Dublin City School District
Administrative Guidelines
 

5311 - ASSISTED ORAL AND GASTROSTOMY - TUBE FEEDING

Children who have a gastrostomy-tube for feeding or are suspected and/or known to have feeding problems or risk factors that may indicate that they need assistance in being fed or eating at school, will need to have a feeding plan in place. These students are, or may be, at high risk for choking, aspiration, malnutrition, and/or dehydration due to difficulties with feeding, chewing, and/or swallowing activities. All high risk students will require a feeding plan, health care provider’s orders, and parental consent prior to implementation of assisted feedings by school staff.

Referral Process
 

A.

A staff member, health care provider, or parent may identify a student with a feeding concern and make a referral to a member of the multidisciplinary team for an assisted feeding evaluation. Whomever receives the referral will contact staff that may include the school nurse, occupational therapist, physical therapist, speech/language pathologist, special education teacher and/or coordinator, and others as appropriate.
 
 

B.

Children also may be referred when they are considered to be at risk for feeding complications due to a change in health condition and/or first-time placement of a feeding tube.
 
 

C.

When a new student enrolls in the District with a feeding tube and/or known feeding issues, the administrator, special service coordinator, or building special education secretary will notify the school nurse for the initiation of orders for a school feeding plan. The authorization and medical recommendations for assisted oral feeding (Form 5311 F2) and/or g/gj-tube (Form 5311 F3) forms as applicable are sent to the student's health care provider.
 
 

D.

Parents are required to sign the release of information (Form 8330 F4) in order for school staff to receive access to all pertinent medical information and allow direct communication with the health care provider. Any diagnostic testing and/or recommendation by the health care provider relative to feeding the child must be submitted to school personnel.

Developing the Feeding Plan
 

A.

Upon receipt of the health care provider’s orders and recommendations, the school nurse will initiate the student’s feeding plan (Form 5311 F6) and notify the intervention specialist/IEP chair to contact members of the multidisciplinary team to complete student observations within 30 days.
 
 

B.

The child’s multidisciplinary team will determine which members of the team will observe or assist the child with a feeding (document on Form 5311 F5).
 
 

C.

After the health care provider’s orders, diagnostic tests, medical information and feeding observations are turned in to the school nurse, the IEP chair will contact the team to meet and complete the feeding plan (Form 5311 F6) as applicable.
 
 

D.

The feeding plan may include recommendations for further health care evaluations, parent strategies, positioning, oral motor skills, diet recommendations, and/or other feeding considerations or modifications.
 
 

E.

If there are no significant changes to the prior feeding plan after staff observations, in lieu of a meeting, the plan may be mailed or sent home by the school nurse for parent to sign and return. If the multidisciplinary team recommendations conflict with the current feeding plan and staff believe the discrepancy prohibits the assisted feeding of the child at school an alternative feeding plan needs to be developed with/through the IEP team.

Staff Training and Implementation of Assisted Oral Feeding Plan
 

A.

School staff will be trained to implement the feeding plan by an occupational therapist, physical therapist, speech/language pathologist, or nurse. Parents may demonstrate tasks but cannot train school staff how to provide specialized care.
 
 

B.

Staff training will include a review of the child's feeding order and plan, two (2) demonstrations by a multidisciplinary member, and two (2) return demonstrations by staff trainee. Training should continue until proficiency is reached by trainee.
 
 

C.

During feeding, there must be a staff member available who has current CPR and Heimlich certification/training.
 
 

D.

Universal precautions (i.e., gloves and hand washing) must be used when contact with body fluids (i.e., blood, feces, nasal secretions, saliva, and urine) is possible.
 
 

E.

Periodic monitoring and retraining and review of assisted oral feeding plan will take place annually.
 
 

F.

All student-assisted feedings are to be recorded on the Student Assisted Feeding Log (Form 5311 F7).

Alternative Non-Oral Assisted Feedings (Gastrostomy Tube)

Students may require alternative feedings via a gastrostomy tube, either in addition to oral feedings or in place of oral feedings. Only a school nurse, RN, LPN, student’s private provider, or medically unlicensed staff, as delegated by the school nurse, can provide assisted gastrostomy feedings during the school day.
 

A.

Delegated gastrostomy tube feedings must always be performed under the supervision of the school nurse and will not be initiated until written health care provider orders and parental consent are on file in the school.
 
 

B.

The decision to delegate gastrostomy tube feedings to a medically unlicensed staff must be done by the school nurse in accordance with the rules set forth by the Ohio Board of Nursing as described in the Nurse Practice Act and related District policies.
 
 

C.

The school nurse is responsible for all situations that require nursing assessment skills and decision making, and needs to be notified whenever there is or seems to be a change in student's health status, infection at the gastrostomy site, blockage, or displacement of tube, leakage from around the gastrostomy, aspiration, and/or choking or vomiting by the student during feedings (see Emergency Procedures for Gastrostomy (G) or Gastrojejunostomy (GJ) Tubes, Form 5311 F4).
 
 

D.

All gastrostomy feedings are to be recorded on either the Student Assisted Feeding Log (Form 5311 F7) or the G-Tube Medication and Treatment Administration Record (Form 5311 F8).

Staff and Parent Assisted Feeding Forms

The following district assisted feeding forms are to be completed as applicable by staff, parents, or health care providers for all students who require an assisted feeding plan at school. Forms can be accessed on the district’s web site www.dublinschools.net by clicking on: Forms/Links; Parents and Students or Staff; Medical/Health Services forms; the numbered form as indicated below.
 

A.

Parent and Health Care Provider Forms
 
 

Form 5311 F2 - Health Care Provider Authorization and Recommendations for Assisted Oral Feedings
 
 

Form 5311 F3 - Health Care Provider Authorization and Recommendations for Assisted Gastrostomy (G) or Gastrojejunostomy (GJ) Feedings
 
 

Form 5311 F10 - Parent Agreement for Mic-Key Gastrostomy (G) Tube Re-insertion
 
 

Form 8330 F4 - Parent Consent for Record Release
 
 

B.

Staff Forms
 
 

Form 5311 P1 - Mic-Key Gastrostomy (G) and Gastrojejunostomy (GJ) Tube Feeding Procedures
 
 

Form 5311 F4 - Emergency Procedures for Gastrostomy (G) or Gastrojejunostomy (GJ) Tubes
 
 

Form 5311 F5 - Staff Observation for Assisted Feeding
 
 

Form 5311 F6 - Student Assisted Feeding Plan
 
 

Form 5311 F7 - Student Assisted Feeding Log
 
 

Form 5311 F8 - G-Tube Medication and Treatment Administration Record
 
 

Form 5311 F9 - Staff Acknowledgement of Nursing Delegation of Mic-Key Gastrostomy (G) or Gastrojejunostomy (GJ) Tube Feedings
 
 

Form 5311 F11 - Staff Acknowledgement of Training for the Administration of Gastrostomy (G) or Gastrojejunostomy (GJ) Tube Medications
 
 

Form 5311 F12 - Parent/Guardian Cover Letter and Authorization for Staff Observations

Approved 7/04
Revised 6/30/10
Revised 2/11/16