Competency training programme that facilitates safe delegation of enteral feeding tasks
Esther Munthali, Practice Development Nurse, Swansea Bay University Health Board
Introduction
Care providers reported inadequate training from the Home Enteral Feeding (HEF) Contractor, which was too short and generic, and did not fully meet individual learning needs, unique & dynamic patient needs or understand the limitations of the care setting. Care providers identified the following priorities:
- enhanced training on medication administration
- individualisation of training
- improvements to record keeping
- care planning and escalation
- training on new elements of care such as displaced tubes.
In response, a Practice Development Nurse (PDN) developed a competency training programme with the aim of complete sign off on three priority service providers within 12 months.
Methods
- Using PDSA, develop a training programme with a focus on patients with learning disabilities due to high demand.
- Use the competency-based training framework for home enteral feeding by paid carers as the foundation.
- Train PDN to assess and delegate enteral tube tasks.
- Collaborate with stakeholders to tailor the service to specific settings and patient needs.
- Structure training with a theory session and manikin assessment, followed by patient assessments.
Outcomes
- All risk-assessed carer settings now have a tube displacement pack in place.
- Carers can identify the risk of sepsis.
- Escalation processes are clearer to staff, especially with the use of care scenarios in both classroom and care settings.
- HEF team documentation has been redesigned based on carer feedback, making it a robust learning tool.
- Strong, trusting relationships with care settings allow for the comfortable highlighting and addressing of concerns.
Learnings
- Developed different pathways for competency assessment for experienced vs. new carer staff due to initial resistance.
- Classroom sessions provided a distraction-free environment, fostering reflective practice and non-judgemental learning.
- Risk assessments identified high-risk patients and highlighted the need for holistic support, especially in understaffed settings.
- Identified that previous tube training was generic and often inadequate, leading to confusion and poor documentation.
- Discovered reliance on managers for troubleshooting, highlighting the need for easily accessible reference resources for carers.
What next?
- Collaborate with HEF contractors for efficient competency training and learning resources.
- Develop an efficient data collection process to monitor the impact of the PDN role and expand the PDN team.
- Create All Wales standards and resources
- Collaborate with learning disability dieticians for seamless transition from paediatric to adult care.
- Collaborate with health boards to capture data showing the impact of the competency training programme.
