Dr Elizabeth Boaden Clinical Lead - Speech and Language Therapist Sandra Wilkes Senior Speech and Language Therapist - NAG member Siobhan Ludlow Specialist Speech and Language Therapist Amy Holehouse Specialist Dietitian Charlotte Armstrong Specialist Dietitian - NAG Member Philippa Pordes Dignity Matron Angela Hewitt Endoscopy Nurse - NAG member Nutrition Advisory Group members Dr (Chair) Mrs C Dr Alistair Martin Phil Chilton Ali Barnes Helen Nutkins Cathy Samsudin Divya Kakkar Consultant Gastroenterologist Consultant Surgeon Consultant Anaesthetist Senior Charge Nurse, Critical care Matron (Emergency Care Division) Modern Matron Senior PN Pharmacist Home Enteral Feeding Dietitian The multidisciplinary team involved in the creation of this document:
Are there any recent life events that may contribute to the person’s capacity? Please specify: Has the person recently taken any form of medication that is likely to impact on their capacity? Please specify: Have relevant health and social care professionals, families and carers been consulted regarding this person’s capacity? Please specify: Assessment of Capacity: Stage 1 – Diagnosis: Does the patient have an impairment of, or disturbance in, the functioning of the mind or □ Yes □ No If yes, is the impairment: □ Temporary □ Fluctuating □ Permanent If temporary/fluctuating, can the decision wait capacity returns? If not please provide details: Stage 2 – Functioning: If yes to the above question, is the patient able to: Understand the information relevant to the decision? □ Yes □ No Evidence – include the actions taken to enhance capacity: AND: Retain that information? □ Yes □ No Please provide details/further information if appropriate/necessary: AND: Use or weigh that information as part of the process of making the decision? □ Yes □ No
Dip a spoon into a liquid and wipe the BACK of the spoon over the tongue Sometimes a slightly thicker such as a smoothie, will stick to the spoon better. Try small amounts of lemon or grapefruit juice on a cotton swab or the back of a small spoon. Whilst the combination of the cold temperature and sour taste often provide greater stimulation of the oral cavity but you should always choose the flavours that the individual prefers. This information is available in Braille, large print and other languages. To request a copy, please ask a member of staff. Reviewed by Readers’ Panel October 2016. Printed December 2016 Review December 2018 Ref: DCS/SLT/0071216 NASOGASTRIC TUBE FEEDING (NGT) PATHWAY YES NO
Home circumstances Have social and domestic circumstances been investigated? Are they satisfactory for tube feeding at home? Yes/No Signed: Designation: Date: If no, investigation into home circumstances should be undertaken. If potential difficulties are identified, consider MDT/best interest meeting. Is the patient capable of undertaking care of the feeding tube independently? Yes/No Signed: Designation: Date: If no, determine/consider other options. Comments: Are family members or informal carers available to manage tube feeding if required? Yes/No Signed: Designation: Date: If no, determine/consider other options. Comments: Has a care agency been identified to care for the tube feeding (if required)? Yes/No N/A Signed: Designation: Date: If no, liaise with social workers to identify appropriate care agency to create care package, or if needed consideration should be given to a nursing home. Please contact dignitary matron where appropriate. Comments: Are arrangements in place regarding training for patient/family/carers on administering feed and medications via the tube? Yes/No Signed: Designation: Date: If no, arrangements need to be made for patient/family/carers to receive this training. Indications for PEG insertion (as per PEG guidelines) CVA Motor Neurone Disease Poor nutritional Status Multiple sclerosis Trauma Head and Neck Cancer Dysphagia Pre radiotherapy/pre surgery Learning disabilities Anorexia or Cachexia Obstructive lesion oesophagus Other – please specify Reason for PEG referral: