what? where? when? - nchn · date of presentation: 24 feb 2015 3 ... review structure and outline...

24 Feb 2015 Date of Presentation: 1

Agency for Clinical Innovation These slides remain the property of ACI

Welcome to Allied Health

Telehealth

Please complete your online evaluation at

https://www.surveymonkey.com/s/gastrotubes

A Clinician’s Guide: Caring for

people with gastrostomy tubes and

devices.

What? Where? When?

24 February 2015

Tanya Hazlewood

Manager ACI Nutrition Network




Learning outcomes

What “The Guide” is

Content and structure

Useful sections and tools

Locate the Guide on the ACI website

Related ACI Activities

Introduction

The Agency for Clinical Innovation ● Pillar - NSW Health

● Clinicians, consumers, managers

● >30 Networks, Institutes and Taskforces

Nutrition Network = 2004



ACI Nutrition Network

Improve

“Nutrition in Hospitals”

Improve

“Home Enteral Nutrition”

Services

NIHC Advisory

Group

Nutrition Standards and Diet Specs Ref

Group

Nutrition and

Mental Health

WG Gastrostomy Guidelines

WG

HEN Data WG

HEN Executive Committee

NSW Health Nutrition and

Food Committee

HealthShare NSW (Food Services, EnableNSW,

Procurement)

Gastrostomy tubes and devices

Inserted directly through the

abdominal wall into the stomach for the delivery of nutrition,

fluids and medications



Background to the Guide

NSW Ombudsman's Report

No state or national guidelines

Patient and staff experience

Need identified by both ACI and GENCA

Partnership formed

“I left hospital

with no information.

Not even a piece of paper”

Patient

“What co-ordination of

care? That is the problem”

CNC

The Guideline Development Group



Our journey

2012 Guideline

development group

established

Initial literature

review

Structure and outline

developed

2013 Evidence check

review completed

1st draft prepared

2014 Consultation round 1 and 2

Final draft prepared and

endorsed Release

2015 Implementation and Evaluation

Practice vs evidence

Are “water trials” needed

before starting enteral

feeds via a gastrostomy

tube?

When can a newly

inserted tube be used for

water flushes /enteral

feeding?

When should a newly

inserted tube be rotated?

What should be used to

flush tubes?

When should an initial

tube be replaced?



Consultation rounds

Overview of the Guide

The target audience: CLINICIANS

Content

▲ The patient journey

▲ Evidence-based recommendations

▲ Practical advice and tools

▲ Patient, carer and staff experience

“A checklist to ensure

transfers/discharges are thorough”

CNC

“Pain syrup was given into the balloon port. The

device became too tight and caused pain”

Parent

http://www.rch.org.au/

http://www.auspen.org.au/

http://www.health.nsw.gov.au/

http://cramfoundation.com.au/NewSite-11-16-13/home



Structure

Se

Section 2: Deciding to

initiate gastrostomy

feeding

Section 1: Health professionals involved in the care of people with gastrostomy tubes and devices

Section 3: Acute Hospital Care : Day of procedure to 24-48 hours

post procedure

Section 4: Ongoing care and

tube/device removal

Section 5: Transfer and Transition

Section 6: Service Evaluation

Co-ordinated multidisciplinary

care Patient centred care

Safe and Appropriate Clinical Management

Communication and Documentation

between staff and services

Key principles



The final documents

Common types of tubes and devices

Gastrostomy tubes

Low profile devices

Specialty tubes



Gastrostomy tubes

Low profile devices



Insertion methods

Endoscopic (PEG)

Radiological (PRG or RIG)

Surgical

▲Laparotomy

▲Laparoscopic (LAPG)

▲Laparoscopic assisted PEG (LAPEG)

Patient/carer preparation and education

All stages ● Pre-insertion

● Pre-discharge

● Ongoing

Verbal and written information

Consider needs and support required



Section 1: Health Professionals Team approach – with patient/carer

● Role for telehealth

● Clinical lead

Registered Nurse

Dietitian

Speech Pathologist

Medical Specialist

GP

Others

Section 2: Deciding to initiate gastrostomy feeding



Section 3: Acute hospital care

Day of procedure to 24-48 hours post procedure

Care and Monitoring

Nutrition assessment

Using the tube

Medications

Transfer of care

A new tube can be used 4-6 hours after

insertion (GRADE B)

No evidence for water trials

Section 4: Ongoing care and tube or device removal

Standard care

Trouble shooting

Replacement

Removal



Section 5: Transfer and Transition

Transfer between services, states and countries

Transition from paeds to adult services

Section 6: Service Evaluation

Mortality

Hospital readmission

Complications

Patient satisfaction

Staff satisfaction

Incident reporting and resolution.



Appendices

Education checklist

Transfer between services form

Bristol stool chart

Record of tube/device replacements

Transition care checklist

We hope the Guide doesn’t end up here



Websites Tools App??

Education and support

Redesign school

Teleconference

Implementation

ACI Website

http://www.aci.health.nsw.gov.au/resources/nutrition





http://www.aci.health.nsw.gov.au/resources/nutrition/gastrostomy-tubes-and-devices/caring-gastrostomy-tubes

http://www.ecinsw.com.au/

















Evaluation

Surveys Focus Groups Data



We hope to see this

Acknowledgements

Project co-chairs

Guideline Development Group

Content Contributors

Nutrition and Gastroenterology Networks

The Executives of the ACI & GENCA

Kirsten Campbell



Any Questions?

24/02/2015

Thank you for attending:

A Clinician’s Guide: Caring for people

with gastrostomy tubes and devices.

Please remember to complete your online evaluation at



what? where? when? - nchn · date of presentation: 24 feb 2015 3 ... review structure and outline...

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