Home Enteral Feeding Team (HEFT) Service

Who are we?

The Gloucestershire HEF Team is based at Gloucestershire Royal Hospital in the Nutrition and Dietetic Department. We provide countywide support to children and adults with enteral feeding tubes in the community. Our team is made up of:

• Specialist Dietitians
• Enteral Nutrition Nurse Specialists
• Dietetic Assistant Practitioners and Dietetic Support Workers
• Administrative staff

Our dietitians are registered and regulated by the Health & Care Professions Council and our nutrition nurses are registered and regulated by the Nursing & Midwifery Council.

Who is the service for?

Most adults and children who have enteral feeding tubes and are registered with a Gloucestershire GP are looked after by the Gloucestershire HEF Team. If you have been discharged from a local hospital with an enteral feeding tube, our team should receive a referral from your hospital dietitian. If you have moved into the area, please request your previous HEF dietitian to contact us to transfer your care.

What we do

Our team works closely with the local community to support patients with enteral feeding tubes at home or in specialist centres. We visit a variety of community settings including:

• patients’ homes
• respite centres
• schools
• care homes
• patients’ place of work

Our dietitians will create a feeding plan which works for you and will monitor your nutritional intake to support your health. Your dietitian may also be able to help with your tube and stoma site care, or they will liaise with our specialist nurses.

Our Enteral Nutrition Nurse Specialist team provide support and advice about enteral feeding tubes, enteral feeding equipment, stoma sites and medication administration via enteral feeding tubes.

Our Dietetic Assistant Practitioners and Support Workers collect relevant medical, social and dietary information from the patient, carer, medical, nursing and other health care staff and feed back to the registered clinicians. They also take measurements such as weight and height, assist with the ordering of patient enteral feeding supplies, assess enteral feeding tubes / stoma sites and carry out basic tube care to support the wider team.

Our administrative staff maintain the administrative part of the service and thereby support the rest of the team.

Where do I get my tube feed and equipment?

Our team currently have a contract with a feeding supplies company called Nutricia. You will be registered on their system Nutricia Homeward MyConneX by your dietitian to receive monthly home deliveries of the following items (as required):

• 60ml purple enteral syringes (single use or reusable as appropriate).
• Feed (small bolus bottles or larger pump bottles).
• A Nutricia feeding pump, stand and pump giving sets.
• Sterile containers (to pour feed or water into).
• Bolus adaptors (to enable a syringe to connect to the larger pump bottles of feed).
• 5ml syringes and pH paper (for checking the position of a balloon gastrostomy tube, button tube or nasogastric tube).
• Spare feeding tube and accessories.

Nutricia Homeward MyConneX deliveries will be arranged on your behalf before you are discharged from hospital.

We advise that you keep a 7-day buffer stock of all required items as well as your monthly supplies. This is important to avoid under or over stocking of supplies which can lead to shortage or wastage. Please note that emergency stock orders can take up to 2 working days to arrange.

You can manage your monthly stock checks online by registering at: www.nutriciahomeward.co.uk/services/online-ordering

You can contact Nutricia for supply and delivery issues, either during office hours (Monday to Friday, 9:00am to 5:00pm) on 0800 028 2667 (free from a landline) or out of hours (Monday to Friday, 9:00am to 5:00pm) on 0800 093 3672.

If you have any feeding pump issues outside the HEFT working hours (Monday to Friday, 8:30am to 4:30pm), please contact the Nutricia out of hours helpline on 0800 093 3672.

Please remember to keep all of your medical supplies out of reach of children and vulnerable adults.

Other supplies

There are some supplies that our team are not able to provide including syringes for medication, ampoules of water for injection, dressings or tape. Some items require a GP prescription; our team will request these via your GP’s surgery.

What can the HEFT help with?

• Provide support and monitoring of your feeding/fluid needs, including concerns with feeding, weight, tolerance (for example, vomiting, diarrhoea, constipation). We can also provide copies of your feeding/fluid plan and assist with any problems with your feeding pump.
• Provide training to set up your feed and equipment.
• Provide advice about looking after your feeding tube and stoma site.
• Liaise with Nutricia if you have any delivery issues.
• If you are planning a holiday and need a letter or supplies to be organised from Nutricia we can arrange this for you. Please request this as soon as you have planned your holiday.
• Provide you with support for any emotional and social aspects of enteral feeding.

What happens when I am discharged from hospital?

Each patient requires different items depending on their dietetic care needs and feeding tube type.

When you are discharged from Gloucestershire Royal Hospital or Cheltenham General Hospital, you will be provided with:

• At least 7 days’ supply of purple enteral syringes. Please note that some enteral syringes are single-use while others are re-usable.
• At least 7 days’ supply of sterile gauze and sterile saline (if the tube has been in for less than 14 days on discharge).
• A Nutricia pump, stand and 7 days’ supply of pump giving sets (if required).
• At least 7 days’ supply of feed (if required).
• A spare balloon gastrostomy tube (if required).

You will also receive the following from the ward dietitian:

• A discharge information pack.
• Feeding / fluid plan.

Going home with a new enteral feeding tube can be overwhelming. After discharge from hospital, you will receive a phone call from a member of the HEF Team. This will be to arrange a suitable date for a dietitian and/or enteral nutrition nurse specialist to visit you at home, as well as discuss any concerns you may have at the time.

The purpose of our home visit is to discuss and provide support and advice regarding your dietetic care needs, feeding tube and stoma site.

As long as you remain under the HEF service, you will be contacted regarding follow up visits. Routinely these take place every 6 months, but this may vary depending on team capacity and clinical need. Support between visits will be available via telephone and email (see our contact details at the end of this page).

Home visits

By agreeing to be seen by the HEFT we will assume that you are consenting to treatment. We will always discuss any treatment with you and agree on an appropriate treatment plan to best suit your needs.

The things we may monitor and discuss with you are:

• Your weight and height (sometimes we may also take additional measurements such as head circumference in babies, waist circumference, handgrip strength or skinfold measurements).
• Your nutrition and fluid plan (we will make sure you are provided with a written or digital copy of the plan).
• Your bowel and urine habits.
• Any lifestyle changes as needed.
• Any recent blood results.
• Your tube and feeding equipment.
• Your stoma site (skin surrounding your tube). This will help us monitor any treatment. It may also be useful for us to take a photograph of your stoma site. We will ask for your consent before doing this; please see the Trust’s ‘Privacy notice’ at www.gloshospitals.nhs.uk/privacy-notice/

During all home visits, please:

• do not smoke in the room where the review is taking place.
• remove pets from the room where the review is taking place.
• treat all members of the HEFT with kindness and respect.

First home visits may last between 60 to 90 minutes. Future visits will usually be shorter.

Collaborative work

If you are referred to a consultant out-of-area but remain registered with a Gloucestershire GP, your dietetic care needs and enteral feeding tube may be managed under the shared care of our team and your out-of-area dietitians / nutrition nurses. Please inform the HEFT if there are any changes advised by your out-of-area team, so we can make adjustments to your feeds and/or equipment orders.

The HEFT liaises closely with other professionals (such as GP’s, consultants, community nurses, speech and language therapists, etc). Information gathered during your consultation may be sent as a letter to update you and the relevant healthcare professionals involved in your care.

What happens if I need to go into hospital with my feeding tube?

If possible, please contact the HEFT if you have been admitted to hospital so that we can make sure a handover is provided to the hospital dietitian. If you are admitted, please take the following supplies into hospital with you:

• If you have a balloon gastrostomy tube or button, take the spare tube/button and extension sets with you. These will not be supplied by the hospital.
• If you have a PEG, take your spare Y adaptor repair kits or Freka repair kit.
• A copy of your most up to date feeding/fluid plan.

You do not need to take your feeding pump or feed unless you are asked by the HEFT or ward dietitian.

Please be aware that patients have different tubes and therefore some of the items listed above may not be relevant.

Contact us

Please contact the HEFT if you feel that you need to be seen sooner than your next scheduled appointment. You must also contact the team if you have any problems or changes relating to your feed, your feeding tube or stoma site or if you have been admitted to hospital.

You can email the HEFT at: ghn-tr.homeenteralfeedingteam@nhs.net

Or call us on 0300 422 5645, Monday to Friday, 8:30am to 4:30pm.

Please be aware that email is not a secure means of communication.

If you require a secure means of communication or need to speak to someone urgently, please contact the team by telephone. There may be times when service pressure requires the phone lines to be unmanned but voicemail messages and emails will be checked regularly during office hours and someone will get back to you as soon as possible.

Please note we are not an emergency service. Our office hours are Monday to Friday, 8:30am to 4:30pm excluding bank holidays. If you require urgent feed or tube related advice outside of these hours, please contact the district nurses (adult community nursing team), CCN’s (children’s community nursing team), Paediatric Assessment Unit or NHS 111.

If your query is not related to your feed or feeding tube, we may not be the best placed professionals to help. In this instance your GP, NHS 111 or in an emergency 999 may be more appropriate.

Further information

PINNT Support Group

PINNT is a national, independent, not for profit membership charity established for over 25 years providing mutual support and understanding to hundreds of adults and children and their families adapting to life on home artificial nutrition. PINNT provides this support direct via local and regional groups, online via forums and literature and a national telephone and email helpline

Tel: 020 3004 6193

Website: www.pinnt.com

Carers UK

For information leaflets for carers relevant to tube feeding.

Website: www.carersuk.org