IMPROVING THE SAFE PREPARATION AND ADMINISTRATION OF ORAL MEDICATIONS VIA ENTERAL FEEDING TUBES

CLINICAL AUDIT & QUALITY IMPROVEMENT PROJECT

Abstract

Background: Safe administration of oral medications through enteral feeding tubes requires appropriate medication selection and formulation, separate preparation and administration, adequate tube flushing, appropriate management of medication–feed interactions, and accurate documentation. However, adherence to these practices may be inconsistent. This quality improvement project aimed to assess compliance with predefined standards for enteral medication administration and improve practice through a targeted Plan–Do–Study–Act (PDSA) intervention.

Methods: A prospective clinical audit and quality improvement project was conducted in Medical B Unit, Ayub Teaching Hospital, Abbottabad, Pakistan. Adult inpatients receiving oral medications through an enteral feeding tube were included using consecutive sampling. Baseline compliance was assessed from 1 July to 15 August 2025 against nine predefined medication-safety standards. Baseline findings were used to develop a multidisciplinary intervention comprising staff education, a standardised one-page medication administration protocol, bedside reminders, medication-specific guidance, reinforcement of appropriate equipment use, and improved documentation practices. A re-audit was conducted from 1 September to 10 October 2025 using the same standards and data-collection approach. Compliance was analysed descriptively and compared using absolute percentage-point changes.

Results: During the baseline audit, 175 eligible medication administrations among 45 adult inpatients were assessed. Compliance varied across the nine standards, with the lowest compliance observed for administration of medicines separately with an appropriate flush between medications (42.3%), pre-medication tube flushing (57.1%), management of medication–feed interactions (55.4%), and post-medication flushing (64.0%). During the re-audit, 147 medication administrations among 51 adult inpatients were assessed. Compliance improved across all nine standards. The greatest improvement was observed in separate medication administration with an appropriate flush between medicines, increasing from 42.3% to 87.5% (+45.2 percentage points). Pre-medication flushing increased from 57.1% to 91.8%, medication–feed interaction management from 55.4% to 89.5%, and post-medication flushing from 64.0% to 92.5%. Compliance with appropriate equipment use increased from 82.3% to 95.9%, while documentation improved from 84.0% to 95.2%. Predefined targets were achieved for appropriate equipment use and documentation, but not for all standards.

Conclusion: A targeted, multifaceted PDSA-based intervention was associated with substantial improvement in the safe preparation and administration of oral medications through enteral feeding tubes. The greatest gains were observed in medication separation, tube flushing, and management of medication–feed interactions. However, several standards remained below their predefined targets, indicating the need for continued reinforcement and periodic re-audit through further PDSA cycles to sustain and further improve practice.