Policy Manual sample

MDT Home Health Care Agency, Inc. 47 PROCEDURE: 1. Wash hands. 2. Inform patient or caregiver regarding purpose of feeding. Demonstrate equipment pieces. 3. Attach pump to the IV pole (if applicable). 4. Plug power cord into grounded receptacle. 5. Assess for presence of bowel sounds. Assess for adequacy of fecal elimination. 6. Check for tube placement using the following techniques: • Aspirate gastric secretions using a compatible syringe. • Inject 5- 10 cc of air with a syringe into tube while listening with stethoscope placed 1 and 1/2 inches below xyphoid process and ausculate air flow 7. Prepare formula according to manufacturer's specifications. Allow feeding to warm to room temperature if refrigerated.. 8. Elevate patient's head 30-45 degrees and instill 30-60cc water to flush tube before initiating feeding. 9. Set up pump and tubing according to manufacturer's directions. 10. Initiate ordered feeding. 11. Pour and measure feeding at patient location. Minimal amounts of food coloring may be added to detect aspiration in high-risk patients per physician’s orders. 12. Deliver feeding at prescribed rate with periodic supervision for: • gastric distention • restlessness • respiratory difficulty • tube displacement • pump malfunctioning Check patient positioning for trunk alignment and extension, especially for those in bed. 13. If movement or turning is necessary, do so slowly with feeding turned off. 14. Maintain patient head of bed elevated for at least 30 minutes after bolus feeding. Maintain head of bed elevated at 30-45 degrees for patient’s with continuous feedings. 15. Interrupt continuous feedings as necessary for recumbent periods or other activity. Always flush tube with water if interruption to feeding is necessary. 16. Continuous feedings may be flushed at intervals. 17. Instruct caregivers to reschedule feeding times if feeding gets behind. Do not increase rate. 18. Monitor intake and output carefully. Teach caregivers to keep detailed intake and output record as ordered by the physician. DOCUMENTATION: Document the amount and type of feeding, the rate of administration, assessment of the lungs and bowels, all teaching and the patient's and caregiver's response on the Clinical Visit Note. Document the patient's tolerance and/or any adverse side effects. ____________________________________________________ ____________________________________________________