The scope of practice for RDs also includes the ordering and monitoring of nutrition interventions to meet estimated nutrient and energy needs, including but not limited to prescribed diets, medical foods, dietary supplements, and nutrition support therapies (i.e., enteral nutrition support) [1]. The Academy of Nutrition and Dietetics offers few calculators, via the ‘Nutrition Care Manual,’ to estimate a body mass index and energy requirements or perform metric conversions, which are essential to the NCP [2]. However, a gap exists for similar tools when calculating a patient’s nutrition support needs. The American Society of Parenteral and Enteral Nutrition does offer an algorithmic practice tools to aid decisions surrounding the appropriateness of nutrition support therapies, but, yet again, a practice tool or calculator for the everyday clinician is missing [3].
References
- The Academy Quality Management Committee Academy of Nutrition and Dietetics: Revised 2017 Scope of Practice for the Registered Dietitian Nutritionist. Journal of the Academy of Nutrition and Dietetics 2017, 118, 141–165, doi:10.1016/j.jand.2017.10.002.
- AND Nutrition Care Manual 2020.
- ASPEN Nutrition Care Algorithm Available online: https://www.nutritioncare.org/Guidelines_and_Clinical_Resources/Toolkits/Malnutrition_Toolkit/Nutrition_Care_Algorithm/.
Purpose: The Enteral Nutrition Formulary Guide is designed to provide a comprehensive overview of nutrition information provided by oral nutrition supplements, enteral nutrition formulas, and modulars. This tool is provided to help identify key macronutrient and micronutrient levels in each supplement, formula, or modular for calculating recommended doses.
Utilization: This tool is available as a modifiable Excel file. Prior to use, update this formulary based on available oral nutrition supplements, enteral nutrition formulas, and modulars. This information can often be found on the product’s nutrition facts label or from the supplier’s website. Once updated, this tool should be referenced when calculating a patient’s estimated nutrient requirements and when discussing available oral nutrition supplements, enteral nutrition formulas and modulars with other healthcare professionals.
Download: An Excel fillable calculator of the Enteral Nutrition Formulary Guide can be found here!
Example of Enteral Nutrition Formulary Guide used at the Javits New York Medical Station from 28 April through 01 May of 2020:
Purpose: The Enteral Nutrition Support Calculator is designed to support RDs when calculating the provision of calories, protein, and fluid for various enteral nutrition formulas. This calculator is meant to provide a quick reference for field hospital clinical nutrition staff and aims to improve efficiency and reduce errors when estimating patients’ nutrition support requirements. Details on nutrient provision should be ascertained from the enteral nutrition formula’s manufacturer’s website.
Utilization: This tool is available as a modifiable Excel file. Prior to use, update the Enteral Nutrition Formulary Guide from above for a quick reference when completing ‘Part B: Select enteral nutrition formula’.
Download: An Excel fillable calculator of the Enteral Nutrition Support Calculator can be found here!
Example of Enteral Nutrition Formulary Guide used at the Javits New York Medical Station from 28 April through 01 May of 2020:
To best use this calculator, we recommend the following:
- Convert the patient's weight from pounds to kilograms in ‘Part A: Re-calculate patient weight.’ This step must be completed to calculate the calories and protein provided by formulary per kilogram patient weight in ‘Part D: Calculate enteral nutrition support recommendations.’
- Enter the patient's weight in pounds in the yellow cell to convert the weight from pounds to kilograms (calculated in adjacent white cell).
- Update ‘Part B: Select enteral nutrition formula’ with information from the Enteral Nutrition Formulary Guide from above. The information entered in the yellow cells includes:
- Calories provided per milliliter of selected formula;
- Protein provided per liter of the selected formula;
- Water provided per lit of the selected formula; and
- Milliliters of formula per container of the selected formula.
- Update ‘Part C: Recommend hourly rate and length of admission’ with your recommended hourly rate and total hours of administration per day to auto calculate the 'Total Volume (mL)' of enteral nutrition provided per day. The information entered in the yellow cells includes:
- The recommended hourly rate of enteral nutrition administration; and
- The recommended total hours of enteral nutrition formula administration per day.
- Review the auto calculations performed in 'Part D: Calculate enteral nutrition support recommendations', which include:
- 'Calories per Day (kcal/d)’ calculated as the product of the total volume of formula delivered from ‘Part C: Recommend hourly rate and length of admission’ and the calories per milliliter of enteral nutrition formula from ‘Part B: Select enteral nutrition formula;’
- 'Calories per Patient Weight (kcal/kg patient)’ calculated as the quotient of the ‘Calories Per Day (kcal/d)’ calculated above and the patient weight in kilograms from ‘Part A: Re-calculate patient weight;’
- 'Protein per Day (g protein/d)’ calculated as the product of the protein per one liter (or one thousand milliliters) formula from ‘Part B: Select enteral nutrition formula’ and the total volume of formula delivered from ‘Part C: Recommend hourly rate and length of admission;’
- 'Protein per Patient Weight (g protein/kg patient)’ calculated as the quotient of the ‘Protein Per Day (g protein/d)’ calculated above and the patient weight in kilograms from ‘Part A: Re-calculate patient weight;’
- 'Water per Day (mL water/d)’ calculated as the product of the water per one liter formula (or one thousand milliliters) from ‘Part B: Select enteral nutrition formula’ and the total volume of formula delivered from ‘Part C: Recommend hourly rate and length of admission;’ and
- 'Containers Formula per Day (containers/d)’ calculated as the quotient of the total volume of formula delivered from ‘Part C: Recommend hourly rate and length of admission’ and the total volume of the formula per container from ‘Part B: Select enteral nutrition formula.’
- Communicate nutrition support recommendations, specifically the number of cartons or liters recommended for your patient, to food service personnel tasked with delivering meals. Limit enteral nutrition support recommendations to only the calculations appropriate for your available enteral nutrition formulary.
