RESULTS: Among hospitalized patients taking
enteral nutrition, 34.8% received
enteral nutrition alone, 30% concomitantly received
parenteral nutrition, and 35.2% received
enteral nutrition after
parenteral nutrition. Combined use of the different formulas was observed in almost all hospitalized patients receiving
enteral nutrition. In total, 61.5% of patients received triple
therapy with Nutrison Fibre,
Fresubin Diabetes, and Supportan. Number of defined daily doses (total dose consumed/defined daily dose, also called DDDs) of formulas in descending order were as follows: Nutrison Fibre,
Fresubin Energy Fibre,
Fresubin Diabetes > Supportan > Peptison, Ensure >
Vivonex,
Fresubin. The ratio of the cumulative DDDs for the three types of
enteral nutrition was 35:2.8:1 (total
protein type to short
peptide type to
amino acid type).
Off-label use of
Fresubin Diabetes was also observed, with most of this formula being prescribed for patients with stress
hyperglycemia. Only 2.1% of
cancer patients received Supportan. There were 35 cases of near misses in dispensing look-alike or sound-alike
enteral nutrition formulas, and one
adverse drug reaction in an elderly malnourished patient who did not receive
vitamin K1-enriched
enteral nutrition during treatment with
cefoperazone. After 4 months of the trial intervention,
off-label use of
Fresubin Diabetes was no longer endorsed by the
Drug and Therapeutics Committee for nondiabetic patients, and the proportion of this formula prescribed for patients with stress
hyperglycemia decreased by 20%, with a 10-fold increase in the amount of Supportan prescribed for
cancer patients. Near misses in dispensing look-alike or sound-alike
enteral nutrition were successfully abolished, and no severe coagulation disorders occurred after prophylactic administration of
vitamin K1-enriched
enteral nutrition in elderly malnourished patients receiving
cefoperazone.
CONCLUSION: This utilization study indicates that continuous quality improvement is necessary and that a
Drug and Therapeutics Committee can play an important role in promoting rational and safe use of
enteral nutrition. Appropriateness of this
therapy still needs to be improved, especially in addressing the issues of non-evidence-based combined use of multiple
enteral nutrition formulas, the relatively high rate of concomitant use of enteral and
parenteral nutrition,
off-label use of diabetes-specific
Fresubin Diabetes, insufficient use of Supportan in
cancer patients, and unnecessary use of Supportan in
intensive care patients not suffering from
cancer.