RT Journal Article
SR Electronic
T1 Improving the care of patients feeding at risk using a novel care bundle
JF Future Hospital Journal
JO Future Hosp J
FD Royal College of Physicians
SP 202
OP 206
DO 10.7861/futurehosp.4-3-202
VO 4
IS 3
A1 Peter Sommerville
A1 Alex Lang
A1 Laura Harbert
A1 Sally Archer
A1 Sarah Nightingale
A1 Jonathan Birns
YR 2017
UL http://www.rcpjournals.org/content/4/3/202.abstract
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.