C = Consequence, L = Likelihood and R = Risk Risk ...

1 Potential RiskWhat could go wrong?Causes / HazardConsequencesCurrent controlsRisk rankingRecommendationsRisk RankingCLRCLR1 Nutritional deficiency and decline in adherence to enteral feeding care plan. Administering Liquidised increased feed of malnutrition and worsening of nutritional disturbance including vomiting, feed volume bestpractice in the UK following full dietetic assessment recommend theadministration of only productsdefined as Foods for SpecialMedical Purposesare used as enteral dietary analysis of a menu plan provided by the the use of web based apps (question validity) which may be used to independently analyse nutritional adequacy. Discuss the patient s fluid requirements and consider the use of nutrient dense fluids to be used to dilute the feed to the required total fluid volume of bolus and required the requirement for a broad spectrum vitamin and mineral the option to combine modes of feeding rather than liquidised food beingused as a sole source of detailed food and symptomdiary is recorded by the increased frequency of monitoring of anthropometry and Assessment Template for Enteral Tube Administration of Liquidised Diettable2 v2_Layout 1 19/03/2014 17:04 Page 1 Potential RiskWhat could go wrong?

2 Causes / HazardConsequencesCurrent controlsRisk rankingRecommendationsRisk RankingCLRCLR2 Patency of the enteralfeeding of enteralfeeding device outside of(and notin line with) themanufacturer sguidance for use. Blockage of device. Reducedlife span of control guidance of liquidised 8 C andabove 63 C. Enteral feeding device require A&Evisit, hospital admission to unblock or replacethe product licencevoided, thus eliminating thepurchasers rightsto refund if to EPSG statement. Recognised UKpractice to usemedical device in line with manufacturer carer/ patient whether they havebeen trained to replace device to preventhospital the lumen size at each and monitor the frequency of cost impact of additional gastrostomy tubes which may be and document in dietetic and medical records that your patient has \chosen to use a medical device which isoutside the scope of the manufacturer s information for use control guidance is unrealisticwith this v2_Layout 1 19/03/2014 17:04 Page 2 Potential RiskWhat could go wrong?

3 Causes / HazardConsequencesCurrent controlsRisk rankingRecommendationsRisk RankingCLRCLR3 Food borne load ofthe liquidised contamination from the utensilsused in preparation and the re-usable enteral feeding ancillary ranging depending on theclinical condition of the patient, consider degree of immunocompro-misation, gut integrity, history ofgut infections altering flora, and stoma site integrity. Provision of aready to feedUHT/sterile designed for re-use within manufacturer to national food safety a risk assessment of the foodpreparation using food safety guidance recommended for to temperature control guidanceof liquidised feed administered to meet infection control food safety guidance if the administration of defrosted food is increased supply of extensionssets and single use enteral feeding syringesto reduce the risk of v2_Layout 1 19/03/2014 17:04 Page 3 Potential RiskWhat could go wrong?

4 Causes / HazardConsequencesCurrent controlsRisk rankingRecommendationsRisk RankingCLRCLR4 Legal action of the health ( Healthand Care ProfessionsCouncil)/ RCN(Royal Collegeof Nurses),Litigation of the health complaintto HCP supportingthe card and care plan documentationConsider the patients care package and impact on this mode of feeding may haveon their professional the risk assessment outcome to the care staff that may be required to administer this mode of feeding during day-care services or respite detailed risk assessment todemonstrate potential risks were highlightedat the onset and the patient or carer with capacity made a fully informed choice tocontinue with the an MDT or GP led best interestsmeeting to ensure responsibility is to demonstrate that the outcome of the risk assessment followedtrust guidance and was escalated as per the an agreement of care document issigned and in research v2_Layout 1 19/03/2014 17:04 Page 4 Potential RiskWhat could go wrong?

5 Causes / HazardConsequencesCurrent controlsRisk rankingRecommendationsRisk RankingCLRCLR5 Cost ImplicationUnplanned financial cost ofdietetic resourcedue to the risk assessmentprocess, full nutritional analysisand recommendedincreased cost topatient/ family tofollow this increased costs to the local health-care economy due to the management ofany nutritional,infectious, enteralfeeding tube complicationsService impact toGP/ Nurse / A &Eequipment budget,caused by increased provision of enteralfeeding devicesand industrial blender in order toreach the required consistency, at a cost of 250- individual commissioned financepackage to highlight the potential impact ofadditional v2_Layout 1 19/03/2014 17:04 Page 5 Potential RiskWhat could go wrong?Causes / HazardConsequencesCurrent controlsRisk rankingRecommendationsRisk RankingCLRCLR6 Infectious complications Potentially borne/ enteral feedingtube borne orstoma site gut/stoma site whichmay require surgical intervention.

6 Depending onseverity may require ITU admissionMonitoring of foodhygiene of enteral feedingtube integrity andstoma siteHighlight the importance of good patient/ carer has been trained and demonstrated competency to clean and manage enteral feeding tube andstoma site in line with local to NNNG Good Practice ConsensusGuideline on Exit Site Management for gastrostomy Tubes in Adults and adequate flushing to maintain patency of the enteral feeding tube as perlocal patient on how to identify signs and symptoms of infection and agreedcourse of action in line with local policy and NNNG v2_Layout 1 19/03/2014 17:04 Page 6