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CH194-Enteral Feeding Policy

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Enteral Feeding Policy

1. Purpose

The purpose of this policy is to ensure that all enteral feeding provided by {{org_field_name}} is carried out safely, hygienically, and in a way that promotes the dignity, wellbeing, and person-centred needs of the individuals we support. Enteral feeding, which includes the delivery of nutrition via nasogastric (NG), percutaneous endoscopic gastrostomy (PEG), or jejunostomy (JEJ) tubes, is a critical clinical task requiring robust governance and highly competent care. This policy supports compliance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, including Regulation 9 (Person-Centred Care), Regulation 10 (Dignity and Respect), Regulation 11 (Need for Consent), Regulation 12 (Safe Care and Treatment), Regulation 14 (Meeting Nutritional and Hydration Needs), Regulation 17 (Good Governance), Regulation 18 (Staffing), and Regulation 20 (Duty of Candour), together with current CQC guidance and assessment expectations relevant to safe systems of care, medicines optimisation, infection prevention and control, staffing, and governance.

2. Scope

This policy applies to all staff involved in the assessment, planning, support, monitoring, documentation, escalation or oversight of enteral feeding within the service, including care staff, senior carers, nurses where employed, team leaders, care coordinators, trainers, quality leads, the Registered Manager and Deputy Manager.

This policy applies to people receiving enteral feeding support in the home’s care setting and covers nasogastric (NG), gastrostomy (including PEG) and jejunostomy/jejunal feeding where the service has assessed that the individual’s needs can be met safely.

Only staff who have received role-appropriate training, have been assessed as competent, and have been authorised by the provider to undertake specific enteral feeding tasks may do so. Staff must work within the limits of their role, competence, delegated responsibilities and current care plan instructions at all times.

3. Related Policies

4. Policy Statement and Principles

4.1 Individualised Assessment, Risk Assessment and Care Planning

Before enteral feeding support is provided, the service must ensure that a current assessment and written care plan are in place, informed by relevant healthcare professionals such as the dietitian, speech and language therapist (where relevant), GP, community nurse, hospital team or other appropriately qualified clinician.

The care plan must be person-centred and must clearly set out:

A documented risk assessment must support the care plan and must be reviewed at regular intervals, after any incident, after hospital discharge, after any change in prescribed feed or medicines, and whenever the person’s condition, capacity, preferences or needs change.

4.2 Consent and Mental Capacity

Valid consent must be obtained before enteral feeding support or medicines administration via an enteral tube is provided. Consent must be obtained lawfully and by a member of staff who has the knowledge and understanding required to explain the proposed care or treatment, its purpose, and any relevant risks, in a way the individual can understand.

Consent must be recorded in the care plan and reviewed routinely, and whenever the person’s wishes, communication needs, clinical condition or capacity may have changed.

Where a person lacks capacity to make a specific decision about enteral feeding or medicines administration, the service must act in accordance with the Mental Capacity Act 2005. Any capacity assessment, best-interest decision, involvement of family members, attorneys, deputies, advocates or other relevant persons, and the rationale for the decision must be clearly documented.

Staff must not provide unsafe or inappropriate care simply because the person, or another person, appears to consent to it. Where there is doubt about capacity, consent, best interests or legal authority, staff must seek management and professional advice before proceeding unless immediate action is required to prevent serious harm.

4.3 Safe Administration and Monitoring

Enteral feeding must only be undertaken by staff who are trained, assessed as competent, and authorised to undertake the specific task for the specific person. Care and treatment must be delivered in a safe way and staff must do all that is reasonably practicable to reduce risks to the individual’s health, safety and welfare.

Before each feed, staff must check the current care plan, prescription or professional instructions and confirm that:

During and after feeding, staff must monitor for pain, distress, nausea, vomiting, diarrhoea, constipation, leakage, blockage, coughing, choking, breathing difficulty, signs of aspiration, intolerance, dehydration, skin or stoma-site concerns, and any other change in condition.

Feeding must be stopped and advice sought immediately if there is any concern about tube position, tube damage, blockage, dislodgement, intolerance, aspiration, deterioration in the person’s condition, or any discrepancy between the care plan and the task to be undertaken.

Where responsibility for care is shared with community nurses, hospital teams or other clinicians, the service must work with those professionals to ensure timely care planning, safe delegation, clear escalation arrangements and continuity of care.

Staff must never improvise feeding instructions or vary the prescribed regimen unless this has been clearly authorised by an appropriate prescriber or clinician and recorded.

4.4 Infection Prevention and Equipment Care

All feeding equipment must be handled in accordance with our CH17 – Infection Prevention and Control Policy. This includes:

Care staff must follow current infection prevention and control requirements, manufacturer instructions, and any person-specific clinical guidance when handling, cleaning, storing and replacing feeding equipment. Staff must monitor the insertion or stoma site for redness, swelling, leakage, bleeding, discharge, odour, pain, skin breakdown or other signs of infection or deterioration, record findings clearly, and escalate concerns promptly in line with the care plan and clinical advice.

4.5 Staff Competency, Supervision and Training

The service must deploy sufficient numbers of suitably qualified, competent, skilled and experienced staff to meet people’s enteral feeding needs safely at all times.

Only staff who have completed role-appropriate training and a documented competency assessment may undertake enteral feeding tasks. Competency must be assessed before the staff member undertakes the task unsupervised, and reassessed at least annually, after any significant incident, after any prolonged period without performing the task, after any change in the person’s needs or equipment, or where there is concern about practice.

Training and competency assessment must include, as appropriate:

Staff competence, supervision, refresher training and any restrictions on practice must be documented and auditable.

4.6 Dignity, Respect and Communication

Care staff must deliver enteral feeding in a manner that preserves dignity, privacy, and comfort. Individuals must be involved in every stage of their care, encouraged to express their wishes, and supported with communication aids if needed. The impact of enteral feeding on emotional well-being, social inclusion and body image is acknowledged and support offered as needed.

Information about enteral feeding support must be given in a format the person can understand, with reasonable adjustments and communication support provided where needed, so that the person can participate as fully as possible in decisions about their care.

4.7 Medication via Enteral Feeding

Medicines must only be administered via an enteral feeding tube where this has been clearly authorised by the prescriber or another appropriate healthcare professional and where specific written guidance is available on how each medicine is to be prepared and administered safely.

Staff must never assume that a medicine can be crushed, opened, diluted or administered via a feeding tube. Staff must not crush tablets, open capsules, mix medicines into feed, or alter a medicine’s form unless an appropriate healthcare professional has confirmed that this is safe and suitable for that individual and route.

Each medicine must be administered separately. The tube must be flushed before and after each medicine, and between medicines, in accordance with the person’s care plan and clinical instructions. The volume of water used for flushing must be clearly recorded and must take account of any fluid restriction.

Medicines must not be prepared in advance for later administration and must not be left unattended. Staff must check whether the person can still take any medicines by mouth, where clinically appropriate, even if they receive nutrition via a tube.

The care plan and medicines records must include:

The service must work with prescribers, pharmacy professionals and other relevant clinicians to ensure medicines are reviewed regularly and remain safe, appropriate and effective.

4.8 Emergency Situations, Escalation and Duty of Candour

Staff must be alert to complications including suspected misplacement, blockage, leakage, dislodgement, aspiration, vomiting, diarrhoea, constipation, dehydration, intolerance, infection, bleeding, severe pain, respiratory distress, collapse or sudden deterioration.

In the event of a concern, staff must immediately take the action specified in the care plan and training, which may include stopping the feed, stopping medicines administration, positioning the person safely, seeking urgent clinical advice, contacting emergency services, contacting the community nurse or out-of-hours service, and informing the Registered Manager or on-call manager without delay.

All incidents, near misses and concerns must be recorded promptly, investigated proportionately, and reviewed for lessons learned and service improvement.

Where an incident meets the threshold for a notifiable safety incident or otherwise triggers the statutory duty of candour, the provider must act in an open and transparent way with the person and/or their relevant representative, including an apology, an explanation of what is known, and a clear record of the actions taken in response.

4.9 Record Keeping, Information Sharing and Confidentiality

Accurate, complete, contemporaneous and legible records must be maintained in relation to enteral feeding support. Records must be securely stored and shared appropriately in line with confidentiality, data protection and information-governance requirements.

Records must include, where relevant:

Records relating to enteral feeding must be audited regularly as part of the provider’s governance system.

4.10 Multi-Agency Collaboration, Shared Care and Transitions

The service will work collaboratively with GPs, dietitians, speech and language therapists, pharmacists, community nurses, hospital teams, discharge coordinators and other relevant professionals to establish and maintain safe systems of care.

Where responsibility for care is shared or transferred, the service must ensure there are clear and timely arrangements for handover, delegation, review, escalation, supply of feed and equipment, medicines guidance, and communication of changes in risk or treatment. Continuity and safety must be maintained during admission, discharge, transfer, respite and any other transition between services.

4.11 Governance, Audit and Quality Assurance

The provider will operate effective governance systems in relation to enteral feeding to assess, monitor and improve the quality and safety of the service. This will include regular audit of care plans, risk assessments, consent records, feeding charts, fluid records, MAR entries, incident reports, training, competency assessments and supervision records.

Audit findings must be reviewed by the management team, actions must be recorded and followed through, and themes or repeated concerns must be addressed through learning, supervision, policy review, training, clinical liaison or other service improvement measures.

The service will seek and act on feedback from people using the service, relatives where appropriate, staff and relevant healthcare professionals to improve the safety, effectiveness and experience of enteral feeding support.

4.12 Service Capability and Safe Acceptance of Care Packages

The service will only accept, commence or continue enteral feeding support where it has assessed that the individual’s needs can be met safely, with appropriate staffing, training, competency, equipment, professional input and governance oversight.

Where the provider is unable to meet the person’s needs safely, or where clinical input, equipment supply, prescribed instructions or staff competence are insufficient, the concern must be escalated immediately and the provider must work with commissioners, families and healthcare professionals to agree safe interim arrangements or alternative provision.

5. Policy Review

This policy will be reviewed at least annually and sooner where required by changes in legislation, CQC guidance, national clinical guidance, medicines safety information, incident trends, audit findings, safeguarding concerns, complaints, duty of candour events, service-user feedback, or changes to the nature of the service provided.

Any review will consider whether the policy remains effective in ensuring safe care and treatment, lawful consent, safe medicines administration, appropriate staffing, robust governance and person-centred support. Updated versions will be communicated to relevant staff and reflected in training, supervision, competency assessment and quality assurance activity.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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