Enteral Therapy Thursday: Professionals Sharing the Patient Experience

Enteral Therapy Thursday: Professionals Sharing the Patient Experience 150 150 Jennifer Smith, MS, RD, CSP, LD, LMT

A multidisciplinary team puts themselves on enteral nutrition for a day to gain insights into the patient experience.

Enteral nutrition for Crohn’s disease is a well-established practice using liquid formulas to treat Crohn’s disease.  Patients who choose this form of treatment either drink the prescribed amount of formula or receive the formula via a feeding tube. Although it is widely used in other countries, its use in the United States is low.

In 2013, a team of dietitians and physicians, along with a nurse practitioner and nurse who specialize in treating children and adolescents with inflammatory bowel disease (IBD), sought to change this low statistic at Nationwide Children’s Hospital.

We started with reviewing the literature, identifying the barriers (provider barriers and patient barriers) and developing resources and tools to overcome these barriers. We developed an algorithm and other materials for providers to assist with starting and managing patients on enteral therapy. And the dietitians developed resources for patients to assist with creative ways to make a diet of mostly drinking liquid formula possible.

While getting all of these materials and plans ready for the enteral therapy program, one important component was missing. A sense of the patient experience. One of the dietitians on the gastroenterology (GI) team, Tracie Rohal, suggested to me that we try it ourselves. What a great idea! For one day, we could experience what we are asking our patients to do.

We pitched the idea to the entire team calling it “Enteral Therapy Thursday.” Each member of the team enthusiastically participated and was prescribed some formula and given a very small allotment of calories from food allowed to eat (in most cases, patients are allowed only 200 calories or less from foods other than the formula each day).

When Enteral Therapy Thursday rolled around, each team member dutifully brought their formula to work and shared different flavors with each other — just as we encourage our patients to try different flavors and brands. One team member placed one of her drinks in the freezer to try it partially frozen. We all went home for the evening and drank our formula instead of eating our “normal” dinner with our families to complete our day of enteral therapy.

As a one-day experience, Enteral Therapy Thursday offered us a glimpse of a patient experience that was very insightful. It was not easy, but it was definitely achievable.

I realized rather quickly that very cold formula tastes better, and it was easier for me to drink the formula using a straw. I saved my calories for dinner and was able to eat a few food items while my family ate dinner. I think I would vary this from day to day if I were doing enteral therapy every day: I might spread my calories throughout the day on some days and use them for lunch or dinner on other days.

Through Enteral Therapy Thursday, I gained an understanding and knowledge that I have been able to pass along to patients. Our patients that have heard about our experience have appreciated their medical team taking the time to try the treatment (even if for one day) that they have chosen to do. Since adopting the Enteral Therapy Algorithm two years ago, we have started 80 patients on enteral therapy and continue to promote its use.

I want to extend my thanks to all who helped to develop our Enteral Therapy Program and participated in Enteral Therapy Thursday: Brendan Boyle, MD, Wallace Crandall, MD, Amy Donegan, PNP, Jen Dotson, MD, Barb Drobnic, RN, Sandra Kim, MD, Karen Rachuba, RD, Tracie Rohal, RD, and Jody Wall, RD.

About the author

Jen Smith, MS, RD, CSP, LD, LMT, is a Clinical Dietitian at Nationwide Children’s Hospital. She has been working at Nationwide Children’s Hospital with an emphasis in Gastroenterology since 2003. She is a board certified specialist in Pediatric Nutrition. In 2009, she was awarded Ohio Dietetic Association’s Recognized Young Dietitian of the Year. She is an active member and has been involved with speaking engagements for many organizations, including the Academy for Nutrition and Dietetics and the Crohn’s and Colitis Foundation of America. She is an active participant in ImproveCareNow, a quality improvement collaborative dedicated to improving care for pediatric inflammatory bowel disease. In addition to working as a dietitian, Jen is also a Licensed Massage Therapist at Nationwide Children's Hospital.