PEG Care and Enteral Feeding Audit - Care Homes

Evidence to check

• • Current person-centred enteral feeding care plan and feeding regimen
• • Tube type, route, prescribed feed, water, medicine and stoma-care instructions
• • Communication, consent, preferences and emergency contact information
• • Care plan matches the latest dietitian, nursing and prescriber advice

Evidence to check

• • Admission and review risk assessments for enteral feeding, aspiration, choking, infection and tube displacement
• • Evidence that risks are reviewed after illness, hospital attendance or change in need
• • Risk controls reflected in current care plans and staff handovers
• • Resident-specific risk information is accessible on every shift

Evidence to check

• • Records of consent for PEG care, feed, flushes and medicines
• • Decision-specific capacity assessments and best-interest decisions where required
• • Involvement of the resident, attorney, family, advocate and professionals as appropriate
• • Observed care confirms consent is sought and refusals are respected and escalated

Evidence to check

• • Training matrix identifying staff authorised for PEG and enteral feeding tasks
• • Resident-specific competency assessments, observed practice and sign-off records
• • Evidence of supervision or restriction from independent practice until competent
• • Current competency after incidents, changes in equipment or prolonged absence

Evidence to check

• • Observation of hand hygiene before and after tube, feed and stoma care
• • Clean preparation area and appropriate PPE where indicated
• • Staff can explain how cross-contamination is prevented
• • IPC audit findings and corrective action where practice is poor

Evidence to check

• • Feed, water, giving set, syringe and extension-set storage checks
• • Expiry-date, stock rotation and opened-feed records
• • Cleaning, drying, replacement and disposal arrangements follow the prescribed or manufacturer instructions
• • Equipment is stored cleanly and separately from contaminated items

Evidence to check

• • Resident-specific pre-administration checks in the care plan
• • Observation of staff checking safety before feed, flushes and medicines
• • Clear instruction to stop and seek advice if tube position or safety is uncertain
• • Staff can explain the checks for a resident they support

Evidence to check

• • Recorded external tube length or prescribed position-marker checks
• • Baseline measurement or other manufacturer/clinical instruction available
• • Records of prompt escalation for movement, looseness or suspected displacement
• • Staff understand when not to use the tube and how to obtain urgent advice

Evidence to check

• • Daily stoma and skin-care records where required by the individual plan
• • Observation of cleaning and drying using the prescribed approach
• • Records of redness, leakage, pain, discharge, swelling or over-granulation and action taken
• • Evidence of community nurse, enteral nurse or GP review when concerns arise

Evidence to check

• • Specific instructions for tube rotation, advancement or adjustment where applicable
• • Competency evidence for any staff undertaking these tasks
• • Documentation of the care undertaken and resident response
• • Escalation records where resistance, pain or other concern was identified

Evidence to check

• • Current prescribed feeding regimen showing feed, volume, rate, route and times
• • Observation of bolus or pump feeding against the prescription
• • Records of missed, delayed, stopped or altered feed and clinical advice received
• • No unauthorised substitutions or changes to the feeding plan

Evidence to check

• • Positioning instructions within the care plan
• • Observation of resident positioning during and after feed or flushes
• • Risk assessment for reflux, aspiration and overnight feeding where relevant
• • Monitoring and escalation records for coughing, regurgitation or respiratory concerns

Evidence to check

• • Pump set-up, cleaning, maintenance and alarm-check records
• • Observation of staff programming the pump in line with the prescribed regimen
• • Evidence that alarms, battery status and faults are acted on promptly
• • Service, replacement or supplier support records where required

Evidence to check

• • Contemporaneous feed and water-flush charts
• • Entries show prescribed amount, actual amount, timing and reason for any variance
• • Daily review of charts and action for poor intake or missed feed
• • Consistency between charts, care notes, handovers and nutritional monitoring

Evidence to check

• • Prescriber, pharmacist or suitably qualified healthcare professional instructions for each medicine given through the tube
• • Medicine administration plan identifies formulation, preparation, flushes and timing
• • Staff seek advice before altering, crushing, mixing or administering a medicine by this route
• • Evidence of review where feed and medicine timing may interact

Evidence to check

• • MAR charts record the enteral route clearly
• • Refusals, omissions, delays and changes have a reason, action and outcome recorded
• • MAR, care plan and medicine administration instructions agree
• • Audit checks for unsafe retrospective entries or unclear route documentation

Evidence to check

• • Care notes, fluid charts and incident records for symptoms of feed intolerance
• • Staff can describe early warning signs and immediate action
• • Records of escalation to dietitian, GP, nurse or emergency services where necessary
• • Changes to the feeding plan or monitoring after symptoms are documented

Evidence to check

• • Weight, nutrition, hydration, bowel, skin and clinical monitoring records
• • Agreed review frequency and thresholds for concern are clear
• • Dietitian, GP or nursing referrals and outcomes are documented
• • Care plans and feeding regimen reflect review outcomes

Evidence to check

• • Current SALT, dietitian and choking-risk guidance where oral intake continues
• • Care and catering staff receive and follow updated texture, fluid and support instructions
• • Observation of oral intake and enteral support confirms the plans are compatible
• • Records of changes in swallowing, coughing or choking and escalation

Evidence to check

• • Oral-care plan and records for residents receiving enteral nutrition
• • Resident preferences for routine, comfort and communication are documented
• • Observation shows dignity, reassurance and involvement in care
• • Opportunities for safe oral intake or social mealtime inclusion are considered where appropriate

Evidence to check

• • Emergency flowchart or resident-specific guidance for blocked, displaced or fallen-out tubes and other urgent concerns
• • Staff scenario responses for pain, bleeding, leakage, infection, aspiration concern and pump failure
• • Incident and escalation records show timely action and advice obtained
• • Staff know when feed and medicines must be stopped pending professional advice

Evidence to check

• • Accessible current contact details for the enteral feeding team, community nursing, GP, pharmacy and out-of-hours support
• • Availability of prescribed spare equipment and contingency supplies
• • Business continuity arrangements for pump failure, supply disruption and emergency transfer
• • Staff can explain how urgent nutrition, hydration and medicine continuity is managed

Evidence to check

• • Hospital discharge documents, outpatient letters and updated feeding instructions
• • Prompt updates to care plans, MARs, stock records, equipment and handovers
• • Evidence staff were briefed before delivering altered care
• • Medication and nutrition reconciliation after transfer

Evidence to check

• • PEG-related incident, near-miss and missed-feed logs
• • Investigation identifies clinical, staffing, equipment and system factors
• • Resident safety checks, family communication and duty of candour records where relevant
• • Learning is shared and followed up through re-checks or competency review

Evidence to check

• • Records of resident, family, advocate and professional involvement
• • Evidence preferences, quality-of-life goals and comfort are considered alongside clinical safety
• • Accessible information and communication support are used
• • Feedback or concerns lead to review and documented response

Evidence to check

• • Current dietitian, SALT, GP, pharmacy, community nurse and enteral specialist recommendations
• • Instructions are translated into clear care-plan and handover guidance
• • Staff can locate and explain current specialist advice
• • Referral outcomes and overdue follow-up are tracked

Evidence to check

• • Audit sample includes observation, records, staff discussion and resident or representative feedback
• • Audit tests different shifts, feeding methods and residents where possible
• • Findings distinguish paperwork completion from safe practice
• • High-risk findings are escalated immediately

Evidence to check

• • Action plans identify an accountable owner, target date and evidence of completion
• • Governance records track overdue PEG care actions and recurring themes
• • Re-audit or observation confirms that changes work in day-to-day practice
• • Service can show sustained improvements in safety, comfort and nutrition outcomes