Authors (including presenting author) :
Ip CY(1), Sze YM(1), Yiu LP(1), Ho WY(1), Wong SY(1), Lam WC(1), Ng PH(1), Ng KW(1), Lau HL(1), Chan CM(1), Yau HT(1), Cheung HT(1), Choi YW(1), Loo CW(1)
Affiliation :
(1) Department of Medicine & Therapeutics, Prince of Wales Hospital, (2)Department of Speech Therapist, Prince of Wales Hospital
Introduction :
Feeding problems including dysphagia and refusal to feed are not rare in people with advanced dementia and neurological degenerative diseases. And feeding problems may lead to malnutrition, dehydration, aspiration pneumonia, choking and even death. To prevent these consequences, we need to consider artificial nutrition and hydration (ANH) as one of the life-sustaining medical treatment. And enteral tube feeding is one of the common choices of ANH. However, it was found that tube feeding could not prevent aspiration pneumonia and improve nutritional status which proved by systematic review and researches. Nevertheless, tube feeding may potentially lead to distress and other complications. Careful hand feeding (CHF) is an alternative for patients with tube feeding, particularly for those who is suffering from terminal illness or advanced dementia. Hospital Authority has updated its guidelines on life-sustaining treatments in the terminally ill in 2015 and provide direction of CHF. It stated that CHF is one of the ethically supported palliative care approach for people with advanced dementia. In view of the need and best interest of our patients, Geriatric team, neurology team of PWH M&T and Speech therapist of PWH jointly launched a pilot program of CHF in geriatric and neurology ward since July 2024.
Objectives :
1. To guide healthcare professionals through a complex decision-making process on CHF with acknowledged risks. 2. To define the assessment, decision-making and documentation process 3. To implement safe practice of CHF 4. To education for healthcare professionals and care givers.
Methodology :
1. Set up CHF pilot program workgroup which include Geriatrician, Neurologist, Speech therapist and nurses. 2. Perform multi-disciplinary team meetings for setting up standardized Guideline for Careful Hand Feeding with Dysphagia 3. Arrange joint educational class and workshop by Speech therapist and Nurses for nurses working in ACE unit and neurology ward 4. Identify and recruit suitable case 5. Discuss with patient and/or caregivers to reach a consensus on the shared decision on CHF 6. Refer Speech therapist for assessment and education 7. Facilitate and assist CHF by nurses with trained feeding technique, special feeding utensils and oral care products 8. Monitor and evaluate CHF progress during the hospital stay 9. Discharge or continue care in extended care setting if clinically allowed
Result & Outcome :
6 sessions of training workshop with 65 nurses attending the training. 100% of the attendance agree or strongly agree with the content of the training and able to meet the objective of the training. 44 patients were recruited into the program with 1 case converted back to the use of tube feeding as requested by patient. No patient has significant or adverse complication developed which related to CHF. Over 85% of the patients or their caregivers agreed and satisfying with this pilot program. And no complaint has been received during the pilot period. We planned to extend the scope of services from ACE unit and neurology unit to other wards in M&T of PWH. Regular training workshop would be launched to enhance and promote the knowledge and concept of CHF
