Risk Feeding : Managing it better Dr Rachael

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Risk Feeding : Managing it better Dr Rachael Murphy, Ros Todd (SLT), Sasha Archer (SLT) I want to eat Patients view of tube Getting home is dependant on having a tube Partner wants tube Tube will mean he is protected while he E and D

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Risk Feeding : Managing it better Dr Rachael Murphy, Ros Todd (SLT), Sasha Archer (SLT)

“I want to eat”

Patient’s view of tube Getting home is dependant on having a tube
Partner wants tube
Tube will mean he is protected while he E and D normally
Tube carries no risk
Wants to Eat and Drink “not large amounts but not nothing at all”

Feeding tube postponed

Partner’s view of tube Wants A to have the tube

Tube will mean A can be risk-free

However if A is not allowed to eat and drink that won’t be a problem; he wont eat and drink

Had not thought about the ‘what ifs’

Spoke to them together: Unless nbm the tube is not the panacea for all risk
A does not wish to be nbm; he would rather die
A has capacity
A and F did not realise they could take a view/ participate in risk assessment

A and F made aware of what could happen
A made aware that F does not want to see AS suffer
Hence both agree to robust ACP

What is Risk Feeding? “When a person continues to eat and drink despite a risk of aspiration and or choking”

Other terms often used:
“Comfort Feeding”
“Pragmatic approach”

Advanced stage of illness
Unsafe swallow, unlikely to change
Food preferences more important than aspiration risk
Not for NGT Why feed with risk?

Risk feeding is common practice

Risk Feeding balances safety and quality of life as equally as possible.

Is there equity of service?

There are several protocols in existence across the UK e.g. Lewisham and Greenwich; Guys and St. Thomas’ Managing it better

Lewisham and Greenwich: “Risk Feeding Toolkit: A safer approach to ethical feeding decisions” Risk Feeding practice elsewhere

Embedded Risk Feeding Policy within the trust
Clear Risk Feeding Pathway
Decision made in consultation with patient, family/carer, SLT and doctor
Proforma includes statement of capacity and recommendations for reducing, but not eliminating risk
Written information and guidance for families
Fully documented feeding with risk status (e.g. On TRAK) Good practice

Process Summary

Proposed protocol:

Supporting documents

Risk Feeding : Managing it better Dr Rachael

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