This guide will help you answer 1.1 Explain legislation, protocols and agreed ways of working that affect working practices related to extended feeding.
Extended feeding describes providing nutrition and fluids to individuals who cannot eat or drink by mouth. This can include enteral feeding, which uses tubes inserted into the stomach or intestine, and parenteral feeding, which involves delivering nutrients directly into the bloodstream through a vein. These methods support people who have difficulties swallowing (dysphagia), serious illness, or injury.
Every aspect of extended feeding is covered by legal, ethical and professional standards. These rules protect the welfare and rights of people receiving care. Staff must comply with legislation and organisational protocols. Agreed ways of working guide every action taken with extended feeding.
Legislation Covering Extended Feeding
Laws set out the main rules and responsibilities for staff providing extended feeding. They aim to protect people needing care, make rights clear, and set standards for safe practice.
The Mental Capacity Act 2005
The Mental Capacity Act 2005 safeguards adults who are unable to make decisions for themselves. This law is very important in extended feeding, where the person may lack capacity due to illness, injury or disability.
Key principles of the Act include:
- Presume capacity unless proven otherwise
- Provide support to help decision-making
- Allow unwise decisions, if the person has capacity
- Act in the person’s best interests if they lack capacity
- Choose the least restrictive option
Applying these rules means a person receiving extended feeding must always be supported to make their own decisions, if possible. If not, decisions about extended feeding, such as tube placement or removal, must be made in their best interests. Staff often take part in best interests discussions.
Staff should record:
- Who was involved in decision-making
- What steps were taken to support choice
- How best interests were established
The Human Rights Act 1998
This law protects fundamental rights and freedoms. Several articles are relevant to extended feeding:
- Article 2: Right to life
- Article 3: No inhuman or degrading treatment
- Article 8: Right to respect for private and family life
In extended feeding, staff must respect dignity and bodily integrity. Forcing feeding may breach Article 3. Withdrawing nutrition and fluids without proper process may risk life (Article 2). Care must always maintain respect and avoid avoidable suffering.
Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
This legislation sets requirements for care providers in England. Two central parts are:
- Regulation 9: Person-centred care
- Regulation 12: Safe care and treatment
Providers must deliver safe, personalised care. Staff should assess risks and write feeding care plans that reflect the person’s needs, wishes and preferences. Only trained staff must carry out tube feeding. Regular reviews and monitoring are needed.
The Care Act 2014
This law outlines duties for local authorities and care services in England. It promotes well-being, independence and safeguarding for adults needing care and support.
Staff must protect people from abuse or neglect related to feeding, for example ensuring proper feeding methods, to avoid the risk of choking or infection. Involving the individual in planning their care is key to respecting their choices.
The Data Protection Act 2018 and UK GDPR
These laws govern how personal data, including medical and care records, must be handled. With extended feeding, information about nutrition, care plans, and health status is highly sensitive. Written and digital records must be kept secure and confidential.
Only authorised staff should access these records. People receiving care should be informed about what information is collected, and how it is used.
Protocols in Extended Feeding
Protocols are step-by-step guides set by employers, NHS organisations or local authorities. They provide practical details on how to deliver extended feeding safely and consistently.
Enteral Feeding Protocols
Protocols for enteral feeding cover:
- Checking tube placement before each feed
- Preparing feeds in clean, hygienic settings
- Using the correct type of feed and equipment
- Setting feeding rates and amounts safely
- Documenting each stage of the feeding process
- Responding to complications such as blockage, dislodgement, or infection
Staff use these directions to prevent risks such as aspiration (feed entering the lungs), tube dislodgement, or cross-infection. Protocols also explain how to wash hands, wear gloves and keep the feeding area clean.
Parenteral Nutrition Protocols
For intravenous feeding, protocols specify:
- How to choose, set up and maintain access lines
- Preparing sterile solutions
- Calculating fluid and nutrient amounts
- Safe administration of nutrition
- Recognising complications such as sepsis, line infection or fluid overload
- Accurate record keeping
Parenteral feeding demands great care to prevent infections and other risks.
Consent and Capacity Procedures
Protocols explain:
- How to check if someone can consent to feeding
- When to use best interests decision-making
- How to record consent
- Who should be involved in complex cases (e.g., Independent Mental Capacity Advocates, family, or multidisciplinary team)
Consent must be checked regularly, not just at the start of care.
Incident and Emergency Protocols
If problems develop, staff follow emergency protocols. For example:
- If a tube becomes blocked, what steps to take
- If someone vomits feed, how to respond
- When to seek help from senior staff or medical teams
- How to complete incident reports
Agreed Ways of Working in Extended Feeding
Agreed ways of working are rules everyone in a care setting must follow. They come from legislation, local policies and professional standards.
Person-Centred Approach
A person-centred approach keeps the individual’s needs, choices, and history at the centre of decisions.
Staff do this by:
- Talking directly to the person, not just family or carers
- Finding out their feeding preferences and routines
- Respecting cultural, religious or personal beliefs (e.g. dietary restrictions, fasting)
- Using a communication aid if the person has difficulties (such as picture cards or voice aids)
Care plans for extended feeding should be reviewed often. Staff discuss with the person, where possible, any issues, preferences, or changes needed.
Safe and Competent Practice
Only competent and trained staff should provide extended feeding. Workers are expected to attend training, keep skills updated and follow supervision arrangements.
Key points include:
- Safe handling of tubes and feeding equipment
- Good infection prevention (washing hands, wearing gloves)
- Checking for signs of discomfort, tube movement or problems
- Knowing how and when to ask a nurse or doctor for help
- Record keeping after each feed
If a worker is unsure, they must speak to a supervisor, manager or nurse. Acting outside scope of competence is not acceptable.
Communication
Staff must communicate effectively with:
- The person receiving care
- Family members or advocates
- Nurses, doctors, dietitians and speech and language therapists
Written and verbal handovers must be accurate. If someone’s condition changes, it must be reported straight away. Any concerns about feeding, risks, or consent issues must be raised with senior staff.
Record Keeping
Accurate record keeping shows what feeding was given, by whom and when. This includes recording:
- Type and amount of feed
- How the person tolerated feeding
- Condition of feeding tube or line
- Any difficulties or incidents
Records are used to monitor the individual’s health and guide any changes to care, and may be reviewed during inspections.
Infection Control
Protocols and agreed ways of working stress infection control as key. Infection risks are higher with extended feeding.
Methods include:
- Sterile techniques when handling tubes and feeds
- Hand washing before and after care
- Keeping feeding areas and equipment clean
- Changing equipment at set intervals
- Using gloves and aprons as directed
If infection is suspected (e.g., redness, pain at tube site, fever), care staff must inform clinical leads quickly.
Safeguarding
Staff have a duty to protect people from neglect and abuse. Neglecting feeding needs, forcing unwanted feeding, or not monitoring for side effects are safeguarding issues.
Teams must follow procedures for raising concerns or making safeguarding referrals.
Respecting Dignity and Rights
Care workers must respect the dignity, privacy, and rights of each person.
This includes:
- Allowing people as much control over their feeding routine as possible
- Maintaining privacy, covering the person during feeding
- Explaining what is happening step by step
- Supporting emotional well-being, such as by offering reassurance
- Listening to concerns or distress about feeding, and taking them seriously
Equality and Diversity
Protocols stress meeting the needs of all individuals, whatever their age, disability, ethnicity, gender identity, or beliefs.
Staff should ensure:
- Cultural and religious dietary needs are respected
- Communication methods match the individual’s ability
- Feeds or timings fit the person’s routines, beliefs, or wishes
Working with Others
Effective extended feeding often involves teamwork.
Common partners include:
- Speech and Language Therapists (SLTs) for swallowing assessments
- Dietitians for nutritional planning
- Nurses or doctors for medical input
- Family or advocates for personal knowledge or support
Workers must know when to refer for specialist input. If there is a problem outside usual care, such as tube dislodgement or allergic reaction, the right professionals must be contacted as soon as possible.
Points for Practice
Extended feeding is closely regulated to protect people and deliver safe, respectful care. Responsibilities include:
- Following laws on rights, consent and safety
- Adhering to protocols, such as checking tube placement and recording feeding
- Working to agreed ways, such as keeping care person-centred and respecting choices
- Communicating clearly with people needing care, family, and other professionals
- Responding swiftly to concerns or potential incidents
Breaching protocols or laws can cause harm and lead to disciplinary action. Following the correct procedures keeps everyone safe.
Final Thoughts
Every person receiving extended feeding has the right to be safe, treated with respect, and have their wishes heard. Legislation and protocols make expectations clear. Staff play a key role by applying these in daily practice, being alert to the needs and preferences of those they support, and seeking guidance when unsure.
Continuous learning and reflection, as well as regular training and supervision, help workers apply these principles and respond to changing needs. Good record keeping, teamwork, and up-to-date knowledge mean better care and protection for vulnerable people.
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