

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Multiple health organizations recommend clinicians scan enteral nutrition barcodes, but this routine process “varies widely among organizations” and “is often taken for granted” in hospitals, the ISMP said in an Aug. 8 article. 

Preterm and critically ill patients typically need adjusted enteral nutrition products, and hospitals often add fortifiers or modulate the formulas with powders and concentrates. At any step in this process, mistakes can happen. Plus, “administering an incorrect formula or fortifier could cause significant metabolic or electrolyte disturbances, allergic reactions or gastrointestinal intolerance,” the ISMP said.

Safety risks, such as the bacterial contamination-prompted 2022 infant formula shortage, also exacerbate the problem. 

Barcode scanning can alert clinicians about incorrect, expired, and recalled enteral nutrition products, and past research has strengthened the case for this safety measure. Over seven years, scanning prevented the use of the wrong human milk 1,226 times and the use of expired human milk 2,103 times, according to a study published in 2021. 

Read the ISMP’s article here.

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