Mickey Gastrostomy Tube Management Guideline Title: Skills Assessment: Mic-key Gastrostomy Tube Management Ref : 1807 Version 4 Document Author: Ratified by: Community Clinical Skills Facilitator Care and Clinical Policies Group Date 4 October 2016 Date: 21 December 2016 Review date: 10 March 2020 Links to policies: 1756 Percutaneous Endoscopic Gastrostomy (PEG) Tube Feeding and Medication Administration for Adults in a Community Setting. 0528 Nasogastric/Gastrosotomy Feeding (Inpatient) 0241 Fine Bore Nasogastric Tube Insertion 1. Purpose of this document 1.1. To assess competence of Registered Nurses, or patient specific carers who have been trained and assessed as competent changing the balloon water weekly and replacing a MIC-KEY gastrostomy tube 2. Assessment Guideline: 2.1. All Registered staff undertaking these procedures must be familiar with Torbay and South devon NHS Foundation Trust (TSDFT) Policy 1756 2.2. Each ward/department should hold a reference copy of Guidelines in a designated easily accessible file. 2.3. All Guidelines should be available on TSDFT website, and internal Trust website 2.4. Superseded versions of guidelines should be removed from the web sites and replaced with the reviewed copy when ratified. 2.5. Any member of staff who becomes aware of new evidence which may cause review of the existing guidelines should contact either the author or the Clinical Governance team 2.6. Only staff who are signed off as competent using this guideline can undertake these procedures. 3. Training: 3.1 Training will be provided by the community clinical skills facilitators in the Ecsel Team at either the Horizon Centre or in the community setting, and by the Nutrition Specialist Nurses at Torbay Hospital. Version 4 (March 2017) Page 1 of 8
Competency sheet: Changing the water in a MIC-KEY Gastrostomy Tube CANDIDATE: DATE: Procedure 1 st Assessment 2 nd Assessment Assessors Signature Gains consent from the Patient or relevant carer Cleans hands using 6 step technique, and puts on disposable gloves Cleans the PEG Tube site with cooled boiled water, or saline and gauze, taking debris out away from the site. Checks the balloon valve is clean and intact Using a sterile 5ml Luer slip syringe, accesses the balloon valve, and withdraws 5ml of water from the retaining balloon Version 4 (March 2017) Page 2 of 8
Procedure 1 st Assessment 2 nd Assessment Assessors Signature Draws up 5ml of sterile water for injection in another 5ml luer slip syringe, using clean no-touch technique Inserts the syringe into the balloon valve, and re-inflates the retaining balloon Removes the syringe and cleans the balloon access port again. Makes the patient comfortable, then disposes the syringes as per Trust Waste Disposal Guidelines Documents the amount of water withdrawn from the balloon, and contacts the Nutrition team, or DN, if it is less than 3mls as the balloon may be perished and need changing Version 4 (March 2017) Page 3 of 8
PASS: metric Pump (Medical Devices) Study Day Signature: Date: If the assessor, or yourself, consider you need more practice, this should be documented in the comments box below: NEEDS PRACTICE: 1 st Assessment Comments: 2 nd Assessment Comments: Date competency achieved: Signature: Date: This document should be photocopied and kept on the staff members personal file for your reference. Version 4 (March 2017) Page 4 of 8
Competency sheet: Replacing a MIC-KEY Gastrostomy Tube Only to be undertaken by Personal Carers or Registered Nurses who have had training from the Nutrition Team CANDIDATE: DATE: Procedure 1 st Assessment 2 nd Assessment Assessors Signature Checks documentation regarding the change date for the MIC-KEY Tube Washes hands and puts on disposable gloves Prepares a clean surface with clinical antiseptic wipes Removes the new MIC-KEY Tube from the sterile package, and fills the 5ml luer slip syringe with 5ml of sterile water using clean notouch technique Inserts a 5ml luer slip syringe into the balloon port of the patient s gastrostomy tube, and draws back the water. Checks the amount of water withdrawn, and disposes of the syringe and water Version 4 (March 2017) Page 5 of 8
Procedure 1 st Assessment 2 nd Assessment Assessors Signature Gently removes the gastrostomy tube from the patient s stomach, turning the tube during removal. Uses a small amount of water soluble lubricant in the tract to assist removal if necessary. Lubricates the tip of the new MIC- KEY tube with a water soluble lubricant, and inserts the new tube into the tract Inserts 5ml of sterile water into the new balloon and gently pulls the MIC-KEY tube up and away from the patients skin until it stops to ensure it s secure Inserts a MIC-KEY extension set into the FEEDING port and listens for air, or aspirates residual stomach contents as shown by the Nutrition Nurses in training If not already attached, put on a new catheter bag and secure with G-straps or statlock Cleans any fluid or lubricant from the patient s stoma and tube Dispose of clinical waste, remove gloves, washes hands and documents the procedure Version 4 (March 2017) Page 6 of 8
PASS: Signature: Date: ** If the assessor, or yourself, consider you need more practice, this should be documented in the comments box below: NEEDS PRACTICE: 1 st Assessment Comments: 2 nd Assessment Comments: Date competency achieved: Signature: Date: Competency Date Signature of Assessor: I confirm I have been competency assessed following training and feel confident to undertake this procedure Client/ Representative/ Carers Signature: Date: Version 4 (March 2017) Page 7 of 8
4. References: The Royal Marsden Hospital Manual of Clinical Nursing Procedures 9 th Ed. (2015) Oxford Handbook of Clinical Skills in Adult Nursing (2009) Skills for Health (2008) EPIC 3 Guidelines (2016) Amendment History Issue Status Date Reason for Change Authorised 3 1 vember 2014 Community Skills Facilitator 4 Ratified 10 March 2017 2 Yearly Update Care and Clinical Policies Group 4 20 February 2018 Review date extended from 2 years to 2 years Version 4 (March 2017) Page 8 of 8
The Mental Capacity Act 2005 The Mental Capacity Act provides a statutory framework for people who lack capacity to make decisions for themselves, or who have capacity and want to make preparations for a time when they lack capacity in the future. It sets out who can take decisions, in which situations, and how they should go about this. It covers a wide range of decision making from health and welfare decisions to finance and property decisions Enshrined in the Mental Capacity Act is the principle that people must be assumed to have capacity unless it is established that they do not. This is an important aspect of law that all health and social care practitioners must implement when proposing to undertake any act in connection with care and treatment that requires consent. In circumstances where there is an element of doubt about a person s ability to make a decision due to an impairment of or disturbance in the functioning of the mind or brain the practitioner must implement the Mental Capacity Act. The legal framework provided by the Mental Capacity Act 2005 is supported by a Code of Practice, which provides guidance and information about how the Act works in practice. The Code of Practice has statutory force which means that health and social care practitioners have a legal duty to have regard to it when working with or caring for adults who may lack capacity to make decisions for themselves. The Act is intended to assist and support people who may lack capacity and to discourage anyone who is involved in caring for someone who lacks capacity from being overly restrictive or controlling. It aims to balance an individual s right to make decisions for themselves with their right to be protected from harm if they lack the capacity to make decisions to protect themselves. (3) All Trust workers can access the Code of Practice, Mental Capacity Act 2005 Policy, Mental Capacity Act 2005 Practice Guidance, information booklets and all assessment, checklists and Independent Mental Capacity Advocate referral forms on icare http://icare/operations/mental_capacity_act/pages/default.aspx Infection Control All staff will have access to Infection Control Policies and comply with the standards within them in the work place. All staff will attend Infection Control Training annually as part of their mandatory training programme. Skills Assessment: Mic-key TM Gastrostomy Tube Management Version 4 (March 2017) The Mental Capacity Act 2005 Page 1 of 1
Quality Impact Assessment (QIA) Please select Who may be affected by this document? Patient / Service Users Yes Visitors / Relatives Yes General Public Voluntary / Community Groups Trade Unions GPs NHS Organisations Police Councils Carers Yes Staff Yes Care Agencies Yes Others (please state): Many patients with these enteral tubes have private carers Does this document require a service redesign, or substantial amendments to an existing process? If you answer yes to this question, please complete a full Quality Impact Assessment. Are there concerns that the document could adversely impact on people and aspects of the Trust under one of the nine strands of diversity? Age Disability Gender re-assignment Pregnancy and maternity Marriage and Civil Partnership Race, including nationality and ethnicity Religion or Belief Sex Sexual orientation If you answer yes to any of these strands, please complete a full Quality Impact Assessment. If applicable, what action has been taken to mitigate any concerns? Who have you consulted with in the creation of this document? te - It may not be sufficient to just speak to other health & social care professionals. Patients / Service Users Visitors / Relatives General Public Voluntary / Community Groups Trade Unions GPs NHS Organisations Police Councils Carers Staff Yes Other Statutory Agencies Details (please state): Needs reviewing by clinicians Version 4 (March 2017) Skills Assessment: Mic-key TM Gastrostomy Tube Management Quality Impact Assessment Page 1 of 1
Rapid Equality Impact Assessment (for use when writing policies and procedures) Policy Title : Skills Assessment: Mickey Gastrostomy Tube Management Version and Date October 2016 Version 4 Policy Author: Community Clinical Skills Facilitator An equality impact assessment (EIA) is a process designed to ensure that a policy, project or scheme does not discriminate or disadvantage people. EIAs also improve and promote equality. Consider the nature and extent of the impact, not the number of people affected. EQUALITY ANALYSIS: How well do people from protected groups fare in relation to the general population? PLEASE NOTE: Any Yes answers may trigger a full EIA and must be referred to the equality leads below Is it likely that the policy/procedure could treat people from protected groups less favorably than the general population? (see below) Age Disability Sexual Orientation Race Gender Religion/Belief (non) Gender Reassignment Pregnancy/ Maternity Marriage/ Civil Partnership Is it likely that the policy/procedure could affect particular Inclusion Health groups less favorably than the general population? (substance misuse; teenage mums; carers 1 ; travellers 2 ; homeless 3 ; convictions; social isolation 4 ; refugees) Please provide details for each protected group where you have indicated Yes. VISION AND VALUES: Policies must aim to remove unintentional barriers and promote inclusion Is inclusive language 5 used throughout? Are the services outlined in the policy/procedure fully accessible 6? Does the policy/procedure encourage individualised and person-centered care? Could there be an adverse impact on an individual s independence or autonomy 7? If Yes, how will you mitigate this risk to ensure fair and equal access? Yes Yes Yes Yes EXTERNAL FACTORS Is the policy/procedure a result of national legislation which cannot be modified in any way? What is the reason for writing this policy? (Is it a result in a change of legislation/ national research?) To assess competence of Registered Nurses preparing and administrating Intravenous Drugs Who was consulted when drafting this policy/procedure? What were the recommendations/suggestions? Members of the Care & Clinical Policies Group and Registered Nurses ACTION PLAN: Please list all actions identified to address any impacts Action Person responsible Completion date AUTHORISATION: By signing below, I confirm that the named person responsible above is aware of the actions assigned to them Name of person completing the form Community Clinical Skills Signature Facilitator Validated by (line manager) Signature Skills Assessment: Mic-key TM Gastrostomy Tube Management Rapid Equality Impact Assessment Version 4 (March 2017) Page 1 of 1