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Registration Number: {{org_field_registration_no}}

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PEG Care and Management Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} provides safe, effective, and person-centred care for service users with Percutaneous Endoscopic Gastrostomy (PEG) feeding tubes. PEG feeding is essential for individuals who cannot consume food orally due to medical conditions, and it requires specialist knowledge, training, and strict hygiene procedures to prevent complications such as infections, blockages, and aspiration pneumonia.

This policy supports compliance with the legal and regulatory framework for domiciliary support services in Wales, including:

• Regulation and Inspection of Social Care (Wales) Act 2016.
• Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017 (as amended) and the Welsh Government statutory guidance for care home and domiciliary support services (last updated 27 March 2024).
• Duty of candour requirements under the 2017 Regulations and statutory guidance, including open and transparent engagement with individuals and their representatives when things go wrong.
• Social Services and Well-being (Wales) Act 2014, including person-centred care and wellbeing outcomes.
• Social Care Wales Codes of Professional Practice (where staff are registered) and All Wales Guidelines for Delegation where PEG-related tasks are delegated by health professionals to social care workers.
• Health and Safety at Work etc. Act 1974 and relevant infection prevention and control requirements.
• Mental Capacity Act 2005 (capacity, consent, best interests) and relevant safeguarding requirements and Wales Safeguarding Procedures.

2. Scope

This policy applies to:

• All employees, including care workers, nurses, and managers who provide PEG care.
• Service users receiving PEG feeding and their families.
• Healthcare professionals and external agencies involved in PEG care planning.

It covers:

• PEG feeding procedures and best practices.
• Staff training and competency requirements.
• Infection control and hygiene standards.
• Emergency procedures for PEG-related complications.
• Monitoring, documentation, and service user support.

3. What is PEG Feeding?

Percutaneous Endoscopic Gastrostomy (PEG) feeding is a method of providing nutritional support directly into the stomach through a surgically placed tube. It is used for individuals with:

• Neurological conditions (e.g., stroke, cerebral palsy, motor neurone disease).
• Swallowing difficulties (dysphagia).
• Conditions requiring long-term enteral feeding.

4. Staff Roles and Responsibilities

4.1 Responsibilities of the Registered Manager

• Ensure all care staff are fully trained and competent in PEG care.
• Conduct risk assessments for service users receiving PEG feeding.
• Ensure PEG feeding procedures align with CIW guidelines.
• Monitor staff performance and provide ongoing supervision.

4.2 Responsibilities of Care Workers

• Follow PEG care plans and feeding schedules precisely.
• Maintain strict hygiene and infection control practices.
• Monitor service user’s response to feeding and report concerns.
• Accurately document feeding times, volumes, and any complications.
• Report PEG tube issues (e.g., leakage, blockages, skin irritation) immediately.

4.3 Responsibilities of Healthcare Professionals

• Assess service users for PEG feeding suitability.
• Provide initial training and competency assessments for care staff.
• Review PEG care plans regularly.
• Respond to medical complications or changes in nutritional requirements.

4.4 Delegated healthcare activities (PEG) – governance and competency

Where any PEG-related task is delegated by a registered health professional (e.g., District Nurse, Nutrition Nurse Specialist, Dietitian or other appropriate clinician), {{org_field_name}} will ensure:

• A written delegation plan is in place for the individual, clearly specifying: the exact task(s) delegated (e.g., administering feed via pump, flushing, stoma site care, administering medicines via PEG), required technique, equipment, infection control standard, and escalation criteria.
• Competency is assessed and signed off for each staff member for that individual and that PEG device, by the delegating health professional or an appropriately qualified assessor, before the staff member undertakes the task unsupervised.
• Ongoing competence is maintained through observation, supervision and refresher training at intervals set by the delegating professional and at least annually, and immediately following any significant change (e.g., new PEG device, new feed regimen, repeated complications, or a return to service after absence).
• Staff must work only within the scope of the delegated task and their competence; any uncertainty, change in the individual’s presentation, or deviation from the plan must trigger immediate escalation to the delegating professional and the Registered Manager.
• Records of delegation, competency assessment, refresher training and supervision are stored in staff files and are available for inspection.

5. Safe PEG Feeding Procedures

5.1 Pre-Feeding Checks

Before administering PEG feeding, care staff must:

1. Wash hands thoroughly and wear gloves.
2. Check the PEG tube position and ensure it is secure.
3. Verify the prescribed feed type and volume.
4. Check for any signs of infection or tube displacement (redness, leakage, pain).
5. Flush the tube with sterile water to prevent blockages.

5.2 Administering PEG Feeds

• Gravity or pump feeding must be administered as per service user’s care plan.
• The service user must be positioned upright (at least 45 degrees) to prevent aspiration.
• The feeding tube must be flushed before and after feeding to prevent blockages.
• Monitor the service user during feeding for signs of discomfort, nausea, or bloating.

5.3 After Feeding Care

• Leave the service user upright for at least 30 minutes after feeding.
• Clean the feeding tube site with sterile wipes and check for skin irritation.
• Record feeding details in the service user’s care notes.

5.4 Administration of medicines via PEG (only where specifically prescribed/authorised)

• Medicines may only be administered via PEG where this route is clearly documented in the MAR and/or the individual’s PEG care plan and has been authorised by the prescriber/pharmacist/appropriate clinician.
• Staff must not crush, open, or alter any medicine unless this has been confirmed as safe and appropriate for PEG administration by a pharmacist or prescriber and is recorded in the care plan/MAR.
• Administer medicines one at a time, flushing with the prescribed volume of water before the first medicine, between each medicine, and after the last medicine (flush volumes must follow the individual plan).
• Do not mix medicines with feed unless explicitly directed by a pharmacist/clinician.
• Any resistance when flushing, leakage, pain, coughing, or deterioration must trigger immediate cessation of administration and escalation as per Section 7 (and emergency services where required).
• All medicines administered via PEG must be recorded immediately on the MAR, including omissions/refusals and reasons.

6. Infection Control and Hygiene Standards

Staff must follow {{org_field_name}}’s Infection Prevention and Control Policy (DCW17) and the individual’s PEG care plan. As a minimum:

• Hand hygiene must be performed before and after any PEG-related task.
• Appropriate PPE must be used (single-use gloves and apron as required; eye/face protection if splash risk is identified).
• Equipment used for feeding/administration must be cleaned/decontaminated and stored in line with manufacturer instructions and the individual plan.
• Clinical waste (including contaminated syringes, dressings and tubing) must be handled and disposed of safely in accordance with IPC and hazardous waste arrangements.
• Any spillages of feed/body fluids must be managed promptly and safely in line with the organisation’s spillage procedure.
• Staff must not provide PEG care if they have symptoms that may increase infection risk and must report this to their manager for risk assessment and duty allocation.

7. Monitoring and Reporting Complications

Care staff must be vigilant for common PEG-related complications, including:

7.1 Signs of Infection or Blockage

• Redness, swelling, or pus around the PEG site – May indicate an infection.
• Difficulty flushing the tube – Could be a blockage.
• Pain during feeding – Could indicate tube displacement or irritation.
• Gastrointestinal symptoms – Vomiting, diarrhoea, or bloating may indicate intolerance.

7.2 Emergency Procedures for PEG Complications

If a PEG tube falls out or becomes displaced:

1. Do not attempt to reinsert the tube – Contact emergency healthcare services.
2. Cover the site with a sterile dressing and prevent infection.
3. Contact the Registered Manager and healthcare provider immediately.

If a PEG tube is blocked:

1. Attempt to flush with warm sterile water (do not use force).
2. If unsuccessful, seek medical assistance.

If a service user shows signs of infection:

1. Clean the site and monitor symptoms.
2. Report to the Registered Manager.
3. Seek medical attention if symptoms worsen.

7.3 Duty of candour (openness when things go wrong)

If a PEG-related incident occurs that results in harm, distress, significant discomfort, or requires unplanned medical attention (e.g., suspected aspiration, PEG displacement, significant stoma infection, feed/medication error), {{org_field_name}} will act in an open and transparent way with the individual and, where appropriate, their representative. This includes:

• explaining what is known at the time and the immediate actions taken;
• offering an apology where appropriate;
• explaining what will be investigated and how the individual will be kept informed;
• sharing the outcome of the investigation and learning/actions taken to reduce recurrence.

Any concerns about candour, bullying, victimisation or obstruction of candour must be escalated to the Registered Manager immediately and managed under the organisation’s whistleblowing and disciplinary procedures.

8. Documentation and Record-Keeping

• Daily PEG feeding logs must be maintained.
• Any complications, concerns, or changes in feeding must be recorded.
• Service user preferences and nutritional requirements must be documented in their care plan.
• All incidents must be reported and investigated in line with CIW requirements.
• CIW notifications (regulated service requirement): Where a PEG-related incident meets the CIW notification criteria (for example: serious accident or injury, allegation of abuse, incident reported to the police, infectious disease outbreak, or any event that prevents or could prevent the service being provided safely), the Responsible Individual (or an authorised delegate) will ensure CIW is notified without delay via CIW Online, and a record of the notification is retained with the incident file.

9. Staff Training and Competency Requirements

• Only trained and competent staff should administer PEG feeding.
• All staff must complete:
  • PEG Care and Feeding Training (practical and theoretical).
  • Annual competency assessments.
  • Infection control training.
• Supervision and mentorship are provided to new staff handling PEG care.

10. Safeguarding and Service User Rights

• Service users must be involved in their PEG care decisions where possible.
• Consent must be obtained before any PEG-related procedures.
• Best Interest Decisions (under the Mental Capacity Act) must be applied for service users unable to consent.
• Care staff must report safeguarding concerns (e.g., neglect, misuse of feeding equipment) to the Registered Manager.

11. Monitoring , Governance and Continuous Improvement

The Registered Manager will ensure PEG care is monitored through:

• planned audits of PEG records (including completeness/accuracy of daily logs, incident forms and MAR entries where PEG medicines are administered);
• review of themes and trends from PEG-related incidents, near misses, infections, blockages, feed omissions and complaints;
• evidence of staff competency sign-off and refresher compliance; and
• learning dissemination and action plans where improvement is required.
  PEG care performance and learning will be included within the service’s wider quality and safety governance arrangements, including reporting and follow-up actions.

12. Related Policies

This policy should be read in conjunction with:

• Medication Management and Administration Policy (DCW21).
• Health and Safety at Work Policy (DCW16).
• Infection Prevention and Control Policy (DCW17).
• Risk Management and Assessment Policy (DCW18).
• Safeguarding Adults from Abuse and Improper Treatment Policy (DCW13).

13. Policy Review

This policy will be reviewed annually or sooner if required by legislative updates, CIW guidance, or operational needs.

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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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