Enteral Tube Policy

Purpose:

This Information Bulletin provides guidance on the process for returning an individual, with a newly placed enteral tube, to their CILA (including ICILA and Host Family CILA) after discharge from the hospital.

Prior to the individual being discharged from the hospital, a meeting should take place between the provider and the Bureau of Clinical Services to discuss plans to have the individual return to the CILA. This meeting can be scheduled by emailing the DDD Statewide Nursing Coordinator at DHS.clinicalservices@illinois.gov or calling 217-785-6183.

The following requirements must be met for the individual to transition back to the CILA:

• The Registered Nurse (RN) Trainer has listened to the recorded "IDHS-Approved Nurse Trainer Enteral Tube Curriculum Webinar" on the DDD Provider Training Website this link: https://www.dhs.state.il.us/page.aspx?item=81882. After completing this webinar, the RN Trainer has emailed the DDD Statewide Nursing Coordinator at DHS.clinicalservices@illinois.gov to request the Advanced Training Enteral Tube Curriculum, test and CBTAs that will be used to train the DSPs.
• All direct care staff that will be caring for the enteral tube have been trained using the IDHS Advanced Training Enteral Tube Curriculum, have scored 80% or higher on the written exam and have successfully completed the CBTA portion of the training. If administering medications via the enteral tube, the DSP should have already completed the initial Medication Administration Training prior to this advanced training.
  • These trainings should not be completed at the same time. The Bureau of Clinical Services may request that this training documentation be sent to the Division for review prior to the individual returning to the CILA after new enteral tube placement.
• The physician that placed the enteral tube should provide documentation that the individual is in stable condition, is not in need of skilled nursing and may be discharged to the CILA.
• Prior to discharge to the CILA, the individual should be tolerating feedings via the enteral tube for at least 48 hours.
• Discharge to the CILA is contingent upon the RN Trainer's clinical judgement. The RN Trainer must follow the Nurse Practice Act when delegating tasks to staff. Information on the Nurse Practice Act can be found here: https://www.ilga.gov/legislation/ilcs/ilcs5.asp?ActID=1312&ChapterID=24.
  •  The Division should be contacted if there is a disagreement regarding when the individual wishes to return home and the provider's ability to provide appropriate care as determined by the Division in consultation with the RN Trainer. 
    • The Division, if appropriate, will consider what reasonable temporary supports can be provided to allow the individual to return home in a timely manner.
• The RN Trainer has assessed the individual and determined that the individual is clinically stable and is willing to delegate the administration of nutrition and medication via the new enteral tube, and the care and maintenance of the enteral tube to the direct care staff.
• Prior to the individual being discharged from the hospital, a follow up appointment with the physician that placed the enteral tube and/or the individual's primary care physician has been scheduled. This follow up appointment should be scheduled within 2 weeks after enteral tube placement.
• An in-person nursing assessment by RN Trainer or visiting nurse on a daily basis to determine if individual is tolerating feedings and/or medications via the enteral tube and to assess the enteral tube insertion site. This daily nursing assessment should be documented in the individual's record. This daily assessment by the nurse should continue until the follow up visit with the physician, at which time the frequency of ongoing assessment by a nurse should be determined. Daily RN Trainer monitoring until the first follow-up visit is not a requirement if the individual is discharged to a skilled care facility prior to returning to their CILA.

The agency will notify the DDD Statewide Nursing Coordinator by email at DHS.clinicalservices@illinois.gov or telephone at 217-785-6183 if individual requires an ER visit, hospitalization or admission to a nursing home/skilled nursing facility within the first 2 months after enteral tube placement. The agency will also notify the DDD Statewide Nursing Coordinator if there are any complications related to the enteral tube during the first 2 months after enteral tube placement.

Effective Date: 

3/23/2021