CHS17.2012 Carry out extended feeding techniques to ensure individuals nutritional and fluid intake

Overview

This standard covers feeding individuals using techniques other than oral feeding. These methods include Percutaneous Endoscopic Gastrostomy (PEG) feeds, nasogastric (NG) tube feeds and subcutaneous fluid infusions. This standard does not cover intravenous techniques for giving fluids. Users of this standard will need to ensure that practice reflects up to date information and policies. Version No 2

Knowledge and Understanding

You need to know and understand:

1. the current European and National legislation, national guidelines, organisational policies and protocols in accordance with any Clinical/Corporate Governance which affect your work practice in relation to carrying out extended feeding techniques
2. your responsibilities and accountability in relation to the current European and National legislation, national guidelines and local policies and protocols and any Clinical/Corporate Governance
3. the duty to report any acts or omissions in care that could be detrimental to yourself, other individuals or your employer
4. the importance of applying standard precautions to carrying out extended feeding techniques to ensure individual's nutritional and fluid intake and the potential consequences of poor practice
5. the importance of working within your own sphere of competence and seeking advice when faced with situations outside your sphere of competence
6. the anatomy and physiology of the gastro-intestinal tract pertinent to the feeding methods being undertaken
7. the types of pathogens specific to the upper gastrointestinal tract
8. potential sources of contamination when undertaking extended feeding techniques and appropriate measures to reduce or deal with them
9. the potential consequences of contamination of feeds and equipment used for extended feeding
10. issues linked to individual's beliefs, values and faiths which influence and impact upon diet and nutritional intake
11. the impact this type of feeding will have on individuals
12. a variety of conditions and situations where feeding may be undertaken by extended methods
13. other staff who may be involved with the nutritional and fluid intake of individuals
14. why fluid intake and balance is vital to the health of individuals
15. why you need to monitor fluid and nutritional intake
16. the adverse effects which may occur during and following procedures and how to identify and deal with these
17. the contra-indications which suggest you may need to stop and seek help and advice
18. how contra-indications may differ for different individuals, conditions and those from different ethnic groups
19. the equipment and materials required for the types of extended feeding techniques relevant to your work area
20. the different types of feed available for the types of extended feeding techniques relevant to your work area
21. how a variety of feeding tubes are put in place and the preparation of the individual for the procedure
22. how to monitor, improve and maintain nutritional and fluid needs of individuals
23. methods used to ensure the extended feeding equipment is correctly positioned prior to feeding
24. the importance of maintaining the correct level of cleanliness for extended feeding techniques
25. the importance of following procedures for extended feeding techniques exactly as specified, and the potential effects of not doing so
26. the importance of packing up used equipment and materials and covering receptacles containing body fluids prior to leaving the immediate care area
27. how and where to dispose of:
    1. used equipment, materials and feeds
    2. body fluids aspirated prior to feeding
28. the importance of immediately reporting any issues which are outside your own sphere of competence without delay to the relevant member of staff
29. the following regarding records:
    1. the importance of keeping accurate and up to date records
    2. the specific records required for reporting on gastric aspirate and the removal of nasogastric tubes

Performance Criteria

You must be able to:

1. apply standard precautions for infection prevention and control any other relevant health and safety measures
2. check the individual's identity and the confirm the planned activity
3. give the individual relevant information, support and reassurance in a manner which is sensitive to their needs and concerns
4. gain valid consent to carry out the planned activity
5. involve the individual and others throughout the procedure
6. confirm all equipment and materials for carrying out extended feeding techniques is:
   1. appropriate to the procedure
   2. fit for purpose
7. ensure the individual is positioned in a way that will:
   1. ensure their safety and comfort
   2. facilitate the method of extended feeding
8. ensure the feeding tube is in the correct position according of the type of tube being used
9. carry out the extended feeding:
   1. at an appropriate time according to the individual's plan of care
   2. using appropriate techniques
   3. using equipment in line with manufacturer's instructions
   4. in a manner which optimises the patient's comfort and dignity and minimises pain and trauma
10. observe the individual throughout the activity, recognise and report any condition or behaviour which may signify adverse reactions to the activity and take the appropriate action
11. ensure that adequate and relevant fluids, feeds and equipment are stocked in the care environment to meet immediate future needs, re-ordering as appropriate
12. complete all documentation as required and report any findings about the process and the individual which may have an impact on their care plan and subsequent care
13. ensure the extended feeding tubes are securely attached in a way that prevent discomfort and promotes dignity of the individual
14. ensure the individual is made comfortable following extended feeding techniques and dispose of waste according to agreed procedures

Additional Information

This standard links with the following dimension within the NHS Knowledge and Skills Framework (October 2004): Dimension: HWB5 Provision of care to meet health and wellbeing needs