Authors (including presenting author) :
Chan CH(1)(5), Wong YY(2)(5), Tse LS(2)(5), Chan KF(1), Cheung YL(2), Ivy Wong(4)(5), Kwan YK(1)(5), Cheng HWB(3)(5), Yam PW(1)(2)(3)
Affiliation :
1 Department of Medicine & Geriatrics (Acute), Tuen Mun Hospital 2 Department of Medicine & Geriatrics (Rehab), Tuen Mun Hospital 3 Department of Medicine & Geriatrics (Medical Palliative Medicine), Tuen Mun Hospital 4 Department of Speech Therapy, Tuen Mun Hospital 5 TMH Careful Hand Feeding Team
Introduction :
Feeding problems are very common in patients with advanced dementia and food-related distress is often encountered during advance care planning. They frequently present to acute hospital with poor oral intake and end up with enteral feeding on discharge. However, there are increasing evidences showing that enteral feeding could lead to complications such as aspiration pneumonia, physical restraints and psychological distress. Although Careful Hand Feeding (CHF) could serve as a feasible alternative to tube feeding, it was not widely practiced even in the geriatric settings in Tuen Mun Hospital. Unfamiliar with the relevant skills, inadequate promotion and fear of legal consequences in health care team are all of the contributing factors for this phenomenon.
Objectives :
The objective of this programme is to enhance and standardize the quality of care on implementing careful hand feeding for patients with advanced dementia in M&G Department at TMH. We hoped that this programme can empower our patients, their carers and the heath care team with structural components in implementing careful hand feeding.
Methodology :
A multi-disciplinary team which comprised with nurses from acute and subacute M&G wards, doctors from Geriatric Medicine and Palliative Care (PC), and Speech Therapists (ST) was formed in May 2019 and a structured workflow on CHF was formulated. Patients with advanced dementia who meet with the inclusion criteria are recruited in our programme. They would be referred to Geriatric Specialty Nurse for detailed assessment and their family members would be interviewed for thorough explanation on CHF. Then they would be seen by Geriatric or PC Specialist for formal documentation and CHF could be initiated as a shared decision.
Result & Outcome :
319 consultations were received for assessment of CHF, there was total 277 patients being recruited for CHF from August 2019 to December 2020. The mean age of the clients was 86.7 ± 9.72 and 57% of them were female; 70% of the clients were living in Residential Care Home of Elderly (RCHE). The mean time from referral to CHF initiation was 0.81 ± 1.41 days, whereas the mean time for discussion with family was 0.63 ± 0.29 days. 34% of them passed away at index admission and another 56% succumbed at 6 months. 99% of the recruited clients continued on CHF upon successful discharge. Phone follow-up to home carer after discharged (n =40), satisfactory rate was 98%. They replied the programme can avoid patient suffer on prolonged enteral feeding, respect patient dignity and more understanding patient’s feeding and care planning. Staff survey from 350 nurses and 120 supporting staffs; there was significant improvement on satisfaction in feeding skills after the training workshop. They expressed that the training workshop was very helpful and unleashed much of their psychological and ethical burden and query towards comfort hand feeding. for sustainable development and success in implementation of CHF.
With the newly implemented workflow pathway, we are more confident in delivering Careful Hand Feeding in every TMH M&G wards. The structured workflow on Careful Hand Feeding can provide a 3-Win situation on patient, family and hospital. And the continuity of support from hospital to community settings, especially in RCHE would be crucial for sustainable development and success in implementation of CHF.
