NASOGASTRIC TUBE INSERTION: A SIMPLE AND PRAGMATIC APPROACH TO PRACTICE IMPROVEMENT
D. Aw, A. Blundell, C. Kotsapas, A. Hill, J. Snape
J Aging Res Clin Practice 2012;1(3):245-247
Fine bore nasogastric tube insertion for enteral feeding is a common procedure performed in hospitals by health care professionals. It is not without risks. The current recommendation for checking nasogastric tube placement is via the use of pH indicator strips, with chest radiography a second line alternative. The National Patient Safety Agency have highlighted cases of death and serious harm from misplaced nasogastric tubes, and it has been recently deemed as a ‘never event’ by the Department of Health. We audited the practice of nasogastric tube insertion in the elderly care medicine wards in a district general hospital over a period of 16 months, and found that, following the recommendations from our initial audit, we could demonstrate that, with improved junior doctor education, in addition to the appointment of a Nutritional Specialist Nurse, that pH testing to check tube positioning increased from 0% to 61% for initial insertions and from 4% to 69% for subsequent insertions. The total number of chest radiographs per patient was also reduced from 2.76 to 0.83.