Client Specific- Enteral Feeding & Medication Administration Competency Checklist
Completed by the nurse while evaluating an Employee's Hoyer Lift Competency. The Nurse and the Employee must sign the completed checklist at the time of evaluation.
Employee Name:
First Name
Last Name
Employee Title:
Please Select
Direct Support Professional
Team Lead
Site Lead
Administrative Assistant- East
Administrative Assistant-BE
Art Specialist
Asst. Vice President of Programs
Camp Lead
Career Discovery Experience Facilitator
Director
Director, Community Integration
Director
Planning & Program Manager, Respite
Program Manager
Quality Support Coordinator, Community Living
Other
Title:
Trainer:
Please Select
Karen Gray, Nurse
Joanne Hester, Nurse
Lucy Byrnes, Nurse
Marlin King, Nurse
Annabelle Hardwick, Nurse
Chad Linn, VP of Compliance & Operations, Nurse
Other
Time
Hour Minutes
AM
PM
AM/PM Option
Date:
-
Month
-
Day
Year
Date
Duration:
Please Select
0.25
0.50
0.75
1.0
1.25
1.50
Location of Training:
Please Select
Noble East
Noble West
Noblesville
Other
Location:
Name of Client:
First Name
Last Name
Voices understanding:
Rows
Pass
Fail
NA
Of what gastrostomy/ jejunostomy tub and why this individual has one.
That a brand of formula should never be changed without doctor's orders.
That each individual's protocol and/or physicians orders should be followed.
That the method of tube feeding, rate and time may not be changed without a doctors order.
That only licensed nurses & staff who have completed tube feeding training & have been evaluated successfully by the nurse may administer tube feedings.
That all medications administration regulations must be followed when administering medications.
Of why water flushes are important and when they should be completed.
Of the importance of good hand washing and cleanliness of G/J- Tube equipment and that this is essential in safe administration of tube feedings and medications.
Of the importance of elevated positioning of an individual during and after tube feedings, flushes and medication administration.
nd states correctly what should be done if a G/J- Tube becomes dislodged or appear to have moved in or out of its usual position.
Of the importance of being careful when working with the tube to prevent the tube from being pulled.
Accurately states what should be done if the individual vomits while feeding is being administered.
Accurately states what should be done if the individual has breathing difficulties during a tube feeding
Accurately states what should be done if the individual develops abdominal cramping during a tube feeding
Accurately states what should be done if the stoma site has redness, swelling or purulent drainage.
Correctly states what should be done if a continuous pump alarm sounds.
Voices understanding of importance of checking residual volumes before G-Tube feedings and what to do if residual amount is greater than 60cc.
Hands on Training/ Observation:
Rows
Pass
Fail
NA
Washed hands and put on gloves before staring the administration of feeding/ medication.
Checked medication administration sheet for feeding orders before beginning.
Ensured the equipment being used was clean before use.
Explained the procedure to the individual before beginning
Ensured the individual was in an upright position before beginning & for 1 hour after the feeding.
Connected extension tubing and syringe correctly and carefully to the G-Tube button, if applicable.
Checked residual amount for g-tubes with piston and syringe correctly and checked orders on medication sheet before proceeding. Documents residual on documentation sheet.
Followed all procedures for preparation of medications, prepares medication s correctly after checking with medication administration sheet orders.
Shaked suspensions vigorously before pouring, and crushed pills finely before mixing with water.
Pours approximately 30cc water flush into syringe and allows it to flow into the stomach/ intestine, unless specific flush amount orders are different (for Jtube may have to replace plunger back into barrel and push in gently for each water flush and medications). Ensures water is not too hot or cold before beginning.
lamped tube just prior to syringe being completely emptied at each step.
Administers medication, one at a time, with a 30cc water flush (or instructed amount) in between each medication.
Flushed with 30cc water flush (or instructed amount) after last medication.
Shook formula container thoroughly and checked container for expiration date.
Administered formula correctly at room temperature.
Disconnected extension tubing correctly and carefully, if applicable.
Cleaned all equipment thoroughly.
Documented medication and feeding correctly on medication administration sheets.
Employee Signature:
Based on this Competency Tool, it is determined that the employee is competent to administer feedings and medications via G/J tube to the individual.
Yes
No
Nurse Signature:
Save
Submit
Submit
Enteral Feed Skills Check off- Client Specific Created: 2/27/25
Should be Empty: