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Journal of Parenteral and Enteral Nutrition
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Nutritional Support Team vs Nonteam Management of Enteral Nutritional Support in a Veterans Administration Medical Center Teaching Hospital

Douglas A. Powers, PHARM.D.

Departments of Surgery and Clinical Pharmacy, University of Tennessee Center for the Health Sciences; and the Department of Clinical Pharmacy, Veterans Administration Medical Center, Memphis, Tennessee

Rex O. Brown, PHARM.D.

Departments of Surgery and Clinical Pharmacy, University of Tennessee Center for the Health Sciences; and the Department of Clinical Pharmacy, Veterans Administration Medical Center, Memphis, Tennessee

George S.M. Cowan, JR, M.D.

Departments of Surgery and Clinical Pharmacy, University of Tennessee Center for the Health Sciences; and the Department of Clinical Pharmacy, Veterans Administration Medical Center, Memphis, Tennessee

R. Wayne Luther, M.D.

Departments of Surgery and Clinical Pharmacy, University of Tennessee Center for the Health Sciences; and the Department of Clinical Pharmacy, Veterans Administration Medical Center, Memphis, Tennessee

David A. Sutherland, PHARM.D.

Departments of Surgery and Clinical Pharmacy, University of Tennessee Center for the Health Sciences; and the Department of Clinical Pharmacy, Veterans Administration Medical Center, Memphis, Tennessee

P. Gregory Drexler, PHARM.D.

Departments of Surgery and Clinical Pharmacy, University of Tennessee Center for the Health Sciences; and the Department of Clinical Pharmacy, Veterans Administration Medical Center, Memphis, Tennessee

One hundred one patients receiving enteral nutritional support (ENS) by tube feeding during a 5-month period were prospectively studied. Fifty patients were managed by a nutritional support team (T) and 51 patients were managed by the nonteam approach (NT). Demographics, primary diagnosis, chronic diseases, medical service, calculated basal energy expenditure (BEE), duration of ENS, and final patient disposition were recorded. Enteral formula, formula modifications, results of laboratory tests and calories delivered were obtained daily. Results of nitrogen balance studies were obtained when available and each patient was monitored for pulmonary, mechanical, gastrointestinal, and metabolic abnormalities.

No significant difference was found between the team and nonteam managed groups in regard to total feeding days, mean feeding days per patient, total laboratory tests, laboratory tests per patient or laboratory tests per day. Significantly more team patients attained 1.2 times BEE (T = 47, NT = 38, p < 0.05) for a significantly greater period of time (T = 398 days, NT = 281 days, p < 0.05). Significantly more team patients achieved a measured positive nitrogen balance than nonteam patients (T = 42, NT = 1, p < 0.05). Formula modifications to correct nutritional or metabolic aberrations were made in 15 (30%) team patients and five (9.8%) nonteam patients (p < 0.05).

The number of individual abnormalities (pulmonary, mechanical, gastrointestinal, and metabolic), as well as total abnormalities occurring in the team-managed group, was significantly lower than in the nonteam managed group (160 us 695, p < 0.05). The results of the study indicate that team-managed enteral nutritional support reduced abnormalities and is nutritionally more efficient when compared to a nonteam approach. (Journal of Parenteral and Enteral Nutrition 10:635-638, 1986)

Journal of Parenteral and Enteral Nutrition, Vol. 10, No. 6, 635-638 (1986)
DOI: 10.1177/0148607186010006635
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