Introduction

Resident Selection

Residents included

All current residents with an active physician order for an Enteral Feed (found in the “Orders“ tab on PCC’s front end).

An Enteral Feed order is an order whose Order Category is “Enteral - Feed”

Business Rules

Questions

1. Tube Feed Diagnosis -  Diagnosis supporting the use of an Enteral Feeding Tube is present in the EMR. (Q901)

   1. Location in PCC:

      1. Diagnosis (Med Diag Tab)

   2. Business Rule:

      1. IF a resident has an active order for an enteral feeding tube,
         THEN there must be a diagnosis that justifies the use of a feeding tube. 
         These include:

         1. Dysphagia

         2. Esophageal Paralysis

         3. Malabsorption

         4. Comatose

         5. Persistent Vegetative State

   3. Due Date:

      1. Within 24 Hours of the order date

   4. Is classified as missed on the report:

      1. N/A

   5. Is no longer relevant to the report:

      1. If the enteral feed order is no longer active

2. Formula Type Order - Physician Must Fill Out Order Properly for Enteral Feed, Including the type of formula. (Q919)

   1. Location in PCC:

      1. Orders

   2. Business Rule:

      1. IF a resident has an active order for an enteral feeding tube,
         AND the order indicates that the tube is used for nutrition,
         THEN there must be a physician order identifying the type of formula administered

   3. Due Date:

      1. Within 24 Hours of the order date

   4. Is classified as missed on the report:

      1. N/A

   5. Is no longer relevant to the report:

      1. If the enteral feed order is no longer active

3. Formula Delivery Type - Physician Must Fill Out Order Properly for Enteral Feed, Including the method of formula delivery. (Q920)

   1. Location in PCC:

      1. Orders

   2. Business Rule:

      1. IF a resident has an active order for an enteral feeding tube, 
         AND the order indicates that the tube is used for nutrition,
         THEN there must be a physician order identifying the method of formula delivery.

         1. Valid delivery methods:

            1. Bolus

            2. Gravity

            3. Pump

   3. Due Date:

      1. Within 24 Hours of the order date

   4. Is classified as missed on the report:

      1. N/A

   5. Is no longer relevant to the report:

      1. If the enteral feed order is no longer active

4. Formula Administration Rate - Physician Must Fill Out Order Properly for Enteral Feed, Including the formula rate of administration. (Q921)

   1. Location in PCC:

      1. Orders

   2. Business Rule:

      1. IF a resident has an active order for an enteral feeding tube, 
         AND the order indicates that the tube is used for nutrition,
         THEN there must be a physician order identifying the rate of formula administration.

         1. Rate of formula administration:

            1. Amount per hour

            2. Continuous

   3. Due Date:

      1. Within 24 Hours of the order date

   4. Is classified as missed on the report:

      1. N/A

   5. Is no longer relevant to the report:

      1. If the enteral feed order is no longer active

5. Formula Administration Duration - Physician Must Fill Out Order Properly for Enteral Feed, Including the duration of formula administration. (Q922)

   1. Location in PCC:

      1. Orders

   2. Business Rule:

      1. IF a resident has an active order for an enteral feeding tube,
         AND the order indicates that the tube is used for nutrition,
         THEN there must be a physician order identifying the duration of formula administration.

   3. Due Date:

      1. Within 24 Hours of the order date

   4. Is classified as missed on the report:

      1. N/A

   5. Is no longer relevant to the report:

      1. If the enteral feed order is no longer active

6. Formula Total Volume - Physician Must Fill Out Order Properly for Enteral Feed, Including the total volume of formula per feeding. (Q923)

   1. Location in PCC:

      1. Orders

   2. Business Rule:

      1. IF a resident has an active order for an enteral feeding tube,
         AND the order indicates that the tube is used for nutrition,
         THEN there must be a physician order identifying the total volume of formula to be administered.

   3. Due Date:

      1. Within 24 Hours of the order date

   4. Is classified as missed on the report:

      1. N/A

   5. Is no longer relevant to the report:

      1. If the enteral feed order is no longer active

7. Order Routine Water Flush - Physician Must Fill Out Order Properly for Routine Water Flushes of the Feeding Tube. (Q902)

   1. Location in PCC:

      1. Orders

   2. Business Rule:

      1. IF a resident has an active order for an enteral feeding tube for any purpose,
         THEN there must be a physician order to routinely flush the tube with at least 100 mL of water.

   3. Due Date:

      1. Within 24 Hours of the order date

   4. Is classified as missed on the report:

      1. N/A

   5. Is no longer relevant to the report:

      1. If the enteral feed order is no longer active

8. Diet Order - Physician Must Fill Out Order Properly for Resident’s Specific Diet. (Q904)

   1. Location in PCC:

      1. Orders

   2. Business Rule:

      1. IF a resident has an active order for an enteral feeding tube,
         THEN there must be a physician order identifying the resident’s specific diet.

   3. Due Date:

      1. Within 24 Hours of the order date

   4. Is classified as missed on the report:

      1. N/A

   5. Is no longer relevant to the report:

      1. If the enteral feed order is no longer active

9. Tube Placement Order - Physician Must Fill Out Order Properly for Tube Placement Checks Prior to Meals or Medication Administration. (Q905)

   1. Location in PCC:

      1. Orders

   2. Business Rule:

      1. IF a resident has an active order for an enteral feeding tube,
         THEN there must be a physician order to check the placement of the Feeding Tube prior to feeding or medication administration.

   3. Due Date:

      1. Within 24 Hours of the order date

   4. Is classified as missed on the report:

      1. N/A

   5. Is no longer relevant to the report:

      1. If the enteral feed order is no longer active

10. AC/PC Meal Water Flush - Physician Must Fill Out Order Properly for Routine Water Flushes of the Feeding Tube Before and After Meals. (Q925)

    1. Location in PCC:

       1. Orders

    2. Business Rule:

       1. IF a resident has an active order for an enteral feeding tube,
          AND the order indicates that the tube is used for nutrition,
          THEN there must be a physician order to routinely flush the tube before and after meals with at least 30 mL of water.

    3. Due Date:

       1. Within 24 Hours of the order date

    4. Is classified as missed on the report:

       1. N/A

    5. Is no longer relevant to the report:

       1. If the enteral feed order is no longer active

11. AC/PC Medication Water Flush - Physician Must Fill Out Order Properly for Routine Water Flushes of the Feeding Tube Before and After Medication Administration. (Q926)

    1. Location in PCC:

       1. Orders

    2. Business Rule:

       1. IF a resident has an active order for an enteral feeding tube,
          THEN there must be a physician order to routinely flush the tube before and after medication administration with at least 30 mL of water.

    3. Due Date:

       1. Within 24 Hours of the order date

    4. Is classified as missed on the report:

       1. N/A

    5. Is no longer relevant to the report:

       1. If the enteral feed order is no longer active

12. Water Flush Between Medications - Physician Must Fill Out Order Properly for Routine Water Flushes of the Feeding Tube Between Medications. (Q927)

    1. Location in PCC:

       1. Orders

    2. Business Rule:

       1. IF a resident has an active order for an enteral feeding tube,
          THEN there must be a physician order to routinely flush the tube in between medications with at least 5 mL of water.

    3. Due Date:

       1. Within 24 Hours of the order date

    4. Is classified as missed on the report:

       1. N/A

    5. Is no longer relevant to the report:

       1. If the enteral feed order is no longer active

13. Tube Feed Care Order - Physician Must Fill Out Order Properly for Routine Care of the Resident’s Feeding Tube. (Q908)

    1. Location in PCC:

       1. Orders

    2. Business Rule:

       1. IF a resident has an active order for an enteral feeding tube,
          THEN there must be a physician order to routinely clean the feeding tube with soap and water every shift.

    3. Due Date:

       1. Within 24 Hours of the order date

    4. Is classified as missed on the report:

       1. N/A

    5. Is no longer relevant to the report:

       1. If the enteral feed order is no longer active

14. Aspiration Precaution Order - Physician Must Fill Out Order Properly to Routinely Check HOB Elevation. (Q909)

    1. Location in PCC:

       1. Orders

    2. Business Rule:

       1. IF a resident has an active order for an enteral feeding tube,
          THEN there must be a physician order to routinely check that the head of the bed is above 30 degrees while receiving Tube Feeding

    3. Due Date:

       1. Within 24 Hours of the order date

    4. Is classified as missed on the report:

       1. N/A

    5. Is no longer relevant to the report:

       1. If the enteral feed order is no longer active

15. Dietary Note - Physician Must Fill Out Progress Note Indicating Use of Feeding Tube. (Q911)

    1. Location in PCC:

       1. Progress Notes

    2. Business Rule:

       1. IF a resident has an active order for an enteral feeding tube,
          THEN there must be a physician progress note that documents the following:

          1. The resident’s use of a feeding tube

          2. The qualifying diagnosis for tube feed use.

    3. Due Date:

       1. Every 60 days

    4. Is classified as missed on the report:

       1. N/A

    5. Is no longer relevant to the report:

       1. If the enteral feed order is no longer active

16. Dietary Nutritional Assessment - The Most Recent Dietary Nutritional Assessment is Completed Correctly. (Q912)

    1. Location in PCC:

       1. Assessments

    2. Business Rule:

       1. IF a resident has an active order for an enteral feeding tube,
          THEN the most recent Dietary - Nutritional Assessment must include:

          1. Pertinent Diagnosis

          2. Fluid Intake Status

          3. Weight Monitoring

    3. Due Date:

       1. 90 Days Since:

          1. The Last Dietary - Nutritional Assessment OR

          2. The Nursing Admission Assessment

    4. Is classified as missed on the report:

       1. N/A

    5. Is no longer relevant to the report:

       1. If the enteral feed order is no longer active

17. Tube Feed Care Plan - Care Plan in Place to Address Tube Feeding. (Q913)

    1. Location in PCC:

       1. Care Plan

          1. Focus

    2. Business Rule:

       1. IF a resident has an active order for an enteral feeding tube,
          THEN there must be an active care plan focus addressing the tube feeding.

    3. Due Date:

       1. Within 24 Hours of the order date OR

       2. For new admissions, 3 weeks after their admission.

    4. Is classified as missed on the report:

       1. N/A

    5. Is no longer relevant to the report:

       1. If the enteral feed order is no longer active

18. Total Feeding MAR - The total amount of formula administered as per Physician’s order for Enteral Feeding is recorded in the MAR. (Q914)

    1. Location in PCC:

       1. Orders

       2. MAR

    2. Business Rule:

       1. IF a resident has an active order for an enteral feeding tube, 
          AND the order indicates that the tube is used for nutrition,
          THEN the amount of formula administered must be recorded in the MAR

    3. Due Date:

       1. The Scheduled date of administration

    4. Is classified as missed on the report:

       1. After the Scheduled date has passed

    5. Is no longer relevant to the report:

       1. If the enteral feed order is no longer active

19. Routine Water Flush MAR - Physician’s order for Routine Water Flushes is recorded in the MAR. (Q915)

    1. Location in PCC:

       1. Orders

       2. MAR

    2. Business Rule:

       1. IF a resident has an active order for an enteral feeding tube,
          AND they have an active order for routine water flushes,
          THEN the Administration of that order must be recorded in the MAR.

    3. Due Date:

       1. The Scheduled date of administration

    4. Is classified as missed on the report:

       1. After the Scheduled date has passed

    5. Is no longer relevant to the report:

       1. If the enteral feed order is no longer active

20. Tube Feed Care TAR - Physician’s order for Tube Feed Care is recorded in the TAR. (Q916)

    1. Location in PCC:

       1. Orders

       2. MAR

    2. Business Rule:

       1. IF a resident has an active order for an enteral feeding tube,
          AND they have an active order for tube feed care,
          THEN the Administration of that order must be recorded in the TAR.

    3. Due Date:

       1. The Scheduled date of administration

    4. Is classified as missed on the report:

       1. After the Scheduled date has passed

    5. Is no longer relevant to the report:

       1. If the enteral feed order is no longer active

21.  Aspiration Precaution TAR - Physician’s order for Checking HOB Elevation is recorded in the TAR. (Q917)

    1. Location in PCC:

       1. Orders

       2. MAR

    2. Business Rule:

       1. IF a resident has an active order for an enteral feeding tube,
          AND they have an active order to check HOB elevation,
          THEN the Administration of that order must be recorded in the TAR.

    3. Due Date:

       1. The Scheduled date of administration

    4. Is classified as missed on the report:

       1. After the Scheduled date has passed

    5. Is no longer relevant to the report:

       1. If the enteral feed order is no longer active

22.  Tube Placement TAR - Physician’s order for Tube Placement Check is recorded in the TAR. (Q918)

    1. Location in PCC:

       1. Orders

       2. MAR

    2. Business Rule:

       1. IF a resident has an active order for an enteral feeding tube,
          AND they have an active order to check the placement of the tube prior to meals and medication administration,
          THEN the Administration of that order must be recorded in the TAR.

    3. Due Date:

       1. The Scheduled date of administration

    4. Is classified as missed on the report:

       1. After the Scheduled date has passed

    5. Is no longer relevant to the report:

       1. If the enteral feed order is no longer active