| Preparation, Storage, Distribution and Handling of Enteral Formula/Medical Food |
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- Purpose
To ensure proper procedure of preparation, storage, distribution, and handling of enteral nutrition formula.
- Definitions
- Enteral Formula / EN Formula / Medical Foods – a food which is formulated to be consumed or administered enterally under the supervision of Clinical Dietitian which is intended for dietary management of a disease or condition for which distinctive nutritional requirements , based on recognized scientific principles, a re established by medical evaluation. Available in the form of liquid or powder (in cans, tetra packs)
- Reconstituted Enteral Formula - enteral formula prepared with modular additives and sterile /purified water.
Formulary Room – the location of enteral formula preparation and reconstitution following standards of aseptic technique.
- Hang Time – The length of time an enteral formula is considered safe for delivery to the patient beginning with the time of formula has either been reconstituted, warmed, decanted or has had the original package seal broken
- Policy statements
Food Service Dietitian, Clinical Dietitian, Nursing Staff are the one responsible in implementation of guidelines in preparation, storage, distribution, handling of enteral formula or medical foods. Refer to Procedures.
- Procedures
- Preparation of Enteral Formula
- The Clinical Dietitian should enter the recommended recipe or enteral nutrition formula through electronic documentation via QuadraMed system (tube feeding / enteral feeds program)
- The Food Service Dietitian will print the list of enteral nutrition formula / tube feeding list daily in the morning via QuadraMed system.
- The Food Service Dietitian will print the list of enteral nutrition formula / tube feeding list daily in the morning via QuadraMed system.
- The Diet Technician will prepare the recipe as endorsed by the Food Service Dietitian and should comply with the hygiene and sanitation guidelines by wearing disposable gown, mask, gloves, and head covers. Prohibition of watches, rings, piercings, or artificial nails.
- The Food Service Dietitian should check the formulary room, hand hygiene and aseptic practices should be in place to prevent contamination by the Diet Technician
- Any instruments or utensils used in EN preparation should either disposable or undergo heat sterilization prior to use.
- Modified enteral formula will be prepared according to the ordered recipe daily. The powder formula / modular will be measured by using the electronic weighing scale, the liquid enteral formula by measuring glass, liquid modular by measuring spoons.
- To use purified or sterile water for reconstituting of the enteral formula. Sterile water is used for preparing infant formula preparation.
- The Diet Technician should use osterizer in mixing, reconstituting the formula, pours the formula through strainer into disposable / administration container.
- A label should be affixed to all EN formula administration containers (sterile plastic containers, bottles) indicating the date – time, name of the formula, dilution, MRN (sticker) of the patient, responsible person for the preparation
- New diet orders / late orders of enteral formula beyond the cut off time at 9:00 AM, the Clinical Dietitian should order verbally over the phone to Food Service Dietitian or Diet Technician.
- Prior to delivery the Food Service Dietitian must do the final checking of the prepared formula based on the updated tubefeeding list.
- The Food Service Staff will deliver the enteral formula at 12:00 PM to specific wards.
- The receiver of the formula in the ward should write the name, badge number and signature once accepted the enteral formula.
- The storage area should be separated from any preparation area to avoid contamination.
- EN formula products either liquid or powder should be stored in a clean and dry table
in the formulary room. It should be labeled with date when it was opened.
- Formulary room should maintain hygiene and sanitation standards. To practice bacterial count not exceeding federal limits for foods (10+ CFU/ml).
- For EN formulas on hold, should be refrigerated after preparation.
- Enteral formula will be used according to the expiry date following FIFO “first in first out.”Ward Area (Wards, Intensive Care Units)
- Once the nursing staff receives the EN formula and not used immediately after preparation, should be refrigerated at temperature of 5 °C to reduce contamination.
- EN formula either in can or tetra packs are stored in a clean, dry cabinet in the ward kitchenette assigned for this purpose.
- Enteral supplements at the bedside should be stored in refrigerator, labeled with patient’s sticker- MRN, name, date and time of opening. If not used within 24 hours after opening must be discarded.
- Unopened enteral supplements that are not consumed by the patient in isolation will remain stored at the bed side.
- Reconstituted formula not used will be discarded after 24 hours of preparation.
- Distribution of Enteral Formula
The Food Service Department shall deliver the enteral formula / supplements to specific wards at 12:00h daily
The nurse will receive the EN formula/reconstituted formula by signing the receiving copy of the Food Service Staff with badge number, complete name.
EN formula should be double checked by the nurse if the container has the proper label – MRN patient, name, type of formula and concentration time of preparation, responsible for preparing before signing in the receiver’s copy.
Enteral supplements ordered as snacks will be delivered during specific snack time delivery.
- Handling of Enteral Formula
The nurse should practice hand hygiene standards before taking the EN formula.
Use 70% isopropyl wipe for cleaning the EN formula in can before opening
The nurse should read the affixed label on the EN formula container before administering to the patient.
Shake the EN formula prior to administration.
Enteral formula should be protected from any heat exposure.
Reconstituted enteral formula must be taken from refrigerator 30 minutes prior administration to allow formula to be at room temperature.
Maximum hanging time for EN formula decanted into sterile bag is 8 hours.
The reconstituted EN formula received from Food Service Department should hang no more than 4 hours.
- Equipment / forms
Electronic weighing scale in grams as a unit of measurement, Osterizer, measuring spoons, measuring glass, disposable mask, disposable gloves, disposable head cap, disposable enteral formula container
- Related references
JPEN J Parenter Enteral Nutr 2009;33;122 originally published online Jan 26,2009; http://pen.sagepub.com
- Appendices
[DPP - All related documents that must be included with this DPP for immediate reference.]
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