Authors (including presenting author) :
Wong SL(1), Leung KN Sharron(1), Wong LY Melody(1)
Affiliation :
(1)Cardiothoracic Surgical Department,Queen Mary Hospital
Introduction :
Nasogastric tube (NGT) care is commonly performed but mismanagement of NGTs can result in significant morbidity and mortality. As a quality improvement project aim at enhancing clinical safety in NGT care, a standardization care program is introduced to improve documentation and guiding nurses towards safe and best practice.
Objectives :
To improve clinical safety in NGT care, by ensuring standard and proper practice in acute clinical setting.
Methodology :
Current practice in NGT feeding was reviewed to identify practice gap. A NGT care standardization program was introduced with recruitment of all nursing staff & students. To align NGT practice with standard documentation, a tube feeding documentation chart was developed to guide practice & provide condition picture for clinical decision. Initial NGT position must be radiological confirmed. Standardized practice of double verification by external length and aspiration pH were performed every 4 hours for subsequent position confirmation. Nursing assessment information including tube external length, gastric residual volume (GRV) & PH, feeding formula were all documented in 4 hours interval. All nurses including students were trained & assessed for procedural competency & documentation integrity through ward-based microlearning sessions. A standardize tube feeding care box with commonly use equipment (PH paper, syringe, soft ruler, spigot, gauze, small transparent plastic container) was designed & use for feeding patient individually to facilitate proper practice. Subsequent audit and training were performed to ensure continuity and monitor of compliance.
Result & Outcome :
After implementing the program, information flow and exchange were improved via standardized documentation presenting overview of tube feeding care. 92% nursing students and novice nurses agreed that documentation chart clearly guide their practice by step and consolidate their school knowledge. Double verification assessment with guiding aim documentation enhanced practice compliance up to 90% and greatly reduced the use of non-recommended methods, e.g., auscultation or water bubbling. Re training with audit was given to non-compliance to rectify malpractice. The 4 hourly documentation practice ensure early detection of tube displacement and it demonstrated the reduction in number of subsequent radiological assessments due to unclear position. Standardized GRV measurement reflected gastrointestinal tolerance, facilitate trend monitoring, and visibly guides nutritious management, it minimizes in-digestive vomiting induced tube displacement and aspiration, therefore, improving patient’s safety and comfort level. Bedside standardized feeding box decrease searching time for misplaced items, enhance conveniences with reduction in 30% feeding procedural time. 85% nurses revealed that easily accessible equipment improve practice compliance and minimizes cross infection due to equipment sharing. Conclusion: The NGT care standardization program makes nursing work visible, decreasing nurse’s performance deviation with improvements in core nursing competency. It reduces clinical risk and enhance the delivery of safe and quality care to patients.
