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Enteral feeding referral pathway for patients with Motor neurone disease in East Berkshire

Enteral feeding referral pathway for patients with Motor neurone disease in East Berkshire. Upper limb skills. Chewing and Swallowing skills. Weight (BMI). Vital Capacity (sitting, lying). Unable to feed self Carer unable/ unwilling to feed. Unsafe swallow SLT report

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Enteral feeding referral pathway for patients with Motor neurone disease in East Berkshire

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  1. Enteral feeding referral pathway for patients with Motor neurone disease in East Berkshire Upper limb skills Chewing and Swallowing skills Weight (BMI) Vital Capacity (sitting, lying) • Unable to feed self • Carer unable/ • unwilling to feed • Unsafe swallow • SLT report • Evidence of aspiration • BMI<18 • 5% weight loss of • standard weight/height • FVC<75% predicted • Respiratory symptoms • Rapidly declining FVC • FVC <50%predicted • FVC falls >25% between sitting and lying • Respiratory Symptoms • Requires NIPPV Respiratory referral For NIPPV (see NIPPV pathway) DISCUSS PERCUTANEOUS ENDOSCOPIC GASTROSTOMY-PEG DISCUSS RADIOLOGICALLY INSERTED GASTROSTOMY-RIG Patient says NO Patient says YES Refer for elective PEG (Kay Lasenby) OR Refer for elective RIG (Dr Mark Charig) Refer Enteral Feeding Team (Anna Clayton) Check mood, intentions and understanding of decision Discuss again at a later date if appropriate Formulate an ‘end of life plan’ ?Advanced Decision to refuse treatment ?Lasting power of attorney Once date for PEG/RIG agreed: Arrange pre PEG/RIG bloods (District Nurse) Book bed Eden suite (Dr Fiona Lisney) Inform Enteral Feeding Team Enteral feeding referral pathway Sept 2009. Review Sept 2011 East Berkshire MND Supportive and Palliative Care Steering Group

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