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Enteral Feeding Policy

1. Purpose

The purpose of this policy is to ensure that enteral feeding is managed safely, effectively, and in a manner that maintains the dignity, health, and well-being of individuals receiving care at {{org_field_name}}. Enteral feeding is used when a person is unable to meet their nutritional needs orally and requires feeding via a gastrostomy, jejunostomy, or nasogastric tube. This policy sets out the procedures for the assessment, administration, monitoring, and review of enteral feeding in accordance with the Regulation and Inspection of Social Care (Wales) Act 2016, relevant NICE guidance, the Health and Safety at Work Act 1974, and CIW regulatory expectations. Our approach ensures clinical competence, multidisciplinary working, person-centred care, and robust record-keeping, while promoting individual rights and reducing risks associated with enteral feeding.

2. Scope

This policy applies to all staff at {{org_field_name}} who are involved in the care of individuals receiving enteral feeding, including nurses, trained senior care staff, agency staff, and managers. It also applies to visiting healthcare professionals and contractors who provide enteral feeding services or support. The policy covers all forms of enteral feeding, including PEG (Percutaneous Endoscopic Gastrostomy), PEJ (Percutaneous Endoscopic Jejunostomy), and nasogastric (NG) tube feeding.

3. Related Policies

This policy should be read in conjunction with:
CHW07 – Person-Centred Care Policy
CHW11 – Safe Care and Treatment Policy
CHW12 – Meeting Nutritional and Hydration Needs Policy
CHW17 – Infection Prevention and Control Policy
CHW18 – Risk Management and Assessment Policy
CHW24 – Management of Accidents, Incidents, and Near Misses Policy
CHW13 – Safeguarding Adults from Abuse and Improper Treatment Policy
CHW39 – Mental Capacity and Deprivation of Liberty Safeguards Policy

4. Policy Details

4.1 Clinical Assessment and Authorisation
No enteral feeding intervention will be initiated without a full assessment by a relevant healthcare professional (e.g. dietitian, consultant, or speech and language therapist). The clinical rationale, method, type of feed, volume, rate, and schedule are confirmed in writing and reviewed regularly. A multidisciplinary plan is created and incorporated into the individual’s personal plan. All enteral feeding plans include information on feeding regime, fluid requirements, equipment used, positioning, risk of aspiration, and emergency procedures. Where appropriate, an Individual Health Care Plan (IHCP) is developed in collaboration with community nursing services.

4.2 Consent and Capacity
Informed consent must be obtained prior to initiating or continuing enteral feeding. Where the individual has capacity, staff must ensure they understand the purpose, risks, and alternatives. Where the person lacks capacity, a formal capacity assessment must be carried out and a best interests decision made in line with the Mental Capacity Act 2005 and CHW39. Families or advocates must be involved in the decision-making process as appropriate. All decisions must be documented, and care plans regularly reviewed.

4.3 Staff Training and Competence
Only staff who have been specifically trained and assessed as competent in enteral feeding may undertake related tasks, including administering feeds, managing equipment, flushing tubes, and observing for complications. Training must be provided by a qualified healthcare professional and include theoretical learning, observed practice, and competency sign-off. Competence is reviewed annually or more frequently if concerns are raised. The Registered Manager ensures that training records are up to date and that cover arrangements are in place when trained staff are not available.

4.4 Administration of Enteral Feeds and Fluids
Feeds are administered according to the individual’s care plan and professional guidance. Staff must:
Check the identity of the individual and ensure correct feed, volume, and time
Perform tube patency and placement checks (e.g. pH testing for NG tubes, visual checks for PEGs)
Position the person appropriately (minimum 30-45° angle) to reduce risk of aspiration
Flush the tube before and after feeding using sterile or cooled boiled water
Monitor for adverse reactions such as coughing, vomiting, abdominal pain, or distress
Ensure feed containers are labelled, in-date, and stored correctly
Record all feeds, flushes, and observations clearly on the relevant charts

Where feeding is pump-assisted, the pump must be checked for accuracy, cleaned regularly, and used in accordance with manufacturer instructions. Staff must be familiar with troubleshooting procedures and know when to contact clinical support.

4.5 Infection Prevention and Control
Enteral feeding presents a risk of infection if not managed hygienically. Staff must follow strict infection control protocols, including:
Washing hands and wearing gloves and aprons before and during the procedure
Cleaning the stoma site daily with warm water and drying thoroughly
Using sterile equipment and avoiding cross-contamination
Disposing of waste in line with CHW22 – Hazardous Substances Policy
Reporting and documenting any signs of infection or leakage immediately

All equipment, including giving sets, syringes, and feed containers, must be replaced as per manufacturer and local health board guidance.

4.6 Monitoring and Review
Individuals receiving enteral feeds are monitored for tolerance, nutritional outcomes, hydration, weight changes, and any clinical complications. Monitoring includes:
Regular weight checks and nutritional screening
Observation of bowel function and fluid balance
Monitoring skin integrity and pressure areas
Recording of all intake, output, and physical observations
Regular review by the dietitian or clinical nurse specialist

Any concerns, including signs of aspiration, discomfort, infection, or poor feed tolerance, are reported immediately and reviewed by the healthcare team. Feeding plans are updated promptly to reflect changes.

4.7 Equipment Management
All enteral feeding equipment is stored safely and securely. Each person has their own labelled equipment, and communal use is not permitted. Pumps and devices are serviced regularly and maintained in line with manufacturer specifications. Disposable items are used in accordance with clinical waste and infection control standards. Equipment faults must be reported to the Registered Manager immediately, and contingency plans (including manual feeding via gravity) are in place in case of pump failure.

4.8 Emergency Procedures
If a tube becomes dislodged, blocked, or damaged, or if the person shows signs of aspiration, vomiting, or difficulty breathing, staff must:
Stop the feed immediately
Reassure and support the individual
Seek urgent clinical advice or call 999 depending on severity
Document the incident and inform the next of kin or representative
Complete an incident form in line with CHW24 and notify CIW where required

All staff involved in enteral feeding receive emergency scenario training, including stoma site bleeding, dislodged tubes, and aspiration response.

4.9 Dignity, Comfort, and Person-Centred Care
Despite being a clinical intervention, enteral feeding must always be delivered with dignity and compassion. Staff must:
Speak respectfully and explain each step of the procedure
Ensure the individual is comfortable, clean, and positioned correctly
Involve the person in their care as much as possible
Support the person emotionally if they feel anxious or frustrated
Provide oral care regularly to promote comfort and hygiene

We encourage social inclusion and normal mealtime routines where appropriate. If others are eating, the person may join, and their feed can be discreetly administered.

5. Policy Review

This policy will be reviewed annually or sooner if clinical guidelines change, equipment standards are updated, or in response to a significant incident or regulatory recommendation. The policy ensures that {{org_field_name}} continues to deliver safe, high-quality, and person-centred care to individuals requiring enteral nutrition.

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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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