For services writing or revising a policy, guideline or standard operating procedure. Most barriers to blended diet outside the home are organisational, and provision usually follows a written policy.
How to approach it
- Convene a working group with dietetics, nursing, catering, infection prevention and control, pharmacy where medicines via tube are covered, and someone with lived experience of blended diet, a tube-fed person or a family carer
- Start from this Toolkit and the Position Statement, not from the previous local policy; the 2021 positions on reheating, stoma maturity, risk assessment and routes have changed
- Ensure local procedures reflect the facilities, resources, and processes available. A policy that assumes a ward kitchen no one can use will not be followed
- Name the service responsible for each step: who assesses, who trains, who monitors, who acts on results
- Set a review date and a named owner
What the policy should contain
| Section | Contents |
|---|---|
| Scope and purpose | Which settings and which people it covers, across the lifespan. That blended diet is a recognised option within personalised care and not a deviation requiring exception. |
| The decision | Shared decision-making as the basis (Part 2). That an individual risk assessment is not required and is not a precondition. The plan records what has been agreed and by whom. |
| Roles and responsibilities | Dietitian, nurse, medical team, catering, setting staff and family. Who trains whom, and how competence is recorded. |
| Continuation on admission | The default is that blended diet continues on admission, with clinical exceptions only (critical care, significant immunocompromise, a change to post-pyloric feeding, biochemical instability, and a clinical need for continuous feeding). The steps to take on admission are in Appendix 9. |
| Methods of provision | Which of the methods in Appendix 9 the organisation supports, and when each applies. |
| Preparation, storage and administration | Labelling, transport, refrigeration, time limits, reheating and warming (Part 7, Appendix 5), administration method and flushing (Part 9), equipment cleaning (Part 4). |
| Infection prevention and control | Confirmation that ordinary food hygiene applies. Any local requirements, and their justification. |
| Monitoring | What is monitored, at what intervals, and which service requests and acts on results (Part 10). |
| Contingency | What is given when a blend cannot be, and what happens if a tube blocks. |
| Training and turnover | Induction for new staff, a record of who has been trained, and a named lead so provision survives staff changes. |
| Documentation | The care plan (Appendix 7), the conversation guide (Appendix 3), the decision letter (Appendix 4), and where they are filed. Records do not cross organisational boundaries, so the person or family should hold a copy to bring with them, and a receiving service should ask for it. |
| Review | Owner, review date, and how people using blended diet, and those who care for them, can raise problems with provision. |
- Require a competency assessment as a precondition of provision. Where a setting uses competency assessment, it covers the enteral tube feeding task rather than the blend, and it is never a precondition the person must satisfy (Parts 11 and 12)
- Set eligibility criteria that gate access to blended diet. The decision is the person’s, supported by their team
- Require reheating for safety where none is required. Reheating is a safety step only where a blend containing chilled ready-to-eat food is for someone more vulnerable to foodborne illness, or where the setting’s own procedures require it (Appendix 5)
- Treat the absence of a national policy, or of a manufacturer’s endorsement, as a reason to decline
Developed for the 2026 Practice Toolkit from the 2021 guidance on updating local policy and from work led by Ruth Stanley on blended diet in settings other than the home.