PT  - JOURNAL ARTICLE
AU  - Peter Sommerville
AU  - Alex Lang
AU  - Laura Harbert
AU  - Sally Archer
AU  - Sarah Nightingale
AU  - Jonathan Birns
TI  - Improving the care of patients feeding at risk using a novel care bundle
AID  - 10.7861/futurehosp.4-3-202
DP  - 2017 Oct 01
TA  - Future Hospital Journal
PG  - 202--206
VI  - 4
IP  - 3
4099  - http://www.rcpjournals.org/content/4/3/202.short
4100  - http://www.rcpjournals.org/content/4/3/202.full
SO  - Future Hosp J2017 Oct 01; 4
AB  - Feeding with acknowledged risk is appropriate for patients unsuitable for tube feeding who have an unsafe swallow that is unlikely to improve. However, without excellent multidisciplinary decision making and communication, patients may spend unnecessarily long ‘nil by mouth’ (NBM) and advance feeding/care plans may not be made or communicated. The FORWARD bundle (Feeding via the Oral Route With Acknowledged Risk of Deterioration) was sequentially co-designed and embedded across different services using ‘plan-do-study-act’ methodology to systematise best practice. Care before and after FORWARD was evaluated using a time-series analysis of 80 patients who had been risk-fed. Time NBM without tube feeding improved from 2 to 0 days (p=0.02) with significantly better documentation of capacity assessments and discussions with next of kin. There were sustained trends to improved rates of best interest discussions and communication of feeding plans to downstream care providers. The significance and applicability of these findings is discussed.