Feeding Hospitalized Patients

2. Feeding Hospitalized Patients

Preparation of the Meals

Space dedicated solely for diet preparation is vital to facilitating the application of nutrition in clinical practice. This area can be as simple as a small counter to allow cans to be opened and bowls to be filled, along with an adjacent sink equipped with a garbage disposal. A few additional items can increase the efficiency of a food preparation/kitchen area. A brief list of items that all practices should consider is provided in Table 2.

Choice of Diet

A fundamental question in the management of every hospitalized patient is whether to feed or not. If the answer is to feed the patient, the next decision concerns the route of administration and the type of food. This topic is explored further in Chapter 14; however, the subject will be discussed as it relates to the logistics of providing nutritional services to the client and patient.

As a policy, clients should be encouraged and instructed to bring the patient's typical diet for feeding during hospitalization. Clearly there are exceptions which should be considered based on the underlying disease and the reason for hospitalization. However, when practical and not contraindicated, feeding the patient's own diet should minimize any potential gastrointestinal distress that may occur due to sudden dietary changes.

When the patient's typical diet is not available, another diet will have to be selected. Highly digestible diets are usually well accepted and tolerated; however, care should be taken to ensure that the diet is not concurrently too high in fat. Although fat can increase palatability and the likelihood of acceptance, it is the experience of the authors that sudden increases in dietary fat appear to be one of the most consistent and least recognized causes of gastrointestinal distress. In addition, although diets higher in moisture are often found to be more palatable, this is not always the case and the patient may have a texture preference for dry food and will reject diets higher in moisture. Therefore, a highly digestible and low fat diet may be the best food to use as a standard hospitalized diet and should be stocked in an amount to meet this need.

Meeting a Hospitalized Patient's Energy Needs

For many hospitalized patients, voluntary consumption of food will adequately meet a patient's energy needs. However, nutritional support may become necessary and, thus, should be an available procedure at all practices. A variety of enteral feeding tubes to meet diverse patient needs can be placed without special equipment beyond the appropriate feeding tubes and diet (i.e., nasoesophageal, esophagostomy or jejunostomy feeding tubes).

Percutaneous endoscopic gastrostomy (PEG) tubes require the use of more expensive and advanced equipment, but all practices should be able to provide adequate nutritional support to their patients without the use of an endoscope.

The use of parenteral nutrition may not be practical at many clinics and, thus, may be limited to RPs. However, as peripherally administered parenteral nutrition solutions with lower osmolarity and higher energy density become more common place and more proven, the use of parenteral nutrition may be more widely used in the future. For further discussion on critical care nutritional support please see Chapter 14.

How to Ensure Owner Compliance after a Diet Prescription in Dogs

A recent study commissioned by the American Animal Hospital Association (AAHA) reviewed client compliance in a variety of clinical areas, including the use of veterinary therapeutic diets. More than 350 veterinary practices throughout the United States participated through interviews and medical record reviews. The goals were to determine compliance levels, identify opportunities to provide better health care for pets through compliance, understand the barriers to compliance and lastly, how to promote compliance.

The report determined that 27% of pets with a medical condition that would have benefited from a therapeutic diet did not receive or follow such a recommendation from the veterinary provider. These findings equated to 11.6 million dogs with one of six diagnosed conditions that could have been helped by the use of a prescription diet that were not fed a therapeutic diet at all, or were not fed a therapeutic diet for an appropriate amount of time.

There are a number of factors that may contribute to a reduction in compliance when it comes to the use of therapeutic diets in our patients:
- The veterinarian's misconceptions about the client's willingness to act
- Cost of the diet
- Convenience
- Willingness of the pet to eat the food
- The owner's nutritional philosophies
- The veterinarian's lack of confidence in their own recommendations
- The possibility that the client may not clearly understand the benefits of the recommendation.

There are steps that we can take to increase compliance when it comes to ensuring that our clients follow a recommendation to use a therapeutic diet:

1. Ensure that you and your staff have confidence in your recommendations.
2. Create understanding and shared expectations through client communication and education.
3. Make the solution easy.
4. Continuous communication.

Compliance with respect to a diet prescription begins with the veterinarian and their staff. When there is a universal understanding and consistency with regard to ensuring client compliance, the patient, client and your veterinary practice all benefit.

References:
- AAHA Compliance Study. Available at: www.aahanet.org.
- Client Compliance. DVM Best Practices, July 1, 2003. Available at: www.dvmnewsmagazine.com/dvm