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CS164
The Nose Knows-Measuring NG Tubes in Critical Care
By: W. Worden & M. Dyer; Saint Mary's Hospital-Mayo Clinic; MN
For further information, please contact: worden.wendy@mayo.edu
Purpose: Aspiration from feeding tubes inadvertently migrating back has caused devastating outcomes for patients. The Neuroscience ICU Practice Committee created a solution. The goal was to improve patient safety, educate staff and standardize practice according to revised policies and AACN Practice Alerts.
Description: After reviewing the literature, patient event data and current guidelines, our practice committee developed a new standard of practice. This included measurement of the NG tube (NGT) in cm, from tip to nare, marking the NGT and charting with each nursing assessment. When an NGT became dislodged it was recommended that the NGT be re-X-rayed to ensure proper placement and replaced if necessary. Education was provided to staff in the form of PowerPoint presentations, bulletin board information, and individual observation. Recommendations were also sent to the informatics department to add the measurement permanently to the nursing flow sheet. To enforce the change in practice, audits were completed by the quality committee and verbal/written feedback was given to each nurse. Written feedback consisted of giving each nurse either a green or pink slip. Management would present a token of appreciation after 5 green slips were collected. The pink slips offered a gentle reminder to focus on our quality improvement goals. Audits were completed monthly and progress was tracked with a threshold of 90% compliance. Results were disseminated to nursing leadership, placed on our staff bulletin board and reviewed at staff meetings.
Evaluation and Outcomes: Auditing occurred for approximately one year and compliance steadily climbed with the dissemination of the feedback forms. Compliance reached 100% with NGT measurement permanently added to the flow sheet. No NGT related events were reported in the Neuroscience Division since implementing this quality initiative. The audit tool, feedback and documentation compliance improved patient outcomes and quality care in our neuroscience population.
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