Clinical Guidelines for PEG placement - Halton and St Helens PCT

Halton and St Helens Division
CLINICAL GUIDANCE
Clinical Guidelines for
PEG placement
For use in:
Halton and St Helens Division
Target Audience:
All Trust Clinical Staff
Purpose:
The purpose of this document is to outline the
processes and procedures involved when
requesting a PEG for a patient in the
community. The document includes criteria for
selection and the paperwork required for
completion
Document Author:
Heulwen Sheldrick and the Community PEG
care pathway development group.
Approved by:
Clinical Guidelines Group or Equivalent
Ratified by:
Clinical Quality and Standards Group
Policy Index No:
HStHCL304
Version Number: 1.0
Effective From: July 2011
Review Date: July 2014
Statutory and legal requirements Mental Capacity Act 2005
Implementation Lead
Community PEG care pathway development
group
The Trust is committed to creating an environment that promotes equality and embraces
diversity, both within our workforce and in service delivery. This document should be
implemented with due regard to this commitment.
This document seeks to uphold the duties and principles contained within the Human Rights
Act. All Staff within the PCT should be aware of its implications.
If clinical activity takes place i.e. examination, hand decontamination should take place before
and after the procedure by following the “Hand Decontamination Policy”.
This guidance is due for review by July 2014. After this date, this guidance and associated
process documents may become invalid. All users should ensure that they are consulting the
current version of this document.

Key individuals involved in developing the document (Internal Staff Only)
Name(s)
Designation
Heulwen Sheldrick
Specialist Speech and Language Therapist
Distributed to the following for approvals and comments
Committee(s)
Members of the Policy Sub Committee (PSC)
Members of the Clinical Policies Guidelines
Group (CPG)
Community PEG care pathway development
group
Individual(s) (Include email address of external
individuals (NON NHS))
Designation
Dr Salahudin Khalid
Deborah Eckersley,
Rhian King
Anne Betteley
Janet Dougherty
Rachel Brown
Dr P O’Toole (acknowledgements for selection
criteria guidance)
Dr G.P Butcher (acknowledgements for selection
criteria guidance)
Prof C.F Kiire (acknowledgements for selection
criteria guidance)
C/N V.Fletcher (acknowledgements for selection
criteria guidance)
Consultant Gastroenterologist, Warrington
and Halton Hospitals NHS Trust
Advanced Dietitian, Warrington and Halton
Hospitals NHS Trust
SLT, Warrington and Halton Hospitals NHS
Trust
Advanced Dietitian, Warrington and Halton
Hospitals NHS Trust
Endoscopy Specialist Nurse, Warrington
and Halton Hospitals NHS Trust
SLT, 5 Boroughs Partnership Trust
Consultant Gastroenterologist, Aintree
Consultant Gastroenterologist, Southport
Consultant Gastroenterologist, Southport
Upper GI Nurse Practitioner, Southport
Page 2 of 27

Revision History and Version Control
Revision
Date
Reason for Change Version No. By Who Version No.
Jul 11 New Document H Sheldrick 1.0
Page 3 of 27

Table of Contents
Clinical Guidelines for decision making about..............................................................................5
PEG placement............................................................................................................................5
Categories 1-4...........................................................................................................................5
Category 5.................................................................................................................................6
Category 6.................................................................................................................................7
Category 7.................................................................................................................................7
Category 8.................................................................................................................................8
Category 9.................................................................................................................................8
Procedure for requesting a PEG ..................................................................................................9
References.................................................................................................................................10
Appendix 1 .................................................................................................................................11
Glossary of Terms ...................................................................................................................11
Appendix 2 .................................................................................................................................12
Contact Details ........................................................................................................................12
Appendix 3 .................................................................................................................................13
PEG Placement Care Pathway ...............................................................................................13
Appendix 4 .................................................................................................................................25
Equality Impact Assessment Tool ...........................................................................................25
Appendix 5 .................................................................................................................................26
Dissemination and Training Plan.............................................................................................26
Page 4 of 27

Halton and St Helens Division
CLINICAL GUIDELINES FOR DECISION MAKING ABOUT
PEG PLACEMENT
PEG feeding should be considered for any patient who is unable to meet his/her nutritional requirements
via the oral route and who is likely to require artificial nutritional support for at least four weeks
There are a number of clinical conditions which may lead to a difficulty in meeting nutritional
requirements via the oral route; they can be divided into the following broad areas: Categories 1-9
Categories 1-4
1. Mechanical dysphagia due to obstruction in the upper aero-digestive tract
e.g. head & neck cancer
2. Neurological dysphagia, where there is the prospect of recovery from the underlying
disease
e.g. some acute strokes
3. Inability to eat due to global neurological damage, where there is the prospect of
recovery from the underlying disease
e.g. brain injury, reversible coma
4. Where there is no problem with eating, but nutritional requirements are increased due
to malabsorption
e.g. cystic fibrosis, Crohn’s disease
Guidelines
PEG should be recommended unless
i) Prognosis is so poor that survival beyond a few weeks in unlikely.
In the terminal stages of life it is common for the patient to lose the desire to eat, and there is no
evidence that providing nutrition in this situation improves the patient’s well-being.
ii)
The patient refuses treatment and is legally competent to do so.
The Mental Capacity Act 2005 states that everyone should be treated as able to make their own
decisions until it is shown that they are not.
A person is unable to make a decision if he is unable to:
Page 5 of 27

a) understand the information relevant to the decision
b) retain that information
c) use or weigh up that information as part of the process of making the
decision
d) to communicate his decision (whether by talking, sign or other means)
The information relevant to a decision includes information about the reasonably foreseeable
consequences of
a) deciding one way or another
b) failing to make the decision.
iii)
The patient has lost the capacity to make decisions, but has made an advanced decision
about artificial feeding being withheld
Under the Mental Capacity Act 2005 an advanced decision means a decision made by a person
after he has reached 18, and when he has capacity to do so that if
a) at a time and in such circumstances as he may specify, a specified treatment is
proposed to be carried out or continued by a person providing health care for him, and
b) at that time he lacks capacity to consent to the carrying out or continuation of
treatment, the specified treatment is not to be carried out
iv)
The patient has lost capacity, but has appointed a Lasting power of attorney
and they have refused treatment.
An appointed Lasting Power of Attorney has the authority to make decisions about the person’s
health and welfare when the person has lost capacity to make their own decisions
v) The patient has lost the capacity to make a decision, but PEG feeding would prolong a life that
is ‘demonstrably awful’ due to pain and distress.
This should be discussed and agreed in a ‘Best Interests’ meeting
Category 5
Inability to eat due to dementia
Guidelines
PEG is not generally indicated, except in particular circumstances
Patients with advanced dementia frequently develop oral feeding problems, eating difficulties or
an indifference to food. This is often in the late stages of the illness where it is not possible to
understand the patient’s wishes. The Alzheimer’s Society states that ‘Quality of life rather than
length of life should be prioritised’
Page 6 of 27

In a review of PEG placement in dementia, PEG was seldom effective in improving nutrition,
maintaining skin integrity, preventing aspiration pneumonia, in improving functional status or
extending life.
However, a diagnosis of dementia should not rule out consideration for PEG. Studies do not
prove that PEG is never indicated in patients with dementia, but do show that the indication is
rare. An example of this may be when feeding is so distressing for a patient that PEG may be
seen to be in their best interest.
In general, careful hand feeding following multidisciplinary assessment and identification of risks
and benefits is preferred, and gastrostomy should not be offered in advanced dementia.
Where the dementia is not the primary cause of the eating difficulty, for example a patient with
dementia who has had a stoke, considerations described under the relevant category should
apply.
Category 6
Where there is no malabsorption or dysphagia but chronic disease is
causing weight loss due to lack of appetite and/or increased catabolism
e.g chronic renal failure
Guidelines
PEG is not generally indicated, except in particular circumstances
In some chronic disease states the nutritional deficit is due to alterations in intermediate
metabolism that are refractory to nutritional therapy (the anorexia-cachexia syndrome). PEG
feeding is futile in these situations
When anorexia is less profound, the loss of appetite can often be overcome by appropriate
dietary manipulation and appetite enhancers. If appetite is likely to improve within 4-6 weeks,
short-term NG feeding may be appropriate. This would be an exceptional decision in the
community
PEG feeding has been shown to be of benefit in a few specific chronic conditions most notably
renal failure patients on dialysis.
Category 7
Neurological dysphagia, where the cause is a progressive
neurological disorder without the prospect of recovery
e.g. Motor Neurone Disease, Multiple Sclerosis, Cerebral Palsy.
Guidelines
PEG may be offered
Page 7 of 27

PEG should be discussed with the patient, pointing out the risks and benefits of the procedure.
The timing of the discussion around the consideration for PEG is very important in progressive
neurological diseases. If possible, they should be allowed time to accept their diagnosis, before
PEG is mentioned, but should not be left too late as in some cases they may derive little benefit if
the procedure is not carried out soon enough, and may not even be possible if the patient is too
unwell.
Category 8
Inability to eat due to severe neurological damage, where there is no
prospect of recovery from the underlying disease
e.g. Minimally responsive state, severe stroke
Guidelines
A trial of PEG feeding may be considered
In situations where severs neurological disease has resulted in total or near total loss of
awareness, and there is no realistic prospect of improving, the concept of ‘quality of life’ looses its
meaning
Recognition that the patient is in this state requires skilled multidisciplinary assessment.
In many such cases the patient’s condition is so poor that death is inevitable whatever treatment
is provided. In these circumstances PEG is contraindicated for reasons outlined above.
If the patient’s condition has stabilised, the only purpose of PEG feeding is to maintain life and
organ function. This is not necessarily in the patient’s best interests, as recognised by law, and in
some circumstances the doctor may be justified in withholding PEG feeding.
In view of the uncertainty of medical prognosis, a trial of PEG feeding may be appropriate to
allow time for further assessment. This should be undertaken for a predetermined period with
prearranged review and the nature and purpose of the trial should be made unambiguously clear
at the outset to all those involved in the patient’s care and, where appropriate, the relatives.
Category 9
Refusal to eat because of a psychiatric disorder
e.g. depression, anorexia nervosa
PEG placement is best avoided
Patient’s who refuse to eat due to a psychiatric disorder will usually also refuse tube feeding and
their autonomy should be respected (unless they are being treated for anorexia nervosa under
the provision of the mental Health Act, 1983)
Nasogastric tube feeding may be enforced under the Mental Health Act for anorexia nervosa, but
this is usually temporary measure and the question of PEG insertion rarely arises.
Page 8 of 27

PROCEDURE FOR REQUESTING A PEG
ACTION
1. It is the responsibility of the person
initiating referral for a PEG to
contact all members of the multidisciplinary
team, and ask them to
complete their sections of the PEG
care pathway.
2. As much detail as possible should
be included so a fully informed
decision can be made
3. All sections of the PEG care
pathway should be collated by the
person initiating referral.
4. The fully completed pathway should
then be sent to Gastroenterology,
and following this an out patient
appointment will be arranged.
5. If it is appropriate to proceed with
the PEG following the out-patient
appointment, arrangements will be
made for the patient to be admitted
for the procedure.
6. If the patient is not able to attend an
out-patient appointment, they may
be given the option of a domiciliary
visit to see if PEG is appropriate.
7. If there is some disagreement
between members of the MDT as to
whether PEG is appropriate, then it
may be necessary to hold a best
interest meeting so a joint decision
about the management of the
patient can be made.
RATIONALE
To ensure all professionals concerned input
into the decision making process.
To ensure a fully informed decision can be
made.
To ensure all information collated is
available on the form
The ensure patient is seen preoperatively
by the appropriate consultant
To ensure appropriate patients undergo
procedure if this is deemed appropriate
To ensure patient is seen if the patient can
not attend out-patient appointment
To ensure a joint decision about the
management of the patients care can be
made.
Page 9 of 27

REFERENCES
Reference
Withholding or withdrawing life-prolonging medical
treatment. British Medical Association. BMJ Books
1999
Ethical & legal aspects of clinical hydration and
nutritional support.
ed Lennard-Jones, JE . BAPEN 1998
Gillick MR. Rethinking the role of tube feeding in
patients with advanced dementia.
NEJM 2000; 342: 206-10
Finucane TE, Bynum JPW. Use of tube feeding to
prevent aspiration pneumonia.
Lancet 1996; 348: 1421-24
Rabeneck L, McCullogh LB, Wray NP. Ethically
justified, clinically comprehensive guidelines for
percutaneous endoscopic gastrostomy tube
placement.
Lancet 1997; 349: 496-98
Oral feeding difficulties and dilemmas. A guide to
practical care, particularly towards the end of life.
Royal College of Physicians. Jan 2010
Relevance (whole
document or section,
please state)
Whole document 1
Whole document 1
Whole document 1
Whole document 1
Whole document 1
Whole document 1
The Mental Capacity Act 2005 Whole document 1
Evidence
Grade
Page 10 of 27

APPENDIX 1
Glossary of Terms
PEG – Percutaneous Endoscopic Gastrostomy – a tube inserted endoscopically into a
patient’s stomach – to provide enteral feeding when non-oral feeding is affected.
Page 11 of 27

APPENDIX 2
Gastroenterology Secretaries
Warrington Hospital
Lovely Lane
Warrington
WA5 1QG
Tel 01928 753085
Fax 01928753119
Contact Details
Warrington
Halton
Adult Speech & Language Therapy Speech & Language Therapy
Warrington Hospital
Halton Hospital
Lovely Lane
Hospital Way
Warrington
Runcorn
WA5 1QG
WA7 2DA
Tel 01925 662062 Tel 01928 753424
Fax 01925 662923 Fax 01928 753313
Speech & Language Therapy
Speech & Language Therapy
Adult Learning Disabilities Service Adult Learning Disabilities Service
7-9 Wilson Pattern St The Bridges Learning Centre
Warrington
Crow Wood Health Park
WA1 1PG
Crow Wood Lane
Tel 01744 457278 Tel 0151 4955300
Fax 01744 457258 Fax 0151
Dietetic Department
Dietetic Department
Warrington Hospital
Halton Hospital
Lovely Lane
Hospital Way
Warrington
Runcorn
WA5 1QG
WA7 2DA
Tel 01925 662459 Tel 01928 753202
Fax 01925 662923 Fax 01928 753411
Page 12 of 27

APPENDIX 3
PEG Placement Care Pathway
For use in the community
This form should be used to refer a patient to the gastroenterology team for consideration for
PEG placement. ALL relevant sections MUST be completed or the form may be returned.
Section One
to be completed the professional initiating the procedure
Patient Name ………………………………………..
DOB …………………
Address ………………………………………………………………………………………………
……………………………………………………
NHS no ……………………….
GP ………………………………………………
Postcode ……………………………
Hospital no (if known) ………………
Surgery ……………………………………….
Patient’s next of kin ……………………………….Relationship to patient ………………….....
1.1 When considering a patient for PEG placement, the following must be considered
The patient must have been seen by a Dietitian and or
Speech & Language Therapist (as appropriate)
Is enteral tube feeding likely to be required for more than 14
days
Unable to meet nutrition, hydration or medication
requirements by oral intake
Risk of significant malnutrition and / or delayed recovery
Is the patient’s medication suitable for administration via
PEG
Yes
(present)
No
(absent)
Page 13 of 27

1.2 Where is the patient currently living
Home alone
Home with carers
Home with family
Nursing Home
Other e.g. hospice ………………………………………………..
1.3 Will PEG be able to be managed in the current home environment …………………..
…………………………………………………………………………………………………………
1.4 Is the patient able to attend an out-patient appointment YES NO
at the hospital for gastroenterology assessment
1.5 Has the procedure and risks been discussed with the patient / family / carer
Yes
No
………………………………………………………………………………………………………..
………………………………………………………………………………………………………..
1.6 If the patient does not have capacity, does the next of kin have Lasting Power of
Attorney
N/A Yes No
If it is unclear whether PEG placement is in the best interests of a patient who is unable to give
consent, it may be appropriate to carry out a ‘Best Interests Meeting’, so that all members of the
multi-disciplinary team involved with the patient can decide on appropriate management. This
may involve the use of an Independent Mental Capacity Advocate (IMCA) if needed.
1.7 Is a Best Interests Meeting indicated
Yes
No
Signed ……………………………………
Contact tel no……………………………
Print ……………………………..
Date ……………………………..
Page 14 of 27

Section 2
To be completed by the GP
2.1 What is the patient’s current medical condition
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
………………………………………………………………………………………………………..
2.2 Do you think PEG placement is in the patient’s best interest
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
………………………………………………………………………………………………………..
…………………………………………………………………………………………………………
2.3 Do you have any concerns about the PEG procedure being carried out on this patient
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
2.4 Are any of the following contraindications present
Possible Contraindications Yes (present) No (absent)
Ascites
Bleeding Disorders
Anticoagulation
Portal Hypertension
Gastro-oesophageal reflux with risk of aspiration
Morbid obesity – BMI > 30
Page 15 of 27

Previous abdominal surgery
Crohn’s disease
Intre-abdominal malignancy
Peritonitis
Peritoneal dialysis
Aortic aneurysm
Recent Myocardial Infarction (within 6 weeks)
Abdominal wall infection
Other – Please specify
2.5 What information about PEG placement have you given the patient
……………………………………………………………………………………………………..
2.6 In your opinion, do you feel the patient has the capacity to understand the information, retain
and consider the options
……………………………………………………………………………………………………..
2.7 Medication
Please complete list of current medications
Prescribed Drug
Dosage
Page 16 of 27

Signed ……………………………………
Contact tel no……………………………
Print ……………………………..
Date ……………………………..
Section Three – Multidisciplinary Checklist
Speech & Language Therapist
Swallowing assessment…………………………………………………………………….
……………………………………………………………………………………………………..
……………………………………………………………………………………………………..
………………………………………………………………………………………………………
……………………………………………………………………………………………………..
Current Speech & Language Therapy recommendations for swallowing
……………………………………………………………………………………………………..
Page 17 of 27

Predicted recommendations following PEG
……………………………………………………………………………………………………...
Do you think PEG placement is in the best interest of this patient
……………………………………………………………………………………………………..
……………………………………………………………………………………………………..
Do you have any concerns about a PEG being carried out on this patient
……………………………………………………………………………………………………..
……………………………………………………………………………………………………..
What information about PEG placement have you given the patient
……………………………………………………………………………………………………..
In your opinion, do you feel the patient has the capacity to understand the information, retain
and consider the options
……………………………………………………………………………………………………..
Signed ……………………………………………..
Contact tel number ………………………………..
Print……………………………..
Date …………………………….
Dietitian
Current weight
Normal weight
Nutritional
requirements
% Weight Loss Energy
Height
BMI
MUST score
Protein
Fluid
Page 18 of 27

Current route of intake Oral NGT NBM
Expected route of intake following PEG PEG + some oral PEG only
Estimated current oral intake / day
Nutritional supplements
………………………..kcal
………………………..g protein
………………………..mls fluid
Estimated Feeding Regime
Refeeding risk identified (may change if delay in PEG procedure) YES
NO
Comments……………………………………………………………………………………….
………………………………………………………………………………………………………..
Aim of PEG feeding……………………………………………………………………………
………………………………………………………………………………………………………..
Do you think PEG feeding is in the best interests of this patient
………………………………………………………………………………………………………..
………………………………………………………………………………………………………...
What information about PEG placement have you given the patient
……………………………………………………………………………………………………..
In your opinion, do you feel the patient has the capacity to understand the information, retain
and consider the options
……………………………………………………………………………………………………..
Signed ………………………………………..
Print ………………………………….
Page 19 of 27

Contact tel no ………………………………..
Date ………………………………….
Any other professional involved in the patient’s care,
e.g. Neurologist, Psychiatrist, Nursing Home staff, District Nurse etc
Name of professional ……………………………………….
Role …………………………
Do you think PEG feeding is in the best interests of the patient …………………………….
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
Do you have any concerns about PEG being placed
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
What information about PEG placement have you given the patient
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
In your opinion, do you feel the patient has the capacity to understand the information, retain
and consider the options
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
Any other comments ……………………………………………………………………………….
…………………………………………………………………………………………………………
Page 20 of 27

…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
Signed ………………………………………………
Contact number …………………………………...
Print …………………………………..
Date …………………………………..
Section 4 Gastroenterology
To be completed at out patient appointment
Notes …………………………………………………………………………………………………
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
Action ………………………………………………………………………………………………..
…………………………………………………………………………………………………………
Page 21 of 27

…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
Biochemistry requested
U&Es, LFTs, Mg, PO4, Corr.Ca, Alb, FBC, BM, and Zinc
TPN profile
Signed …………………………………….
Date ……………………………………….
Print ……………………………….
Time ……………………………….
Consent
To be completed by Gastroenterology
2.1 Is the patient capable of giving own consent Yes No
(if no, refer to section B)
2.2
Section A Yes No Signature Date
Has the procedure, long term implications and
practicalities of long-term care been discussed with the
patient
Has any written information been given to the patient
Have any points raised from discussion and written
information been discussed
Has consent been obtained for PEG placement
Consent Form No 4 must be used and signed
Section B Yes No Signature Date
Has the procedure, practicalities and long-term
implications of PEG placement been discussed with the
Page 22 of 27

elatives/carers
Has any written information been given to the
relatives/carers
Does the patient’s relative/carer consider the PEG
placement is in the best interest of the patient
Does the referring Doctor consider PEG placement to
be in the best interest of the patient
2.4 If the patient does not have capacity, does the next of kin have
Lasting Power of Attorney
N/A Yes No
Signed ……………………………………
Contact tel no……………………………
Print ……………………………..
Date ……………………………..
Please continue with the in-patient PEG care pathway, from page 5
Page 23 of 27

Identification of
ANS
consideration.
SALT
Risks and benefits
of ANS in relation
to
aspiration/choking
.
Dietitian
Risks and benefits of
ANS in relation to
maintenance of
nutritional status and
hydration.
PEG leaflet/MND
leaflet provided.
GP
Other
Professionals.
Eg
Gastroenterology.
Case Review
Community PEG Care Pathway
Agree ANS appropriate refer to
gastroenterology for opinion if not
already involved in care.
Agreed ANS not appropriate and
document accordingly.
ANS instigated eg PEG inserted.
Refer to Acute PEG Care Pathway.
Enteral feeding regime.
Community follow up.
SALT
Dietitian – BAPEN medication info
Feed Contract Nurse – Feed contact info
GP
District Nurse etc.
Page 24 of 27

APPENDIX 4
Equality Impact Assessment Tool
To be completed with the corporate document when submitted to the appropriate committee for
consideration, approval and ratification.
1. Does the corporate document affect one group
less or more favourably than another on the basis
of:
Age No
Disability (learning disabilities, physical
disability, sensory impairments, mental health
problems)
Yes/No
No
Gender Reassignment No
Marriage and civil partnership No
Pregnancy and maternity No
Race (including gypsies and travellers) No
Religion or belief No
Sex No
Sexual Orientation No
2. Is there any evidence that some groups are
affected differently
No
Comments
If you have identified that there is a potential for one or more groups to be affected differently,
then you must now complete a full Equality Impact Assessment Process to ensure that the Trust
has covered its legal duties under the Equality Act 2010. For any advice in completing the
above or a full EqIA please contact Vikki Morris, E&D Manager on 01744 457279 or
vikki.morris@hsthpct.nhs.uk
Page 25 of 27

APPENDIX 5
Dissemination and Training Plan
To be completed with the corporate document when submitted to the appropriate committee for
consideration, approval and ratification.
The status column must be given a Red, Amber or Green rating with evidence to demonstrate
an action has been completed.
DISSEMINATION PLAN
Title of document:
Clinical Guidelines for PEG placement
Dissemination Lead: (Print name and
contact details)
Heulwen Sheldrick
Speech and Language Therapy
01928 753424
Proposed action to retrieve out-of-date
copies of the document:
Date finalised: Sept 2011
Previous document already being used Yes
If yes, in what format and where Electronic/Intranet
Although recently developed – over past 6 months
Withdraw from the internet/intranet/portal
To be disseminated to:
Disseminated
by whom
Timescale
(Date)
Status
R A G
Paper
or
Electronic
Comments
Trust Times
Team Brief
Training sessions (Give Details Below)
Other (Give Details Below)
PEG team Ongoing A
IMPLEMENTATION PLAN
The implementation of the guideline is in place as this guideline is now being used by
professionals across the Community Trust and hospital Trusts.
However, there is a plan for wider dissemination in order that GP’s / community
nursing/MDT’s are aware of this guideline/process. Dissemination is dependent on
professional networks across Halton and Warrington. There are plans to disseminate this
through the Clinical Commissioning Committees, GP/Medics protected Learning time
sessions etc. This process is underway (Sept 2011)
Training Timescale Owner Status
R A G
Training Event (Please provide details of available training venues/dates
to educate staff about this document)
See above
PEG
team
A
Training Plan Lead (Please provide details of staff who will be
responsible for overseeing this training)
See above
PEG
team
A
Compliance Monitoring Timescale Owner Status
R A G
Methodology to be used for monitoring/audit (please include PCT
Audit Proposal Form)
Clinical audit
Heulwen
Sheldrick
and PEG
R
Page 26 of 27

team
Responsibilities for conducting monitoring/audit PEG team Heulwen
Sheldrick
and PEG
team
Frequency of monitoring/audit (e.g. annually, 6 monthly etc) annually Heulwen
Sheldrick
and PEG
team
Process for reviewing/reporting results Audit
feedback
Heulwen
Sheldrick
and PEG
team
R
R
R
Denotes: Action not yet taken or deadline for action not met. Action plan to address this must be provided.
Denotes: Action partially implemented.
Denotes: Action complete.
Page 27 of 27