A315 FREQUENCY AND PREDICTORS OF FASTING ORDERS IN INPATIENTS WITH ULCERATIVE COLITIS: THE AUDIT OF DIET ORDERS - ULCERATIVE COLITIS (ADORE-UC) STUDY

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Abstract

Background: Current clinical practice guidelines suggest that ulcerative colitis (UC) patients admitted due to a disease flare should be offered a normal diet or enteral nutrition unless such a diet is not tolerated. Despite this recommendation, concerns about iatrogenic malnutrition from unjustified NPO or clear liquid diet (CLD) orders exist. Aims: We aim to describe the frequency and audit the appropriateness of NPO and CLD orders among hospitalized UC patients and identify predictors of unjustified fasting. Methods: We conducted a retrospective cohort study of all UC patients who were admitted to the gastroenterology (GI) service or the general internal medicine (GIM) service at an academic hospital between January 2009 and December 2014. The frequency and duration of bowel rest orders and the number of meals missed because of these orders were assessed. Bowel rest orders were considered justified if the patient had intractable nausea or vomiting, pancreatitis, bowel obstruction, toxic megacolon or were awaiting endoscopy, or if alternative enteral or parenteral nutrition was provided. Patients with unjustified fasting orders were identified and the number of missed meal opportunities was measured. A logistic regression model was used to assess predictors of unjustified fasting in admitted UC patients. Results: A total of 187 admissions in 158 UC patients were identified during the study period and included in the final analysis. The majority of the admissions were under the GI service (148/187, 79.1%). The mean age at admission was 35.0 years (standard deviation [SD] = 15) and 83/158 (52.5%) were female. The median length of stay was 8 days (interquartile range [IQR]