When a patient receiving enteral tube feeding in hospital is medically stable, they may be considered for discharge back to their own home or residential care. If appropriate the patient should be supported to self-manage their own feeding tube and tube feeding regimen. Where the patient is not able to self-manage then the patient's family or health/care agencies should be trained, and documented as competent to care for the patient's tube and administer the prescribed feed plan. Hospitals should have care pathways in place to support the safe discharge of patients on enteral tube feeding into the community setting within the local trust enteral feeding policy.
The list below is recommended information which may enhance a seamless transfer to the primary care setting:
- The individualised feed, fluid and medication regimen.
- The agreed method of feed delivery.
- Aftercare of the feeding tube and stoma site in line with tube manufacturer’s guidance.
- Infection control guidance to minimise infection risk from feed, hanging times, tube flushing and stoma aftercare, in line with local infection control policy.
- Trouble shooting guide on common tube, feed and stoma complications.
- Depending on local agreement, 7 or 14 days’ provision of feed, medication, tube ancillaries and feeding pump if appropriate.
- Contact details of the health professionals involved in the patient's care.
- Details of the service provision from the enteral feed contract provider to include delivery process, out of hours support, contact numbers and nursing service provision. This will vary dependent on local contract agreements.
Once home it is important that enteral feeding plans are designed to suit the patient’s individual circumstances. This will include the:
- appropriateness of both pump and bolus feeding.
- level of support the patient requires, if in their own home.
- patient’s daily routine with an aim to reduce the negative impact of home enteral feeding on their quality of life.
- timing of social, nurse or therapist visits.
- target nutritional intake for the patients as assessed by the dietitian.
Patients will require the provision of feed and ancillaries (such as syringes, giving sets and extension sets) in the community to enable them to continue with the feeding regimen. These can be provided via the local pharmacy and health professionals, or through the services of a home care delivery company.
It is best practice for patients on home enteral feeding to receive support from a well-coordinated multi-disciplinary team. This team may include a dietitian, nutrition nurse, dietetic/nursing assistants, and speech and language therapists. There is scope for health professionals to have extended roles to optimise the support the patient can receive.
The service supporting patients on home enteral feeding has a responsibility to:
- Facilitate the smooth transition from hospital to home.
- Monitor the nutritional status and make changes to the feed plan as indicated.
- Monitor the tube integrity and stoma health, initiating interventions as indicated.
- Respond to tube and stoma complications to avoid unnecessary hospital admissions, or for patient to be aware of the procedure if they experience such complications.
- Liaise with other health and social care professionals to resolve any nutritional or tube related issues.
- Where appropriate optimise the patient's capacity to meet their nutritional requirements via the oral route, to either reduce reliance on enteral feeding or expedite tube removal. This can be achieved by maintaining effective communication with health professionals in the hospital and community setting with regards the appropriateness of oral feeding.
- Coordinate specialist review if unable to resolve complications in the community.
Patients receiving home enteral feeding can experience all the complications described in the enteral feed complications section. Locally agreed care pathways should be in place to guide how any of the following complications are resolved:
- displaced, damaged or blocked feeding tube
- infected, leaking or over-granulated stoma site
- gastrointestinal disturbance such as diarrhoea, constipation, nausea or vomiting