Coffey L M, Carey M
Department of Clinical Investigation, Walter Reed Army Medical Center, Washington, D.C. 20307-5000.
J Am Diet Assoc. 1989 Jan;89(1):64-8.
Two hundred registered dietitians in health care facilities in the United States were surveyed to ascertain practices in enteral nutrition formulary management. A random selection of members of the Clinical Nutrition Management Dietetic Practice Group of The American Dietetic Association comprised the sample population. The response rate was 74%. The facilities were typically private, nonprofit, acute-care, with a capacity of 201 to 500 beds. Dietetic departments were primarily responsible for procuring, preparing, and distributing enteral nutrition formulas, Physicians, however, primarily initiated orders for formulas. Approximately 15% of hospitalized patients required enteral nutrition formulas, yet modular formulas were rarely used. More than 75% of the facilities utilized enteral nutrition formularies. Ninety-five percent of dietitians believed that establishing objective criteria for evaluating enteral nutrition formulas was important. Cost-containment through decreased product duplication, staff education, inventory management, and quantity ordering advantages were cited as motivating factors in criteria development. Osmolarity, lactose content, and product availability were identified as being the most important criteria in enteral product evaluation. The costs of enteral formulas were included in the standard room rate when the dietetics department was responsible for procuring and supplying enteral formulas. Patients were billed directly when the pharmacy department was responsible for purchasing or supplying enteral products. This study provides data from which a model may be developed to guide health care professionals in enteral formulary decision making.
对美国医疗保健机构中的200名注册营养师进行了调查，以确定肠内营养配方管理的实践情况。美国饮食协会临床营养管理饮食实践小组的成员随机抽样构成了样本群体。回复率为74%。这些机构通常是私立的、非营利性的急症护理机构，床位容量为201至500张。饮食部门主要负责采购、制备和分发肠内营养配方，然而，医生主要负责开出配方订单。大约15%的住院患者需要肠内营养配方，但组件式配方很少使用。超过75%的机构使用肠内营养配方集。95%的营养师认为制定评估肠内营养配方的客观标准很重要。通过减少产品重复、员工教育、库存管理和批量订购优势来控制成本被认为是制定标准的推动因素。渗透压、乳糖含量和产品可得性被确定为肠内产品评估中最重要的标准。当饮食部门负责采购和供应肠内配方时，肠内配方的成本包含在标准病房费用中。当药房负责购买或供应肠内产品时，直接向患者收费。这项研究提供的数据可用于开发一个模型，以指导医疗保健专业人员进行肠内配方决策。
