Nutrition support is one of the most high-risk and high-impact areas of clinical nutrition. Even the most dedicated dietitians can make mistakes when managing patients on tube feeds or parenteral nutrition (PN). Whether you’re brand new to this specialty or want to sharpen your clinical skills, here are the most common mistakes dietitians make in this area, and how to avoid them:
1. Underhydrating Tube-Fed Patients
Hydration often takes a backseat during tube feeding calculations. Many dietitians forget to include appropriate water flushes, IV fluids, or adjust for increased needs (fever, GI losses, etc.). This can lead to dehydration, electrolyte imbalances, and poor outcomes.
2. Making Mistakes During Tube Feeding Calculations
Errors in enteral nutrition calculations, whether its calories, total volume, protein, or infusion rate, are surprisingly common. It can be tricky to keep all the numbers straight, especially when comparing multiple formulas, ordering for complex patients, and altering tube feeding prescriptions.
3. Being Too Timid to Recommend Tube Feeding or PN
Many dietitians wait for the physician to bring up nutrition support, instead of leading the charge. This can delay interventions and worsen malnutrition.
4. Jumping Into Nutrition Support Without Aligning with Goals of Care
Sometimes, we’re so eager to do something for the patient that we forget to ask: Does this align with their wishes and goals of care? Autonomy is the #1 principle of Western medicine, and it’s important to uphold this at all times. We shouldn’t let our desire to feed patients, our personal convictions, or our individual beliefs and opinions get in the way of providing patient-centered care. Additionally, patients may desire aggressive treatment, including nutrition support, at the end of life. It can be very difficult to navigate these situations and communicate appropriately with terminally ill patients, family, and the interdisciplinary team.
5. Overlooking Transitions to Home or Post-Acute Care
Discharging a patient on tube feeding or PN isn’t as simple as placing an order. There are logistical, educational, and insurance barriers that most of us didn’t learn in our internships.
Inside the Nutrition Support Skills Course, you’ll learn how to calculate fluid needs step by step, and ensure your patients are adequately hydrated through formula, flushes, and other sources. You’ll also learn about acid/base balance, and how to approach acid/base disorders. You’ll master enteral nutrition calculations through practice problems, real-life case studies, and detailed calculation guides, so you can get the math right every single time. I help you build the clinical confidence to advocate for tube feeding or PN based on ASPEN guidelines. No more second-guessing yourself!
The Course Teaches You:
- How to critically assess whether nutrition support matches the patient’s medical condition and goals of care, and how to initiate the right conversations with the care team. Earn 1 ethics CPE for completing the ethics module (1 ethics CPE is required by CDR every 5-year cycle).
- Real-world discharge planning, including transitioning patients from one care setting to another (for even more on this, check out my CNSC Exam Study Guide).
- Master tube feeding and parenteral nutrition math with my detailed calculation guides and TPN Calculation Cheat Sheet. I teach you a tried and true method for calculations that has helped hundreds of students world-wide.
Why This Matters
These are common challenges real dietitians face in clinical practice, and I noticed many of these same gaps in traditional nutrition support training. That’s why I build the Nutrition Support Skills Course, the first ever online course designed to educate and empower clinical dietitians. Most nutrition support courses on the market teach “classic” topics such as malnutrition, medical nutrition therapy, PES statements, and ASPEN guidelines for initiating nutrition support. But, students kept coming to me having completed traditional courses and feeling frustrated by a lack of emphasis on real-world scenarios
Students came to me with questions like:
Ok, so I know when we should start TPN on this patient, but how do I advocate to feed them when the doctor doesn’t agree?
How do I address a provider who places consults for low albumin?
What happens when the team doesn’t want to feed a patient who is obese and has a wound and has been NPO for 7 days?
Math isn’t my strong suite, and it takes me hours to calculate a TPN order.
I have a new job as an entry-level clinical dietitian, but my internship didn’t teach tube feeding calculations, and the other dietitians here all do their math differently. None of it makes sense!
This isn’t just a theoretical course, it’s a hands-on, practical training designed for working dietitians who want to:
- Build mastery in enteral and parenteral nutrition
- Learn to calculate and troubleshoot EN & PN with confidence
- Navigate real-life scenarios, from ICU to rehab facilities
- Advocate effectively for timely nutrition interventions
- Feel confident and competent in complex cases
Avoiding these common nutrition support mistakes isn’t about being perfect, it’s about being prepared. With the right knowledge, support, and tools, you can step into the nutrition support space with confidence.
Whether you’re prepping for the CNSC exam or managing complex patients, the Nutrition Support Skills Course is the foundation you need to take your clinical skills to the next level.
