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.”