Introduction

This document outlines the information required, and the expectations of a Hireup Support Worker when providing enteral feeding support and of the Client when enteral feeding is required on shift. 

This policy aims to ensure the standard of service delivery remains safe and high quality and to provide guidance to Support Workers, outlining what duties are acceptable for them to complete and what duties are outside of the scope of a Support Worker.

An enteral feeding plan is to be completed by an appropriate, registered health professional, such as a doctor or dietician. This plan should be reviewed every 12 months or as otherwise stated by the treating health professional. 

Hireup Values 

Hireup’s values provide us with the direction in which we engage with our community and develop policy and process across the business. 

We recognise that enteral feeding is personal in nature, and only a part of a person’s overall support needs. By upholding the value of ‘the person is the point’ we take an individualised approach to enteral feeding support.  

Hireup acknowledges Clients and their families are experts in their individual enteral feeding support. Central to this understanding is the principle of ‘championing choice’ and control for Clients to make informed decisions about their enteral feeding support. Whilst Hireup is not responsible for the assessment or development of a Client’s enteral feeding support plan, we support Clients to engage with suitable health professionals and to be involved in the planning and management of their enteral feeding, as well as any individual training arrangements. 

Definitions

Support Worker: a person that provides support to the Client, typically in a paid capacity. 

Enteral Feeding: A form of nutrition that is delivered into the digestive system as a liquid. This may take up the person's entire intake or may be used as a supplement to oral intake.

Tube Feeding Care Plan: a document that outlines for service users:

• Route of feeding (i.e. NJ/PEG/PEJ)
• Timing of feeds
• Type of enteral feed (including formula type)
• Administration of feeds or medications (if medications are administered through the enteral feeding tube, a separate medication authority form is also required)
• Equipment needed (such as PPE)
• Techniques to support safe and enjoyable mealtimes
• Stoma care
• Risks to look for and action required to respond to risks
• Troubleshooting and emergency management 
  
   

Percutaneous Endoscopic Gastrostomy (PEG): a flexible tube that is placed through the abdominal wall into the stomach, bypassing the mouth and the oesophagus.

Percutaneous Endoscopic Jejunostomy (PEJ): a flexible tube that is placed through the abdominal wall into the small bowel (jejunum).

Nasogastric Tube (NG): a small tube that is inserted into the nostril, goes through the oesophagus and ends in the stomach.

Nasojejunal Tube (NJ): a small tube that is inserted into the nostril, goes through the stomach and ends in the jejunum.

Stoma: an opening to the inside of the body, created surgically or occurring naturally (for example, the mouth, nose or anus).

Stoma care: use of equipment and consumables such as skin sealants, barriers or powders to maintain a healthy stoma.

Guidelines

Service Provider 

As a service provider, Hireup will: 

• Work with the Client (or their Account Manager where applicable) to determine their support needs, and determine what documentation is required.
• Determine areas of enteral feeding and mealtime management that are within the scope of practice for a Support Worker to complete. Nasogastric feeding cannot be completed by Support Workers without prior written approval from Hireup.
• Regularly review the tube feeding plan to ensure the information provided is the most up to date and appropriate.
• Provide Support Workers with written procedures for the provision of enteral feeding, in conjunction with the Client, their Account Manager and their Health Professional (where practicable).
• Ensure Support Workers have access to support plans and ensure these plans are only updated by a registered and relevant health professional.
• Identify areas of education and training for Support Workers.
• Provide Support Workers with appropriate training and assessment to ensure the safe provision of enteral feeding, including regular supervision.
• Provide Support Workers with access to personal hygiene guidelines 

Support Worker

A Support Worker MAY: 

• Perform any task that is listed on the plan, apart from those listed in this policy that require written approval from Hireup, or that must be completed by a health professional. If concerned or unsure, talk to the Client (or their Account Manager where applicable), and contact the Hireup support office for support.
• Access supervision outside of scheduled supervision timeframes by contacting Hireup directly.

A Support Worker MUST: 

• Complete online training modules provided by Hireup prior to providing enteral feeding support or within the allocated time frame, unless otherwise specified by Hireup.
• Follow the support plan as provided and raise any concerns with the Client (or their Account Manager where applicable) immediately as well as notify Hireup.
• NOT change any part of the plan or deviate from the plan provided.
• NOT change or replace the feeding tube if it is dislodged, damaged or in need of replacement.
• NOT provide nasogastric feeding support without prior written approval from Hireup.
• Report any issues or concerns arising from the delivery of enteral feeding support (such as displaced feeding tube, stoma site changes, persistent moist cough) to the Client (or their Account Manager where applicable) and/or their health professional immediately, followed by an incident report to Hireup once safe to do so.
• Identify any gaps in knowledge and report these to Hireup for further advice.

Client

A Client MUST:

• Provide Hireup with an honest and accurate account of their support needs.
• Provide a support plan to Hireup that outlines their specific enteral feeding support requirements, completed by an appropriate, registered health professional.
• Have the plan reviewed by an appropriate, registered health professional when changes occur. At a minimum, the plan should be reviewed every 12 months unless otherwise indicated on the plan.
• Advise Hireup of any changes to support needs, requirements or the tube feeding plan.
• Report any concerns regarding Support Worker’s capability in providing enteral feeding support to Hireup for further advice.