Changes Coming to Formula Ordering Procedure

A recent external review and some Eye on Safety events have revealed challenges in the formula order entry process. Feeding pediatric patients is an increasingly complicated task. We continue to strive to make ordering those feeds as simple, yet complete, as possible. A multidisciplinary group developed the following modifications that will go into effect on March 21.

1. “No Dilution (Full strength)” option will be removed, and “Special Recipe” is the preferred choice if you have a recipe and are unsure of the concentration. No Dilution is confusing, and sometimes conflicts with other information supplied in the feeding order. If you want Full Strength, simply check the concentration listed in the name of the formula. If you want another concentration, select it specifically (i.e., 24kcal/oz or 18kcal/oz). If you are unsure, but have a recipe for water and the formula, then select “Special Recipe” and write out the details.  
2. Non-Formulary Formula will now have a separate order. We highly encourage all patients to be fed with formulas on our formulary. Just like medications, we have internal checks to make sure the right product is received by our patients. When there is a special exception or the caregiver insists on using a home formula, we need to take additional precautions to ensure the safety of our patients. “Other” will no longer be an option under the list of formulas. If a caregiver wants to provide their own formula, please write an order for Non-formulary Formula. This order will trigger a Nutrition consult so our dietitians can review the feeding plan and help determine if we can purchase the formula or continue to use home supply. The RN will also complete an Acknowledgement of Risk form with the caregiver.
3. Breastmilk back-up options will need to be ordered separately. Please place a separate order for formula plus any additives to clarify what is added to breastmilk vs. formula, as they may be different. The route, volume and frequency will need to be updated in each order separately when making changes.
4. Daytime boluses with a continuous night drip for nipple/gavage feeds is now an option in all our feeding orders, so this can be conveyed in one order.

Our dietitians are always happy to help – if you are unsure how to enter a feeding order, please enlist their support.  Contact Kristy Anderson or Lauren Maskin, M.D. with any questions or concerns.