Development and Pilot Evaluation of a Resident-Focused Nutrition Support Educational In-Service for a Veterans Affairs Medical Center

Abstract

Inappropriate use of parenteral nutrition (PN) can increase patient risk, contribute to preventable complications, and place unnecessary demands on healthcare resources. At the Salem Veterans Affairs Medical Center (VAMC), resident physicians have the authority to initiate nutrition support orders. Facility-level trends suggested variability in PN ordering practices and inconsistent alignment with evidence-based nutrition support guidelines. The purpose of this project was to develop and pilot-evaluate a resident-focused nutrition support educational in-service and accompanying decision-support tool designed to improve awareness and application of guideline-based nutrition support practices. The project was informed by Salem VAMC PN utilization trends, interdisciplinary stakeholder input, and literature describing limited formal nutrition support education in medical training. A recorded educational session was developed to address indications and contraindications for enteral nutrition and PN, appropriate PN initiation, PN-related complications, transition off nutrition support, and application of nutrition support guidelines to a patient case study. The pilot evaluation was conducted with Nutrition Support Team members and related stakeholders using Likert-scale survey items and open-ended feedback to assess perceived need, acceptability, appropriateness, feasibility, and usefulness. Survey responses (n=10) demonstrated strong support for formal resident physician nutrition support education, with 100% of respondents agreeing that training is needed at the Salem VAMC. Most respondents viewed the presentation as relevant and appropriate, with 90% agreeing it could serve as an educational resource. Additionally, 100% perceived the decision flowchart as a useful quick-reference tool. Feedback informed revisions to shorten and refine the final materials. Future implementation should include resident feedback and evaluation of PN utilization trends over time.