Adult Enteral Feeding guidelines

Transcription

1 Adult Enteral Feeding guidelines Full Title of Guideline: Adult Enteral Feeding guidelines Section 10.0 Procedure for discharging patients on Home Enteral feeding Author (include and role): Anne How (Therapy Service Manager in Dietetics) Tracey Buchanan (Nutrition Nurse) Division & Speciality: Clinical Support (Therapy Services) Scope (Target audience, state if Trust wide): Surgery (Nutrition) Trust Wide Review date (when this version goes out 01/04/2022 of date): Explicit definition of patient group to which it applies (e.g. inclusion and exclusion criteria, diagnosis): Changes from previous version (not applicable if this is a new guideline, enter below if extensive): All adult patients who are being considered for or are receiving enteral nutrition Structural changes Some changes made in some sections based on recently published NHS Improvement documents See references Summary of evidence base this guideline has been created from: This guideline has been registered with the trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt contact a senior colleague or expert. Caution is advised when using guidelines after the review date or outside of the Trust. Section Content Page 10.0 PROCEDURE FOR DISCHARGING PATIENTS ON HOME ENTERAL FEEDING Discharge planning tasks and person(s) responsible for completing Nasogastric tube discharge checklist 4 Nasojejunal discharge checklist 5 2 Timing of discharge 6 Avoiding future a&e visits with tube/stoma related problems 6 1

2 10.0 PROCEDURE FOR DISCHARGING PATIENTS ON HOME ENTERAL FEEDING Before discharging patients home on enteral feeding it is important to ensure that their feeding can be safely managed in the community and that they or their carers have the following information: How to care for and manage a stoma, feeding tube and infusion devices. How to manage common problems. How to get assistance in the case of emergencies or problems they cannot deal with such as blocked or displaced tubes (both in and out of normal working hours). What to expect in terms of dietetic monitoring and follow up. TABLE 1: DISCHARGE PLANNING TASKS AND PERSON(S) RESPONSIBLE FOR COMPLETING: Task Inform the ward dietitian of any discharge planning as early as possible. Assess the patient s home circumstances and ability to manage the feed. Identify who will manage the stoma, tube and feeding at home. Inform the ward Dietitian as soon as discharge planning begins so that they can put everything in place as outlined below. Identify whether the patient will be under the local team or be out of area for dietetic follow up. If the patient will be out of area then liaise with the local team for follow up. Arrange for the feed company nurses to train the patient/carers/care home to manage the stoma, tube and feeding. Adjust the feeding regimen as appropriate to suit the patients home routine and circumstances. Ensure that the patient/carers have a plan of who to contact/where to go should their tube become displaced or blocked (see notes below). Person (s) responsible for completing task Ward nurse or medic Medics on referral for tube placement. Nutrition nurse during pre-peg assessment (if applicable) Ward nurses/discharge co-ordinator Discharging doctors Nutrition nurse (if involved) 2

3 If the patient has an NG or NJ tube then the relevant discharge checklist (see checklists below or ) should be used to ensure adequate plans are in place. Provide 7 days supply of feed and required feeding equipment/ancillaries for home. This should be increased to a 10 day supply if there will be a bank holiday during this time. Provide written information about enteral feeding and care of the tube, including the patients feeding regimen for home and appropriate contact numbers Register the patient with the homecare company for home deliveries of feed and ancillaries. Prescriptions for feed are not required for patients with a GP in a Nottinghamshire CCG. Hand over dietetic care of the patient to the relevant dietitian for follow up in the community to organise the supply. Ward nurses to check the patient leaves NUH with the supply on discharge. 3

4 Nasogastric Tube Discharge Checklist Yes No Is the patient/carer competent to administer feed via the nasogastric tube? Is the patient/carer aware of how to and competent to check the centimetre marking of the nasogastric tube to confirm position before commencing feeding? Is the patient/carer aware of how to and competent to aspirate and check the ph? Is the patient/carer aware of what to do if the tube moves or comes out? Is the patient/carer aware of what to do if the tube becomes blocked? Is the patient/carer aware that they should sit at a 45º angle while feeding or flushing the tube? Is the patient/carer aware not to commence feeding or flush the tube until the position is confirmed? Is the patient/carer aware of who to contact if any issues arise? All standards must be met for the patient to be discharged safely from acute to community care. Blockages/displacements which cannot be managed at home: It is very important that as part of discharge planning it is decided what the patient should do if they have a tube blockage or displacement which cannot be resolved at home. This needs to be discussed and decided with the discharging doctors. A&E visits should be avoided unless absolutely necessary. The best option will vary depending on the patients individual circumstances (eg whether they can also eat and drink, how mobile they are etc) and also where they are discharged from. There is no community service in Nottinghamshire to replace NG tubes in Adults. 4

5 Nasojejunal discharge checklist Yes No Has the pt/carer been trained by the Homeward nurses to administer their feed/flushes/meds and care for the tube? Is the pt/carer aware that they need to flush their tube 4 hourly (except when asleep at night) to help prevent blockages? Does the pt/carer know how to unblock the tube at home if it becomes blocked? Has the pt/carer been advised to change the dressing/fixation tape on their cheek and neck? (this only needs doing when it starts peeling off or looks dirty) Has a supply of dressings/fixation tape been arranged for the pt? Is the pt aware to contact their Homeward nurse or nutrition nurse if they feel the tube has moved more than 10cm? The patient has been clearly informed of what they should in this situation and this has been documented in the medical notes Blockages/displacements which cannot be managed at home: It is very important that as part of discharge planning it is decided what the patient should do if they have a tube blockage or displacement which cannot be remedied at home. This needs to be discussed and decided with the discharging doctors. A&E visits should be avoided unless absolutely necessary. The best option will vary depending on the patients individual circumstances (eg whether they can also eat and drink, how mobile they are etc) and also where they are discharged from. There is no community service in Nottinghamshire to replace NJ tubes. 5

6 10.2 TIMING OF DISCHARGE The above tasks should be completed as early as possible to avoid any delays in discharge. If the patient is not stable on their feed or they/their carers have not been adequately trained to manage their feeding, stoma and tube safely then discharge may need to be delayed until safe AVOIDING FUTURE A&E VISITS WITH TUBE/STOMA RELATED PROBLEMS Most tube and stoma related problems can be dealt with in the community without the need for a hospital visit. Patients and carers must be fully informed about whom to contact/where to go if they have a problem with their feeding tube or stoma which they cannot resolve at home, both in and out of normal office hours. This needs to be planned before discharge and is particularly important with tubes which are more easily displaced such as NG/NJ/balloon retained tubes. All patients receive an information booklet on discharge with the relevant information and contact numbers. The most appropriate person to contact will vary depending on the individual circumstances of the patient, for example where they were discharged from, whether they remain under the care of a hospital consultant and their medical condition. If it is safe to do so (first consider the person s ability to take fluids, essential medications eg for epilepsy/parkinsons and the risk of hypoglycaemia in diabetic patients) then it may be appropriate for the patient to wait to contact the relevant person in normal office hours rather than trying to access help out of hours. 6