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Home Enteral Feeding: Analysis and Improvement of Organizational Models

Paccagnella, Agostino MD; Marcon, Maria Lisa PgDip; Rebuffi, Stefania PgDip; Garna, Antonella PHARMD; Mauri, Alessandra PSYCH; Maccari, Daniela PHARMD; Paiusco, Patrizia MD; Spinella, Nello MD

doi: 10.1097/QMH.0b013e31829a6d55
Original Articles

Aim: The purpose of this study was to analyze the organizational models of home enteral feeding used in 5 local health authorities (LHAs) in the Veneto region (Italy). By comparing these models with the main guidelines, the authors have attempted to determine the “minimum standards” to be adopted at an organizational level.

Materials and Methods: This 3-stage study analyzes procedures, precoded actions, and recordable processes. Stage 1: objectives were defined, work methods selected, and reference guidelines chosen. Stage 2: flowcharts were drafted to show the actions and work paths taken for the 5 LHAs. Stage 3: flowcharts were compared with data from the literature.

Results: The study shows that very different organizational models exist. For instance, by comparing organizational processes with the procedures prescribed by the guidelines, it can be seen that the mean percentages of actions taken by the 5 LHAs, for patients in both rest homes and nursing homes, rarely exceeds the threshold of 50% (on a scale from 0% to 100%).

Conclusion: This study shows that home enteral feeding is neither optimized nor uniform in the 5 LHAs and that standardized methods are not used for clinical monitoring.

Metabolic and Nutrition Unit (Drs Paccagnella and Mauri and Mss Marcon and Rebuffi) and Social-Health Care Districts Coordinating (Dr Spinella), Local Health Authority ULSS 9, Veneto; Pharmacy Service, Local Health Authority ULSS 7, Veneto (Dr Maccari); Pharmacy Service, Local Health Authority ULSS 1, Veneto (Dr Garna); and Social-Healthcare Districts, Local Health Authority ULSS 8, Veneto (Dr Paiusco), Italy.

Correspondence: Agostino Paccagnella, MD, U.O. Malattie Metaboliche e Nutrizione Clinica, Ospedale Ca' Fondello, 31100 Treviso, Italy (

The authors acknowledge the contributions of the following colleagues: Medical and Pharmacist Working Group (in alphabetical order): A. Attanasio, C. Baruffi, M. Bedin, L. Bernardi, S. De Col, A. Digito, E. Di Giorgi, P. Facchin, P. Favretto, M. Fornaini, G. Giacomazzi, M. Giometto, B. Gorini, H. Heras, M. Inzalaco, C. Longato, L. Milani, A. Manzoni, I. Morassutti, V. Negrin, P. Paludetti, S. Regazzo, M. Sambataro, S. Tabaccanti, R. Villanova, A. Visentin, G. Zerbinati; Nurses and Dietitians Working Group (in alphabetical order): V. Botta, F. Cadorin, M. Cendron, P. Cenerelli, P. Chiamulera, F. Dalle Mule, T. De Conto, B. Favero, L. Favero, L. Fornaro, G. Foschini, S. Michieletto, P. Michielin, M. Pagan, D. Pizzolato, M. C. Pol, C. Rizzardi, L. Roncada, M. T. Semenzin, A. Scantamburlo, A. Schiavinato, S. Stocco, E. Susin, E. Tabacco, A. Tittonel, L. Zanette, D. Zanin; Steering Committee: P. P. Faronato, M. Tessarin, M. C. De Marco, N. Lo Monaco.

The authors declare no conflicts of interest.

© 2013Wolters Kluwer Health | Lippincott Williams & Wilkins