Authors (including presenting author) :
Kwong Wing Yan, PMH APN(LKB)
Affiliation :
Lai King Building, Princess Margaret Hospital
Keyword 1: :
Careful hand feeding
Keyword 2: :
Feeding option
Keyword 3: :
Feeding skills
Introduction :
Feeding problem is prevalent among older adults or dependent patients. This is also one of the most difficult problems causing tremendous stress and frustration to relatives and carers. Artificial tube feeding is a common practice, however, studies have indicated that tube feeding offers no benefits in terms of survival, pneumonia risk, pressure injuries, and nutritional status while increasing physical suffering and eventually impairing patients’ quality of life. Careful Hand Feeding (CHF) can be an alternative feeding option to tube feeding to the patients. To enhance the quality of life of patients with feeding problem and to support relatives or carers on feeding issue, Dependent Eating Enhancement Problem (DEEP) is launched.
Objectives :
1.To educate patients’ relatives and carers on comfort feeding strategies and CHF skills 2.To equip Nurses and Patient Care Assistants (PCAs) on CHF skills so as to provide ongoing support to patients’ relatives and carers
Methodology :
DEEP is an Inter-disciplinary team approach programme which includes Doctors, Nurses, Speech Therapist (ST), Dietitian and Patient's relatives. Patients in LKB who met the following inclusion criteria were recruited: 1. Patients with poor feeding problems (Admission problem, poor oral intake of 2 days or more ≤ half portion of meal) 2. Patients with swallowing difficulties. After patients' recruitment, doctors would document the decision of CHF on patient notes, signed consent for CHF with relatives and made referrals to concerned disciplines. Nurses would allow the flexible visiting hours for patients’ relatives or carers, implemented CHF according to individualized feeding plan and reinforced knowledge and skills of CHF to patients’ relatives and PCAs using CHF cue card; Ongoing reviews using DEEP care plan, MST, monitoring of intake and output and body weight and reviews in team round would also be done; If patient was in imminent dying phase, psychosocial support and oral care to patients were offered. ST would provide swallowing assessment and management for patients and educated CHF skills to patients’ relatives or carers, nursing and supporting staffs. Dieticians would provide nutritional assessment and management for patients. Patients' relatives or carer would feed the patient using CHF technique learnt form ST. To strengthen nurse and PCAs’ knowledge and CHF skills, staff trainings was provided by multi-disciplines via Train-the-trainer (TTT) program and in-service trainings.
Result & Outcome :
87 patients were recruited in DEEP in 2025. Average patients’ unplanned < 28 days re-admission rate after joining DEEP in 2025 was 0.27. Total 44 feedbacks were collected in 2025, all respondents satisfied with DEEP and agreed that CHF adopted in DEEP improved patients’ quality of life. For staff trainings and feedback, 111 nurses and 80 PCAs were trained on CHF via TTT in 2025. Two sessions of in-service trainings were conducted with a total of 26 nurses and 23 PCAs attended. All participants agreed that the training content was useful to work, not only enhanced their knowledge and skills on CHF, but also the confidence of caring patient with feeding problems. Way Forward: CHF offers a feasible alternative feeding option to improve quality of life of patients. Meanwhile, DEEP empowers both patients’ carers and staffs’ knowledge, skills and confidence in caring for the one who suffered from feeding problem. In the future, it is hoped that more patients would be recruited and be benefit in DEEP.
