18/04/2020

Information for patients receiving home enteral nutrition (HEN)
Help us to help keep you safe during the COVID-19 pandemic

 
Introduction

Your hospital clinical teams, HEN providers and the national NHS bodies are working closely together to ensure your service continues with minimal disruption throughout this challenging period. This information has been prepared to reassure you and help you understand what measures have been, or are being, put in place by your hospital clinical teams and homecare providers to protect you and continue to provide a safe service. The government is urging everyone to pull together and there are things that you, and your family, can do to help as well, which we have included below.

Over the next few months it is anticipated that the pressure on the NHS and the HEN providers will peak to an unprecedented level. As it is not possible to know how the situation will develop, the NHS and HEN providers are planning for a number of potential situations.

How can you protect yourself and help the NHS during the COVID-19 pandemic?

• As we are all being encouraged to do so, please continue to follow the government’s advice on regular hand washing and social distancing.
• Informaiton for members of the public to protect themselves from COVID-19 can be found at: www.nhs.uk/conditions/coronavirus-covid-19/
• Continue to follow the social distancing guidance stringently, as outlined by the government. Whilst challenging, it is one of the ways to keep yourself/your child safe. For advice on social distancing please visit: www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people/guidance-on-social-distancing-for-everyone-in-the-uk-and-protecting-older-people-and-vulnerable-adults
• For advice on travel and for those who are working visit: www.gov.uk/government/topical-events/coronavirus-covid-19-uk-government-response
• Unless the amount of nutrition you need has changed (as advised by your healthcare professional), please only order your usual amount of enteral feed and ancillary items as this will help ensure availability of products to all.
• If you have community nurses supporting you with routine enteral tube care, please consider which aspects of your care you, or a family member, could undertake temporarily to reduce contact with others and ease pressures that may arise through the absence of NHS staff and increased numbers of patients to support.
• Please ensure your HEN provider has a current email address and mobile number for you. If you wish to set up an additional ‘contact’ for your homecare service at this time, please let your HEN provider know.

Enteral feed supply deliveries

You may have been informed by your HEN provider or healthcare professionals, about changes to how you receive your enteral feed supplies. Here are some further tips to help you manage during the COVID-19 period:

• It remains important that you have an adequate supply of the enteral feed and ancillaries to continue your normal enteral feeding plan.
• Make sure you organise or have your delivery when you have seven days’ enteral feed and ancillaries remaining to allow for any delays in your delivery getting to you.
• Complete accurate monthly stock checks. If you have too much stock, please consider asking for less at your next delivery.
• The HEN provider driver may have been advised that they are no longer able to bring your enteral feed and ancillaries into your home. If this is the case, we suggest the following steps:
  • If able to bring the supplies in yourself. Only lift the supplies that you able to. If the boxes are too heavy, unpack them at the door and take items in gradually.
  • If you are unable to bring in the supplies yourself and there is another person in the household to do it, it may be necessary for you to ask a close family member, reliable friend or neighbour who has not had COVID 19 symptoms in the previous seven days, to help.
  • If asking someone from outside your household to help, ensure they clean their hands prior to touching the supplies and on leaving your property.
  • All members of the household should move into another room or retain 2m distancing.
  • If you have no-one to help you, call your supporting clinical team for advice.
• During the COVID-19 pandemic you will not need to sign for your delivery. Instead your driver will ring the bell and wait at a distance for you to answer the door. The driver will sign on your behalf to confirm you have received your delivery. Delivery drivers have been asked not to leave products unattended, in full view. Please contact your HEN provider to let them know where to leave your delivery if you are unable to immediately bring the items into your home.
• Due to anticipated increase in demands it may not be possible for you to have the same drivers you usually have. Please be understanding if there are changes to your delivery times and days.
• If you have items that need to be returned, please consider if you can continue to store them until after the current situation changes or ends, except for feeding pumps which should be returned as a priority so they can be cleaned and serviced for other patients to use.

Temporary changes in how your healthcare professionals work

It is likely that routine visits from the healthcare professionals who help you with your HEN will be postponed until further notice with a focus on providing only essential face-to-face contact. Healthcare professional teams are losing some staff due to self-isolating or being re-deployed to other areas; please accept that you may be contacted less frequently than before and contact may be with a different healthcare professional to the one you usually see.

If a home visit is required the healthcare professional may contact you beforehand to check if you have, or anyone in your household has, symptoms of COVID-19 (or has done for the past seven days). This will allow them to take the right precautions for all concerned, during the visit. Seeing staff use extra protective equipment - where needed - may be upsetting and may also raise issues in recognising them. Protective clothing may be worn in line with the government’s guidance and is designed to protect you and those involved in your care as sensitively as possible.

The main aim of all the steps is to protect you and the healthcare professionals to prevent the spread of coronavirus.

Enteral feed equipment - we need your help

There is an urgent need for extra enteral feeding and equipment nationwide. If you have a pump that is not in use and has not been returned, please contact your HEN provider at your earliest opportunity to arrange for it to be picked up. If you have a spare pump, please discuss with your healthcare professional whether this is needed at this time as returning it even on a temporary basis may help others during a period of increased demand.

If you are on pump feeding, your dietitian may discuss with you the option of changing to bolus feeding (this involves administering the enteral feed using a syringe) or gravity feeding. This will not be recommended if your dietitian feels it could impact on how well you tolerate your enteral feed.

Although we are pursuing actions to ensure we have enough pumps to meet the increased demand, should your pump malfunction during a period when there is a shortage of pumps available nationally, the dietitian will discuss alternative feeding methods to ensure you continue to have your enteral feed.

Managing tube and stoma complications

It’s important that you continue to contact your healthcare professional if you have any concerns with regards to your enteral feed plan, any feed tolerance issues, tube or stoma complications. You will be supported remotely if possible and advised if direct contact is required.

Some tips to be prepared are:

• Ensure you have spare parts in your home e.g. feeding end, clamps.
• If you are not aware of how to replace parts on your feeding tube, you may wish to ask your healthcare professional to train you how to do this.
• Take the opportunity during this period to make sure you know what to do if your enteral feeding tube becomes damaged or displaced.
• If you have a balloon retained gastrostomy, ensure you have a spare tube of the correct size and that it is in date.
• Ensure you have spare stoma saving devices e.g. EnPlug or Corstop ACE stopper, if your local area uses these to place in the event of a displaced tube.

If you have a discharging, painful, inflamed stoma site, please inform your healthcare professional. They may try to assess this remotely, over the phone, using video call technology or by asking for a photo to be taken. The healthcare professional will provide advice and liaise with your GP with regards to appropriate treatment.

Training to enhance self-care to help manage nursing and social care visits

If your healthcare professional asks you, or a family member to consider being trained on part or all of your routine care procedures to manage pressures on the service, this will be discussed with you before it is initiated. An example of when this might be considered is to reduce the need for nurses or carers entering your home during a time when you may have increased anxiety about social contact. Training may be offered on:

• Administering your own enteral feed, water flushes or medications.
• Performing routine tube-related care such as rotating and advancing your gastrostomy tube.
• Resolving tube complications such as replacing feeding ends or unblocking tubes.
• Self-managing stoma complications by removing and re-applying dressings; self-applying any creams.
• Taking a swab to test for infection; the nurse may support you to be able to do this yourself.

 Holidays

Government restrictions and guidance are being updated regularly. Please see PINNT’s advice on travel

Latest government and health advice

For all the latest government advice please visit: www.gov.uk/government/topical-events/coronavirus-covid-19-uk-government-response and for health advice for members of the public visit: https://www.nhs.uk/conditions/coronavirus-covid-19/
 

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