Other Titles
Clinical Therapies for the Pediatric Population
Abstract
Session presented on Saturday, July 25, 2015:
Purpose: The safety of bedside insertion for NG/OG tubes has become of increasing concern, particularly in pediatric patients. Serious safety events involving the misplacement of NG/OG enteral tubes prompted a review of our existing practices by a multidisciplinary team. The focus of the review was to assess existing practice and its alignment with the current literature and best evidence on the topic of NG/OG tube placement. The purpose of this project was to 1) educate multidisciplinary patient care staff to the risks associated with NG/OG tube insertion; 2) revise practice to align with current best evidence regarding NG/OG tube placement; 3) increase patient safety during NG/OG tube insertion through increased monitoring and ongoing patient assessment.
Methods: To accomplish the goals of improved patient safety while aligning practice with current best evidence, a multidisciplinary team consisting of advance practice nurses, the medical patient safety officer, and nursing leadership took on the following tasks: 1) reviewed the current pertinent literature related to NG/OG tube placement verification; 2) benchmarked our institution with other tertiary care pediatric hospitals of similar size and patient populations; 3) incorporated the expert opinions of advanced practice nurses, bedside clinical nurses, and physicians familiar with the literature and with the clinical challenges of NG/OG tube placement; 4) engaged in small group discussions and education sessions with multidisciplinary groups throughout the institution on proposed practice changes; 5) identified a sub-group of patients at increased risk for tube misplacement, with recommendations on verification of NG/OG tube placement in this group; and 6) revised the order panel in the electronic medical record for NG/OG tube insertion to align with the practice changes. The coordinating team developed a stepwise approach to the procedure using a problem-solving algorithm to guide patient assessment during NG/OG tube placement. An electronic learning module was created pertinent to all clinical patient care providers, and standardized documentation was developed for the procedure.
Results: Following a comprehensive examination of current practice throughout our institution and an extensive literature review, changes were made in May 2014 to the procedures and standard of practice for NG/OG tube placement. The changes have been adopted hospital-wide for all in-patient and perioperative areas, inclusive of intensive care units. Quarterly checks are ongoing to determine impact and adherence to the new practice changes.
Conclusion: Education to all patient care providers using current best evidence resulted in changes to the current practice of NG/OG tube placement and movement of the procedure to the domain of multidisciplinary patient care rather than solely nursing care. A multidisciplinary collaborative team with input from many stakeholders for this procedure resulted in changes to the practice and standards for NG/OG tube placement to enhance patient safety during the procedure.
Sigma Membership
Non-member
Type
Presentation
Format Type
Text-based Document
Study Design/Type
N/A
Research Approach
N/A
Keywords:
NG Tube Placement, Pediatric Enteral Tube, Feeding Tube Safety
Recommended Citation
Irving, Sharon Y.; Crawford, Jacqueline E.; Goldberg, Elizabeth; Mohan, Anne; Ford, Nancy; and Davis, Daniela H., "Practice change for patients with nasogastric/orogastric enteral tubes: Safety improvement initiative" (2016). INRC (Congress). 208.
https://www.sigmarepository.org/inrc/2015/presentations_2015/208
Conference Name
26th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
San Juan, Puerto Rico
Conference Year
2015
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Acquisition
Proxy-submission
Practice change for patients with nasogastric/orogastric enteral tubes: Safety improvement initiative
San Juan, Puerto Rico
Session presented on Saturday, July 25, 2015:
Purpose: The safety of bedside insertion for NG/OG tubes has become of increasing concern, particularly in pediatric patients. Serious safety events involving the misplacement of NG/OG enteral tubes prompted a review of our existing practices by a multidisciplinary team. The focus of the review was to assess existing practice and its alignment with the current literature and best evidence on the topic of NG/OG tube placement. The purpose of this project was to 1) educate multidisciplinary patient care staff to the risks associated with NG/OG tube insertion; 2) revise practice to align with current best evidence regarding NG/OG tube placement; 3) increase patient safety during NG/OG tube insertion through increased monitoring and ongoing patient assessment.
Methods: To accomplish the goals of improved patient safety while aligning practice with current best evidence, a multidisciplinary team consisting of advance practice nurses, the medical patient safety officer, and nursing leadership took on the following tasks: 1) reviewed the current pertinent literature related to NG/OG tube placement verification; 2) benchmarked our institution with other tertiary care pediatric hospitals of similar size and patient populations; 3) incorporated the expert opinions of advanced practice nurses, bedside clinical nurses, and physicians familiar with the literature and with the clinical challenges of NG/OG tube placement; 4) engaged in small group discussions and education sessions with multidisciplinary groups throughout the institution on proposed practice changes; 5) identified a sub-group of patients at increased risk for tube misplacement, with recommendations on verification of NG/OG tube placement in this group; and 6) revised the order panel in the electronic medical record for NG/OG tube insertion to align with the practice changes. The coordinating team developed a stepwise approach to the procedure using a problem-solving algorithm to guide patient assessment during NG/OG tube placement. An electronic learning module was created pertinent to all clinical patient care providers, and standardized documentation was developed for the procedure.
Results: Following a comprehensive examination of current practice throughout our institution and an extensive literature review, changes were made in May 2014 to the procedures and standard of practice for NG/OG tube placement. The changes have been adopted hospital-wide for all in-patient and perioperative areas, inclusive of intensive care units. Quarterly checks are ongoing to determine impact and adherence to the new practice changes.
Conclusion: Education to all patient care providers using current best evidence resulted in changes to the current practice of NG/OG tube placement and movement of the procedure to the domain of multidisciplinary patient care rather than solely nursing care. A multidisciplinary collaborative team with input from many stakeholders for this procedure resulted in changes to the practice and standards for NG/OG tube placement to enhance patient safety during the procedure.