HOME TUBE FEEDING THE BASICS IN ACTION UBC DIETETICS PROGRAM Module 2 of 2
SCOPE OF THESE MODULES Modules 1 & 2 address the following Nutrition Care Process steps • Intervention • Monitoring and Evaluation Assessment and Diagnosis are not explicitly addressed in these modules, but are critical parts of providing tube feeding nutrition care Refer to your prior learning on assessment and diagnosis related to tube feeding nutrition care 2
REVIEW AND REFRESH Module 1 addressed the following topics • Overview of home tube feeding • Development of a tube feed schedule • Tube feed delivery methods 3
LEARNING OBJECTIVES FOR THIS MODULE 1. Identify resources used to develop, monitor and evaluate a home tube feeding care plan 2. Describe the processes involved in providing home tube feed education and support 4
OUTLINE FOR THIS MODULE • How to obtain home tube feeding equipment and supplies • Providing education and support • Home tube feeding troubleshooting 5
HOW TO OBTAIN EQUIPMENT AND SUPPLIES What does the individual need? • Formula • Feeding set (tubing, with or without bags) • Syringes • IV pole (if needed) • Pump (if needed) • Prescription for pancrealipase (to clear blocked feeding tube) 6
HOW TO OBTAIN EQUIPMENT AND SUPPLIES Where does the individual live? • Determine pharmacies that are close to home/convenient • The individual’s usual pharmacy may or may not carry required equipment and supplies – may need to explore other pharmacies • Registered Dietitians (RDs) working in the home community can be a resource for recommending and ordering tube feeding supplies 7
HOW TO OBTAIN EQUIPMENT AND SUPPLIES What about funding? • Usually the individual and/or family pays (~ $250-450/month) • Funding may be available for tube feeding equipment and/or formula (e.g. extended health, Ministry, Veterans Affairs) • Some specialty programs or specific groups (e.g. Cystic Fibrosis Clinic, First National Health Authority) may fund their clients • Ensure that applicable forms are filled out if funding is required • May need to write letters to support applications for funding • Funding tends to be more readily available for elemental and semi- elemental formulas with appropriate clinical indication • Specific health authority sites will have further information on funding sources and application processes 8
HOW TO OBTAIN EQUIPMENT AND SUPPLIES Important Considerations • Order early to ensure supplies are available when needed; it may take 5-10 business days to obtain supplies. This should be factored into discharge planning (if working with an inpatient) • Ordering equipment and supplies may be the responsibility of the individual/family or the RD, depending on the site/program • Location and availability of products will determine how much to order at once and keep stocked at home • RD can assist by providing up to date pricing/stock information • Pumps may be available via free loan program • Red Cross Health Equipment Loan Program is an option for IV poles 9
PROVIDING EDUCATION AND SUPPORT Teaching a individual and family about a home tube feed and how to manage it at home will generally include the following topics: • What is tube feeding? • Details about the individual’s specific feeding tube • Details about required tube feeding supplies • The tube feed schedule • Techniques to administer the tube feeding • Cleaning and storing feeding supplies • Giving medications (typically taught by nurses) • Hygiene for the tube site • Preventing and solving problems with the tube feed 10
PROVIDING EDUCATION AND SUPPORT • Key goals of the education process are to work alongside the individual and family to develop a plan collaboratively, and increase confidence to carry out plans at home • RDs play a key role in assessing readiness for managing tube feeds at home, including communication with other team members about readiness • RDs may have different levels of involvement in the education process; some education roles are shared with other professions (e.g. nurses, pharmacists) 11
PROVIDING EDUCATION AND SUPPORT NOTE: • A checklist to keep track of education topics may be useful and commonly used in some practice areas • Education checklists and/or teaching manuals are available at health authority sites – refer to site-specific resources for more information Useful education and support resources My Tube Feeding.ca - excellent overview of home tube feeding, including providing education Oley Foundation - good information for professionals and clients 12
PROVIDING EDUCATION AND SUPPORT Monitoring and Evaluation Considerations Discuss parameters that individual and/or caregiver(s) may need to monitor at home • Weight • Hydration status • GI symptoms (e.g. aspiration, nausea, vomiting, bowel movements) • Tube complications (e.g. tube moves, falls out, gets plugged) • Skin condition (e.g. tube site redness or irritation, signs of infection) • Blood work 13
PROVIDING EDUCATION AND SUPPORT Monitoring and Evaluation Considerations Determine a plan for ongoing support • Discuss with individual and family: their roles in monitoring, and who they should contact for support • Ensure any referrals to community practitioners are arranged ahead of time so support is available when it is needed • Community referral resources and processes may differ in different areas of the province/country • Consider sending information about tube feeding care plan to the client's family doctor or other physician who will be providing ongoing care 14
HOME TUBE FEED TROUBLESHOOTING • Site-specific health authority materials will address education and support related to home tube feed troubleshooting • MyTubeFeeding.ca also provides helpful troubleshooting tips on • Nausea, Vomiting, Reflux • Diarrhea • Bloating/Cramps/Feeling of fullness • Constipation • Dehydration/Thirst • Rapid weight gain • Losing weight • Sudden Coughing/Trouble Breathing • Blocked Feeding Tube • Feeding tube falls out 15
APPLY YOUR LEARNING What information would you gather from an individual and family to help them choose the best tube feeding schedule for home? You have an appointment scheduled with Mr. Jones to educate him and his family on his home tube feed. What will you need to address during this appointment? 16
LIVING LIFE WITH A TUBE FEED With a solid plan in place, life can be lived to the fullest with a tube feed Watch Gunnar’s story: https://www.youtube.com/watch?v=wb_TL5dSaKA 17
Thank you to the UBC Dietetic Education Core Council Home Tube Feeding Working Group, and British Columbia Health Authorities for contributing to the development of these modules
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