December 12, 2018

First admitted gastrostomy tube change by Dietetics

The Dietetics department admitted their first patient for a routine Gastrostomy (PEG) tube change last week. PEG tubes are required in patients who are unable to meet their nutritional needs via eating, and are often managed via the Northern Health Home Enteral Nutrition (HEN) service.

In 2015, Northern Health was one of five sites that received funding from DHHS to develop a credentialing program for dietitians to undertake advanced scope of practice in gastrostomy tube management. In 2016, the first Northern Health Advanced Practicing Gastrostomy Dietitian was credentialed.

At this time, an outpatient PEG clinic was set up in partnership with the Gastroenterology Department whereby routine balloon gastrostomy tube replacements were completed for HEN patients by the credentialed dietitian.

Two years post implementation of the PEG clinic, there are now two credentialed Advanced Practice Gastrostomy Dietitians; more than 80 PEG replacements have occurred; 80% of which were independently managed by the credentialed Dietitian, without the need for Gastroenterology or radiology input.

Tracey Martin, Advanced Practice Dietitian at Northern Hospital says that Advanced Practice Gastrostomy Dietitians have assisted in streamlining the care of patients with PEG tubes in the community. They also facilitate earlier discharge for inpatients requiring PEG tube replacements, allowing patients to bypass ED or radiology, freeing up these services for more urgent cases and reducing the demand on medical staff.

“From 6 December, PEG replacements and removals are conducted as an admitted procedure in the Allied Health (Foot) Procedure Unit single room; a space that is more suitably set-up for this procedure,” she said.

This will also allow for patients who are not managed by the HEN program to be admitted for routine PEG replacements, rather than their current pathway of coming into ED or radiology.

Lee-Anne is a patient with Cerebral Palsy who has had a PEG tube since 2012. Her mother, Lorraine, said that it’s much easier now for them to come directly to Allied Health.

“We now spend only half an hour, in a more relaxing environment. These procedures used to take half a day for us and we had to go through different departments. The communication with staff is a lot better,” she said.

The Advanced Practice Gastrostomy Dietitians are also working closely with the Gastroenterology Department, ward nursing staff and Emergency Department, to further improve the management of PEG tubes across the hospital.