Smart Phone Application for Enteral Nutrition

Study Overview
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Brief Summary
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Internal medicine resident physicians were provided an ipod with the EN application to assist them in choosing EN formulas for patients during their ICU rotation. The primary outcome was improved initiation of EN within 24 hours of admission. Secondary outcomes include, time to initiate EN, goal calories reached, infections rates, length of stay, mortality, and concordance with clinical guidelines.

Detailed Description
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Background: Resident physicians are frequently uncomfortable ordering enteral nutrition (EN) and are unaware of the variety of formulas and supplements available for different disease processes. Many depend on a clinical dietitian to assist with recommending EN formulas and patient energy requirements which may not be readily available upon patient admission. This creates a barrier to early initiation of EN and non-compliance with Society of Critical Care Medicine and American Society of Parenteral and Enteral Nutrition clinical guidelines. Objective: Internal medicine resident physicians were provided an ipod with the EN application to assist them in choosing EN formulas for patients during their ICU rotation. The primary outcome was improved initiation of EN within 24 hours of admission. Secondary outcomes include, time to initiate EN, goal calories reached. Design: This study is a retrospective chart review to evaluate the impact of a smart phone/device application (EN application) to assist resident physicians when ordering EN. The study is a single center trial conducted at an academic teaching facility. All patient data was obtained by a retrospective chart review of patients admitted to the intensive care unit (ICU) at The University of Oklahoma Medical Center.

Official Title
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Smart Phone/Device Application to Improve Delivery of Enteral Nutrition in Adult Patients Admitted to the Medical Intensive Care Unit

Conditions
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Nutritional and Metabolic Diseases

Intervention / Treatment
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* Other: Tube Feeding Application


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Admitted to the ICU Require Mechanical Ventilation Physician plans to order enteral nutrition for the patient Exclusion Criteria: Death likely within 24 hours Needing parenteral nutrition Cannot tolerate enteral nutrition for any reason

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Pre- Application<br>Patients admitted prior to use of tube feeding application | |
| Post- Application<br>Patients admitted when tube feeding application was being used. | Other: Tube Feeding Application<br>* A smart device application was developed and used to help residents determine the best enteral nutrition prescription for patients admitted to the ICU<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The primary outcome was improved initiation of EN within 24 hours of admission | percent of patients with enteral nutrition ordered within 24 hours of admit compared to all patients admitted | The time frame does involve a change in practice. The change is introduction of a smart app- 12 months prior to the smart device being used in the ICU by residents and 12 months during which the smart application was use by the ICU residents | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total time to initiate EN | total hours between admit and when enteral nutrition is ordered | The time frame does involve a change in practice. The change is introduction of a smart app- 12 months prior to the smart device being used in the ICU by residents and 12 months during which the smart application was use by the ICU residents | 
| Percent of goal calories received prior to discharge from ICU | percent of calories received (a percent of the total recommended calories for the patient) | The time frame does involve a change in practice. The change is introduction of a smart app- 12 months prior to the smart device being used in the ICU by residents and 12 months during which the smart application was use by the ICU residents |