Utilizing a Home Tube Feeding Protocol:
Enhancing Continuity of Care in the SCI/D Veteran Population
Kelly Skinner, MSN, RN, CRRN, WCC, CFCN, NP-C, GNP-BC; Tracey Presley, MSW, LICSW;
Angela DiTucci, RDN, LDN; and Nancy Brooks, BSN, RN-BC, CRRN, CFCN, WCC.
VA Boston Healthcare System
Objectives:
1. To enhance the clinician’s knowledge on the current standards and
practices related to home tube feeding.
2. Describe how the Home Tube Feeding Protocol was implemented
at the VA Boston Healthcare System for SCI/D Veterans.
Background: According to the Office of Inspector General (OIG)
Report, 27 VHA facilities were evaluated to determine compliance
with the Joint Commission standards and the VHA requirements
related to establishing and implementing tube feeding
policies/practices, managing and documenting tube feeding in the
medical record, and providing continuity of care for patients receiving
tube feeding. Consequently, the OIG issued recommendations and
the VHA Central Office Interdisciplinary Enteral Nutrition (EN) Task
Force was responsible for addressing these recommendations to
develop a training module which could be utilized by VA facilities.
Design: The Home Tube Feeding Protocol was designed so that
seamless communication of the plan between inpatient and
outpatient ensures a successful transition home. Is your SCI/D
Veteran/caregiver ready for home tube feeding?
Methods: The Home Tube Feeding Protocol is an inter-professional
process where nutrition, social work, case management, and nursing
templates were developed. Education tools were created to allow for
consistent team teaching so the Veteran and caregiver can
demonstrate competency, knowledge and teach-back related to tube
feeding.
Results: This poster presentation will illustrate how the Home Tube
Feeding Protocol was rolled out at the VA Boston Healthcare System
in order to ensure the SCI/D Veterans receive safe and effective tube
feeding if they are unable to meet nutritional needs by oral intake or
when oral intake might be contraindicated.
Conclusions: The SCI Center at VA Boston Healthcare System strives
to put policy into practice to ensure the SCI/D Veteran receiving tube
feeding and the caregiver has an optimal discharge to home. The
continuity of care from inpatient to outpatient is maintained so that
the Veteran’s tube feeding goals are achieved, monitored and
adjusted as needed. Future research is needed to focus on veteran
centered outcomes such as veteran satisfaction, staff satisfaction,
decreased readmission rates and decreased home tube feeding
complications and challenges.
Support: N/A
Dietitian
Nursing/
Case
Manager
Social
Worker