Advance Care Planning - Tube Feeding Presentation

Presentation in PDF format.

Objectives

  • Define advance care plan
  • Describe the steps of advance care planning
  • Identify risks, benefits, and alternatives to tube feeding
  • Identify components of interdisciplinary care plans

Advance Care Plan

  • A process of planning future medical care
  • An exploration of goals and values
  • A determination of a decision maker

Steps to Advance Care Planning

  • Discuss care options
  • Document the person's informed choices
  • Review and update
  • Apply directives when need arises
  • Obtain informed consent

Before Tube Feeding

  • Optimize nutritional intake
  • Evaluate the medication regimen
  • Look for underlying causes of weight loss

Alternatives to Tube Feeding

  • Carefully hand feeding
  • Provide therapy, if needed
  • Consider appetite enhancers

Intended Health Benefits of Tube Feeding

  • To provide adequate nourishment when there is unintended, reversible weight loss
  • To improve clinical status
  • To enhance comfort and quality of life
  • To prolong life

Limitations of Tube Feeding

  • In end-stage disease, there is no persuasive evidence that tube feeding:
    • Prevents pressure sores
    • Prevents malnutrition
    • Prevents aspiration pneumonia
    • Prolongs life
  • Feeding does not reverse the cachexia of endstage illness

Disadvantages of Tube Feeding

  • Causes physical discomfort
  • Individual response to discomfort can lead to the use of restraints
  • Does not provide the gratification of taste
  • Can cause diarrhea, electrolyte imbalance, and hyperglycemia
  • Adds risks of bacterial contamination

Indications for Tube Feeding

  • Tube feeding is a medical intervention – not a normal function like eating
  • All medical interventions require a rational basis for expecting benefit AND
  • The individual/responsible party must agree

Interdisciplinary Care Plan

  • Identify the rational indication for tube feeding
  • Develop measurable goals for tube feeding
  • Establish interventions

Tube Feeding Care

  • Reassessment
  • Effectiveness of therapy
  • Implement recommendations

Tube Feeding Summary

  • Assessment
  • Care Plan
  • Care

Vision

The HHS Quality Monitoring Program vision for tube feeding in LTC is that “Tube feeding will only be used when it benefits the individual.”