Enteral feeding is defined as artificial nutritional support which is given enterally via a tube into the gut. To ensure that nutrition support is provided efficiently and effectively there must be standard policies and procedures, which are locally accepted, in place within an organisation(Footnote 1 – Footnote 3 ). Parenteral and Enteral Nutrition Group standards(Footnote 4 ) determine that all nutrition and dietetic services have written policies and procedures on the provision of nutritional support both within the hospital and the community.
In 2003, the Trust Enteral Feeding Group developed Enteral Feeding Guidelines (EFG), with the aim of acting as a reference and teaching resource for the dietetic department, nursing and medical staff throughout the trust. The objectives of the audit were to assess compliance and understanding of the EFG and to highlight any aspects of practice where training or changes in practice were necessary.
Data was collected by dietetic and nursing staff during a 10-week period, between 23 March 2006 and 30 May 2006. Thirty-eight episodes of care involving patients receiving enteral feeds were included in the audit. Of these n 27 (71%) were nasogastric, n 1 (3%) nasojejunal, n 8 (21%) gastrostomy and n 2 (5%) jejonostomy. Results of thirteen EFG standards audited are shown in the Table.
Compliance with many standards was poor. Least compliance was with date and time documented on feed bag, best compliance was with correct feed being given against dietetic prescription. A recurring theme was poor documentation; in many cases pH had been tested or length of tube measured, but not recorded.
The EFG have been revised and rewritten as a result of the audit and in light of recent NHS patient safety alerts(Footnote 5 , Footnote 6 ). A trust-wide EFG teaching tool and daily NG feeding documentation and check list have been produced. The trust-wide use of lilac coloured syringes and Medicina indicator pH strips has been introduced. The audit will be repeated in Spring 2008.
