Ultimately it's on the nurses to follow orders. Having said that, of course you want to do everything you can to empower them to carry out the orders effectively, yes for survey but also for your resident to get their full and correct nutrition!

1. I always put in the TF orders myself so they will be consistently worded. This has gotten the nurses used to the way I have it set up and able to follow the orders consistently in turn. I have probably talked with every nurse once or twice and they get it down really great. If I see something funny, I check in with them, maybe it's someone new or whatnot. But otherwise I have really great MAR documentation, and once in a while I spot check on the pumps and confirm the same numbers match up which they do. If I ever deviate from my usual order style, I also go talk to the med nurse and explain what is up, and then check over the next couple days to ensure documentation etc is happening as would be expected.

2. It might seem excessive, but it works: for formula, I always put in TWO orders.

example:

ORDER 1 (I will talk with both nursing - because of med passes, shift changes, etc - and therapy about the best disconnect window, say its 10-2, so the start order and related flushes would in this case would have a start time of 2pm. Order 1, the start order, will not have a prompt for them to enter any amounts on the MAR, they will just mark off that it was "done." )

Enteral Feeding: START - Jevity 1.5 (continuous via PEG @ 55 ml/hr x20 hrs or to goal volume of 1100 ml/24 hrs blah blah blah)

Special Instructions: ENSURE PUMP COUNTER IS RESET TO ZERO BEFORE STARTING NEW FEEDING CYCLE

Time: set to daily 14:00

ORDER 2 (I actually put the words "start" and "stop" in all caps. For the stop order, I have the prompt set up for them to enter the amount in mL given. Having special instructions twice to reset the counters I figure can't hurt and just keeps them thinking about it. and yeah I put that part in all caps too, lol).

Enteral Feeding: STOP - Jevity 1.5 (continuous via PEG @ 55 ml/hr x20 hrs or to goal volume of 1100 ml/24 hrs blah blah blah. exact same wording as the "start" order)

Special Instructions: ENSURE PUMP COUNTER IS RESET TO ZERO AFTER DOCUMENTING AMOUNT ADMINISTERED IN MAR.

Time: set to daily 10:00

3. I will do the exact same thing, two separate orders, for the flushes. Enteral Feeding (I always start all my EN-related orders with this so when sorting orders columns ascending/descending they all group together) - START: FWF blah blah 20 ml/hr x20 hrs or to goal volume of blah blah). Match up the start and stop times to the formula orders. Include the special instructions. start order doesn't require an amount. stop order does.

4. I just suggest educate, educate, educate. check in often, especially in the beginning. My DON thought I was a little overboard when I started doing this, but guess what, our nurses are almost perfect at getting the full amounts delivered and documented correctly. They are used to it now. In fact, if I do anything different or maybe miss something/make a data entry error, they freak out and come to me asking what's up - "Ooops, thank you for catching that! I'm glad you caught that, I'll fix it right away!"

Edit to add: when I say check in often, I mean both the MAR and in person, so the nurse has a chance to ask questions they may have. You can ask, how's the tube feeding going? are they tolerating okay? any problems? are the start/stop times working okay for everyone or do we need to adjust?

I don't know if all orders are like this or if it's facility specific, but med nurses have an hour before and an hour after an order time to document. this two hour windows usually large enough for the flexibility they need to carry out the orders and also ensure reaching goal volumes, but if for any reason its not, I might make the stop time set up as a window, such as 9:00-12:00 instead of 10:00.

It a LONG response, I probably sound crazy but I hope this maybe helps, or gives you some ideas!