Pass
Fail or
N/A	Assessed
By:
(RN
Name)	

PROCEDURE FOR CONTINUOUS FEEDINGS	
   1.			Checks physician’s orders	
2.			Gathers equipment and water for flush (20 cc of H2O if not otherwise specifically prescribed).	
3.			Informs individual of what is being done	
4.			Positions individual in correct position	
5.			Washes hands	
6.			Marks bag or bottle with current date and time	
7.			Fills feeding bag with no more than 4 hours worth of formula unless otherwise directed by RN, NP or Physician..	
8.			Primes tubing before connecting bag to pump.	
  9.			Clamps feeding bag tubing (of both old and new feeding bags) prior to removing old feeding bag from pump.	
10.			Connects new feeding bag tubing to pump and sets desired rate on pump.	
11.			Separates barrel from plunger of syringe.	
12.			Clamps/pinches G/J-tube before unplugging or disconnecting tubing.	
13.			While G/J tube is still clamped or pinched, places tip of syringe into G/J tube and pours 20cc (or other amount if so prescribed) water into barrel of syringe.	
14.			Unclamps tube and allows water to slowly enter stomach/intestine by gravity. (For J-tube, may have to replace plunger back into barrel and push water in gently.)	
15.			Clamps/pinches tube just prior to syringe being completely emptied.	
16.			Connects tube to clean feeding bag tubing and unclamps tube.	
17.			Rechecks setting on the pump and turns pump on.	
18.			Documents that feeding has been hung, the rate of feeding and how individual is tolerating procedure.

			PROCEDURE FOR DISCONTINUATION OF FEEDING
	
   1.			Verifies by looking at physician’s orders and MAR sheet that it is time to stop the feeding.  	
2.			Gathers equipment and water for flush (20 cc if not otherwise specifically prescribed.	
4.			Informs individual what is being done.	
5.			Turns off pump.	
6.			Clamps or pinches G/J tube.	

7.			Disconnects tube from feeding bag tubing.  If feeding bag is to be used again, ensures tubing does not get contaminated.	

8.			While G/J-tube is still clamped/pinched, separates barrel from plunger of syringe and places tip of syringe into tube.	
  9.			Pours 20 cc or other prescribed amount of water into syringe, unclamps tube and allows water to flow into stomach/intestine by gravity.  (For J-tube, may have to replace plunger back into barrel and push in gently.)	
10.			Clamps/pinches tube just prior to syringe being completely emptied.	
11.			Inserts plug in tube.  	
12.			Unclamps tube.	
13.			Checks G/J tube placement by measuring tube	
14.			Documents as appropriate	

COMPETENCY EVALUATION TOOL for G/J TUBE CONTINUOUS FEEDING and DISCONTINUATION of FEEDING
Individual Name:_____________________ Staff Name:______________________
Date:____________________

                                                                                                                           OPTIONAL

Based on this Competency Assessment Tool I,_________________________________
                                                                                         Name of RN

have determined that ___________________________ is competent to administer
                                           Name of Staff Person

continuous feedings via G/J tube and discontinue feedings via G/J tube to

__________________________________.
             Name of Individual

__________________________________________           ________________      ____________________
                   Signature of RN                                                            Date                            Phone Number

__________________________________________                              ___________________________
            Signature of Staff Person                                                                            Date