Dataset Information

Competence in confirming correct placement of nasogastric feeding tubes amongst FY1 doctors.

ABSTRACT: Foundation year one (FY1) doctors are required to confirm correct placement of nasogastric (NG) feeding tubes on chest radiography on a regular basis. Many FY1s do not receive formal training during medical school or during the FY1 year. Multiple incidents of harm to patients, including death, resulting from incorrect placement of an NG feeding tube have been reported to the National Patient Safety Agency (NPSA) since 2005. Our audit assessed the confidence and knowledge of FY1 doctors in correctly confirming NG placement using a qualitative questionnaire. The results showed that both confidence and knowledge on the topic were remarkably poor. Our intervention consisted of a teaching session to the FY1 cohort, which included information on NPSA guidelines for identifying correct NG placement. A post-teaching questionnaire was attained from the same group of FY1s. Confidence and knowledge of the criteria had significantly improved. We concluded that there is clearly a need for teaching on this subject at an undergraduate and post-graduate level. The interactive peer-led style of our teaching session was shown to be highly effective. The addition of handouts and posters in the clinical workplace acted as helpful reminders for junior doctors to use at the point of need. Our project has highlighted a gap in training which poses a serious potential risk to patient safety. We have created a simple solution which, if adopted on a local and national scale, will facilitate a reduction in avoidable harm to patients.

SUBMITTER: Lee S

PROVIDER: S-EPMC4652695 | biostudies-literature | 2013

REPOSITORIES: biostudies-literature

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Competence in confirming correct placement of nasogastric feeding tubes amongst FY1 doctors.

Lee Sindy S Mason Eleanor E

BMJ quality improvement reports 20130918 1

Foundation year one (FY1) doctors are required to confirm correct placement of nasogastric (NG) feeding tubes on chest radiography on a regular basis. Many FY1s do not receive formal training during medical school or during the FY1 year. Multiple incidents of harm to patients, including death, resulting from incorrect placement of an NG feeding tube have been reported to the National Patient Safety Agency (NPSA) since 2005. Our audit assessed the confidence and knowledge of FY1 doctors in correc ...[more]

PMID: 26734165

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Project description:BackgroundNG (nasogastric) tubes are used worldwide as a means to provide enteral nutrition. Testing the pH of tube aspirates prior to feeding is commonly used to verify tube location before feeding or medication. A pH at or lower than 5.5 was taken as evidence for stomach intubation. However, the existing standard pH strips lack sensitivity, especially in patients receiving feeding and antacids medication. We developed and validated a first-generation ester-impregnated pH strip test to improve the accuracy towards gastric placements in adult population receiving routine NG-tube feeding. The sensitivity was improved by its augmentation with the action of human gastric lipase (HGL), an enzyme specific to the stomach.MethodsWe carried out a multi-centred, prospective, two-gate diagnostic accuracy study on patients who require routine NG-tube feeding in 10 NHS hospitals comparing the sensitivity of the novel pH strip to the standard pH test, using either chest X-rays or, in its absence, clinical observation of the absence of adverse events as the reference standard. We also tested the novel pH strips in lung aspirates from patients undergoing oesophageal cancer surgeries using visual inspection as the reference standard. We simulated health economics using a decision analytic model and carried out adoption studies to understand its route to commercialisation. The primary end point is the sensitivity of novel and standard pH tests at the recommended pH cut-off of 5.5.ResultsA total of 6400 ester-impregnated pH strips were prepared based on an ISO13485 quality management system. A total of 376 gastric samples were collected from adult patients in 10 NHS hospitals who were receiving routine NG-tube feeding. The sensitivities of the standard and novel pH tests were respectively 49.2% (95% CI 44.1‑54.3%) and 70.2% (95% CI 65.6‑74.8%) under pH cut-off of 5.5 and the novel test has a lung specificity of 89.5% (95% CI 79.6%, 99.4%). Our simulation showed that using the novel test can potentially save 132 unnecessary chest X-rays per check per every 1000 eligible patients, or direct savings of £4034 to the NHS.ConclusionsThe novel pH test correctly identified significantly more patients with tubes located inside the stomach compared to the standard pH test used widely by the NHS.Trial registrationhttp://www.isrctn.com/ISRCTN11170249 , Registered 21 June 2017-retrospectively registered.

Dataset Information

Competence in confirming correct placement of nasogastric feeding tubes amongst FY1 doctors.

Publications

Competence in confirming correct placement of nasogastric feeding tubes amongst FY1 doctors.

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