Home Enteral Nutrition: Towards a Standard of Care

Abstract

The purpose of this overview is to make the case for the establishment and publication of standards for home enteral nutrition (HEN) therapy in adult patients who require a long-term alternative to oral feeding. Overviews can provide a broad and often comprehensive summation of a topic area and, as such, have value for those coming to a subject for the first time. It will provide a broad summation, background and rationale, review specific considerations unique to HEN (tubes, products and supplies) and we describe a recent audit of seven HEN programs which highlights tube and process related challenges. Based on the overview of the literature and our experience with the audit we propose a way forward for best home enteral nutrition care.

The experiences and support needs of people living at home with an enteral tube: a qualitative interview study

“…Gramlich et al . have made the case for a standardised approach to HEN and Boland et al . described the need to develop national guidelines for HEN service provision to inform local policy.…”

“…The presence of nutrition support teams in clinical settings varies from country to country and co‐ordinated support for people receiving home enteral nutrition (HEN) can be lacking . A recent systematic review by Majka et al .…”

People with enteral tubes and their carers' views of living with a tube and managing associated problems: A qualitative interview study

“…Enteral tubes include gastrostomy and jejunostomy tubes (placed radiologically, endoscopically or surgically) and nasoenteric tubes. People who receive nutrition and fluid via ET in the long‐term commonly have a gastrostomy tube placed (Gramlich, Hurt, Jin, & Mundi, ). Nasoenteric and jejunostomy tubes may also be inserted for use in the home setting but this is less frequent (Gramlich et al, ).…”

Addressing Frequent Issues of Home Enteral Nutrition Patients

“…With those increases, clinicians must learn how to navigate the complex decentralized reimbursement processes in a diverse patient population . HEN patients have significant comorbidities and feeding challenges that require a team‐based approach and caregiver competence . HEN populations are sometimes older with cognitive and/or mobility limitations.…”

“…HEN populations are sometimes older with cognitive and/or mobility limitations. Frequent diagnoses include dysphagia, neurological impairments such as stroke, and a variety of cancers . Alternately, many HEN patients are able to resume normal daily activities such as work, school, and leisure activity.…”