Enteral Nutrition Support Consultation Note (Inpatient)

Date/Time of Assessment: [Date and time]

Consulting Clinician: [Name, credentials, discipline/service]

Consult Requested By: [Service and clinician name]

Reason for Consult: [EN initiation / regimen adjustment / tolerance concern / transition planning / other] (Include urgency if relevant.)

Patient Snapshot

[Brief 2-3 sentence narrative including age, sex, primary diagnosis/admission reason, and key comorbidities or clinical constraints affecting enteral nutrition such as renal failure, hemodynamic instability, aspiration risk, fluid restriction, or ventilator status]

Nutrition-Relevant History

Current Diet Order and Oral Intake: [Current diet order and adequacy of oral intake; quantify if available; include NPO status and duration if applicable] (If unknown, state explicitly.)

Prior/Current Nutrition Support: [Prior or current EN/PN this admission or at baseline; include dates if known] (If none or unknown, state explicitly.)

GI/Surgical History: [Relevant dysphagia, gastroparesis, obstruction, GI surgeries, fistulae, or other factors impacting route or tolerance]

Medications Impacting EN: [Medications affecting motility or tolerance such as prokinetics or opiates; calorie-containing infusions such as propofol; medications with tube-feeding interactions]

Food Allergies/Intolerances: [Allergies or intolerances relevant to formula selection] (If unknown, state: "Unable to confirm; none documented.")

Objective Data

Anthropometrics: [Height] | [Current weight] | [BMI] | [Usual body weight if known] | [Percent weight change over interval] (Note if weight interpretation is affected by fluid status or if using estimated/stated weight.)

Nutrition-Focused Physical Exam: [Findings supporting malnutrition assessment: subcutaneous fat loss, muscle wasting, edema] (If not performed, state "NFPE deferred" with brief rationale.)

Pertinent Labs: [Electrolytes (Na, K, Cl, CO2), BUN/Cr, glucose, Mg, Phos; add CBC, LFTs, triglycerides, or others as indicated; include dates and note trends if relevant]

Clinical Status: [Hemodynamic stability including pressor use or escalation concerns; respiratory and airway protection status; abdominal exam findings including distension, pain, bowel sounds; GI symptoms including nausea, vomiting, stool output and consistency] (Use objective tolerance indicators rather than vague statements.)

Enteral Access

Device: [Tube type: NG / OG / NJ / PEG / PEJ / G-J], [French size], [Termination site: gastric / post-pyloric], [Placement date if known]

Verification Status: [Method of placement confirmation and timestamp] — [Tube verified and OK to use for feeding/medications / Placement verification pending; do not initiate feeds until confirmed / Placement verification not found in chart; recommend confirming prior to initiation]

Access Plan: [If no tube and EN indicated: recommended route with rationale and responsible service for placement] (Omit if tube already in place and verified.)

Current Enteral Nutrition Regimen

(Include this section only if patient is currently receiving EN; omit entirely if not on EN.)

Formula: [Product name and caloric density in kcal/mL]

Delivery Method: [Continuous / Cyclic / Bolus] at [Current rate in mL/hr or bolus volume and frequency]

Total Daily Volume: [mL/day at current regimen]

Modular Protein: [Product, dose, and frequency] (If none, state "None."))

Water Flushes: [Scheduled flush volume and frequency; medication flush guidance]

Delivery vs Needs: [Current delivery as percent of estimated needs]

Estimated Nutritional Needs

Energy: [kcal/day range] | Protein: [g/day] | Fluid: [mL/day or guidance if relevant]

Method and Assumptions: [Weight-based / predictive equation / condition-specific adjustment]; [Dosing weight used and rationale if adjusted for obesity or edema]; [Data limitations and need for reassessment if applicable]

Assessment and Nutrition Diagnosis

(Prioritize problems by clinical severity. Include separate subsections for each identified problem.)

[Problem 1 Title]

Assessment Summary: [Concise synthesis of pertinent findings supporting the problem]

Nutrition Diagnosis (PES): [Problem] related to [Etiology] as evidenced by [Signs/Symptoms]

Clinical Reasoning: [Brief rationale linking objective data to diagnosis and implications for EN]

[Problem 2 Title]

(Include additional problems only if identified.)

Assessment Summary: [Summary of pertinent findings]

Nutrition Diagnosis (PES): [Problem] related to [Etiology] as evidenced by [Signs/Symptoms]

Clinical Reasoning: [Brief rationale]

Enteral Nutrition Prescription

Route/Access: [Gastric / Post-pyloric] via [Device to be used]

Formula: [Full product name], [kcal/mL], [Key characteristics if relevant such as fiber-containing or disease-specific]

Delivery Method: [Continuous / Cyclic / Bolus] via pump

Initiation and Advancement: Start at [mL/hr or bolus volume], advance by [increment] every [interval] to goal [mL/hr or regimen]; goal daily volume [mL/day]

Modular Protein: [Product], [dose], [frequency], [administration instructions] (If none indicated, state "None recommended.")

Water Flushes: [Scheduled flush volume and frequency]; [Medication flush guidance]; [Adjustments for fluid restriction if applicable]

Aspiration Risk Mitigation: [Head-of-bed elevation recommendation]; [Rationale for continuous vs bolus]; [Indication for post-pyloric access or prokinetics if relevant]

Hold Criteria: [Explicit parameters for holding feeds: recurrent vomiting, suspected aspiration, severe abdominal distension, escalating hemodynamic instability; if gastric residuals monitored per institutional policy, include threshold and action]

Procedure Coordination: [NPO windows and feed resumption guidance around anticipated procedures]

Refeeding Risk Assessment

Risk Level: [High / Moderate / Low / Unable to fully assess]

Plan: [If elevated risk: conservative initiation strategy, electrolyte monitoring frequency with focus on phosphorus/potassium/magnesium, thiamine supplementation if indicated] (If low risk, state: "No significant refeeding risk identified based on history and labs; standard monitoring.")

Monitoring Plan

• Clinical Tolerance: [N/V, abdominal exam, stool output/consistency, aspiration signs] — [Frequency] — [Responsible party]
• Laboratories: [Electrolyte monitoring frequency based on refeeding risk and clinical status; glucose monitoring if hyperglycemia concern]
• Nutrition Delivery: [Track percent of prescribed volume delivered; identify avoidable interruptions] — [Reporting cadence]
• Weight: [Frequency] (Note interpretation caveats for fluid shifts.)
• Tube Care: [Patency, site integrity, position verification per institutional policy]

Communication and Follow-up

• Notifications: [Primary team / RN / Pharmacy notified of recommendations]
• Orders: [Orders placed / Orders pended / Recommendations only]
• Provider Actions Needed: [Tube placement confirmation, medication orders, electrolyte replacement, or other items requiring action] (If none, state "None.")
• Reassessment: [Planned reassessment interval]
• Discharge Planning: [If discharge with EN anticipated: home regimen, supplies, caregiver training needs] (Omit if not applicable.)