Authors (including presenting author) :
Lam Wai Man (1)
Ng Sheung Ching (1)
Lung May(1)
Chan Sherlock (2)
Kwok Ying (1)
Mok Shan Shan (1)
Ma Chi Ming (1)
Yip Choi Wan (1)
Kwok Ying (1)
Mak Kit Nga (1)
Affiliation :
(1) Department of Medicine, Haven of Hope Hospital
(2) Department of Speech Therapy, Haven of Hope Hospital
Introduction :
Comfort feeding is a recognized feeding modality in patients with advanced dementia and terminally ill patients with other advanced illness. However, the understanding and practice of comfort feeding are highly variable among different service units and wards, adversely affecting the quality of patient care and patient outcome.
Objectives :
1. To formulate an evidence-based clinical guideline in Haven of Hope Hospital (HHH) which will be applied hospital-wide.
2. To promulgate the guideline, provide education and training to staff, and to implement in all wards of HHH.
Methodology :
A multidisciplinary cross-specialty working group was formed in 2021 with the mandate to formulate a hospital-wide clinical guideline and to promulgate and implement the guideline in all wards. Members include doctors and nurses from medical, geriatric, pulmonary and palliative care services and speech therapist. The scope of application was defined to be patients with dysphagia or other feeding problems who are suffering from advanced dementia or advanced malignancy and advanced organ failure rendering them terminally ill. The underlying ethical principles, the inclusion criteria, the clinical workflow, and the components of communication including formulation of a communication checklist were agreed upon. An on-line communication meeting with the geriatric team of another hospital was arranged to learn from their experience of successfully implementing comfort feeding in their unit. A hospital-wide training session was run.
Result & Outcome :
Pilot trial of the guideline in 20 patients from different wards and units in September 2022 was completed, showing feasibility of adopting the revised workflow. Twelve patients had advanced dementia and nine had advanced malignancy. Comfort feeding was successfully started in all patients and was continued till death or discharge in 17 (85%) of them. Two patients were changed to receive combined comfort feeding and nasogastric tube feeding due to poor oral intake. It was terminated in one patient as the family had changed their mind. The clinical guideline was revised considering the feedback from the pilot trial and was fully implemented in all wards of HHH in December 2022.
