Introduction Nasogastric tube (NGT) insertion is commonly performed but mismanagement of NGTs can have disastrous consequences for patients. Misplacement of an NGT which results in feeding into the respiratory tract has been listed as an NHS England ‘Never Event’ since 2009. Despite the focus on safe usage, between 2011 and 2016 there were 95 reported incidences of fluid or medication being introduced into the respiratory tract via an incorrectly placed NGT 1. Improved education in the identification of incorrectly placed NGTs is required to help address this patient safety issue.
Method The nutrition team at Lancashire Teaching Hospitals NHS Trust (LTHTr) has developed an e-learning tool to teach junior doctors the correct methods for confirming NGT position with a view to improving their competence and confidence. The tool provides information on indications and contraindications for NGT insertion, a protocol for checking position including nose-ear-xiphysternum (NEX) measurement and pH testing. It provides formal teaching of chest x-ray (CXR) interpretation and a structured approach to assessing anatomical landmarks: “the 2Cs and 2Ds” (clavicle, carina, diaphragm and deviation) consistent with NPSA 2016–006 alert. Multiple choice questions assess the interpretation skills. The tool was evaluated in training sessions with 39 doctors of different levels of experience. Pre- and post-training questionnaires were completed, assessing trainees’ perceived competence in correctly confirming NGT position (using Likert scales).
Results 90% of those who attended the training sessions had never experienced using a similar tool in the context of teaching NGT position confirmation. After completing the training package, there was a significant increase in the participants’ Likert scores related to confidence in correctly confirming NGT position using CXRs (p<0.01), describing anatomical landmarks (p<0.01), and training a colleague in CXR interpretation ( p<0.01). Attendees were satisfied that the tool addressed the issues regarding NGT insertion and the importance of correctly confirming position.
Conclusion The e-learning tool is endorsed by the National Nutrition Nurse Group and completion will be compulsory for all trainee doctors rotating into LTHTr from August 2017. Further evaluation of the tool is necessary but it is hoped that its use will improve the safety of patients with NGTs in LTHTr. There is scope for extending the use of this tool beyond our trust and methods for increasing its availability are being evaluated with NHS Improving Quality.
. NHS improvement. Patient Safety Alert: Nasogastric tube misplacement: continuing risk of death and severe harm. Available from: https://improvement.nhs.uk/news-alerts/?articletype=patient-safety-alert (2016)
Disclosure of Interest None Declared
- enteral feeding
- Nasogastric tube
- Patient safety