Enteral nutrition (EN) provides nutrients through a feeding tube for individuals who cannot meet their nutrition needs orally, yet retain adequate digestive and absorptive function. These patients are vulnerable to EN-related adverse events (e.g. infectious, metabolic, gastrointestinal, and nutrition complications) that can result in increased morbidity and mortality. Nonetheless, research has identified numerous medical, nutrition, and cost benefits when EN is used appropriately. A government report concluded the use of early EN in critically ill and surgical patients has great potential to improve patient outcomes and there is strong evidence to support its widespread implementation. Yet, many healthcare practitioners lack up-to-date training to deliver EN in the safest and most effective manner. In part, this is because mastery of evidence-based knowledge and specialized skills can be challenging and time consuming to learn; and a comprehensive, interdisciplinary EN training program is not widely available. For this Phase I SBIR proposal, Medantic Technology ([MT], a medical education software company) will collaborate with the American Society for Parenteral and Enteral Nutrition ([A.S.P.E.N.], a professional nutrition society) to develop the prototype of a Web-based, self-directed Enteral Nutrition Practitioner Tutorial (ENPT). ENPT will employ principles of active learning in a multi-modal distance-learning platform using evidence-based didactic presentations, interactive patient simulations, applications of clinical reasoning skills, and formative feedback to enhance end users' core competencies for the best practice delivery of EN. This Phase I effort will provide proof-of-feasibility and lay the foundations for Phase II development of the ENPT product and research of its pedagogical effectiveness.
The specific aims of the Phase I project are to 1) design the ENPT curriculum, 2) identify key software features, 3) prepare the content development plan, 4) build and demonstrate the ENPT prototype, and 5) design the Phase II research plans. Completion and evaluation of ENPT in Phase II will provide a much-needed training resource for healthcare practitioners and fulfill the goals of: 1) promoting safe practices to maximize the potential benefits and reduce preventable EN-related complications, and 2) providing a research opportunity to identify educational methods that most effectively influence EN-related practice behaviors. By applying medical and behavioral research to help reduce the nation's burden of illness, this project is consistent with the mission of NIH. Furthermore, this proposal offers an innovative approach to help fulfill the key healthcare aims set forth by the Institute of Medicine's (IOM) Quality Chasm reports by promoting safe, effective, patient-centered, timely, efficient, and equitable care to the increasing number of patients who require EN in institutional and home care settings. Project Relevance: a fundamental objective of medical education is to assure that healthcare practitioners incorporate best practice research into routine patient care in a timely manner. The product to be developed, an Enteral Nutrition Practitioner Tutorial (ENPT), will offer innovative computer-assisted instruction (CAI) to facilitate healthcare practitioners' ability to translate evidence-based EN research into practice behaviors and system-wide protocols and guidelines. Medantic Technology (MT) believes that: 1) the most dramatic public health implications of the proposed ENPT will be to maximize the potential benefits of EN, while reducing the incidence of preventable adverse events associated with the delivery of EN and 2) research conducted in Phase II will demonstrate that use of the tutorial leads to favorable effects on practice behavior. ? ? ?
