ESPEN 2012 - Late breaking abstract submission

Topic: Late Breaking Abstract

Abs n°:ESPEN12-1890

Abs Title: IS NASOGASTRIC FEEDING TUBE REPLACEMENT ACCORDING TO UK NATIONAL PATIENT SAFETY AGENCY GUIDELINES SAFE AND PRACTICABLE IN THE COMMUNITY SETTING?

B. J. Jones ^1,*A. Jones ¹A. Evans ¹

¹Homeward, Nutricia Ltd, Trowbridge, United Kingdom

Rationale: Commercial homecare companies (CHC) provide support to 90% of home enteral patients in UK^1 -10% have a nasogastric feeding tube (NGFT) ¹. NGFT misplacement is defined as a “Never Event” by the NPSA (UK National Patient Safety Agency). To prevent such events, CHC nurses must comply with NPSA guidance² including confirmation of gastric aspirate pH <5.5 in the absence of which, radiological imaging is mandatory. The aim was to audit compliance by community nursing staff from a single CHC with NPSA guidance.

Methods: 6 month prospective audit of community NGFT replacement to May, 2012. This followed training of all involved Nutricia nurses in NPSA 2011² compatible risk assessment tools and protocols.

Results: A risk assessment tool was used in 100%, a care plan was available in 71%, supervising healthcare professional informed in 86%  and acid suppressants were stopped appropriately in 86% cases. 374 NGFT changes were reported by 28 nurses in 153 patients, with multiple changes in 52%. NPSA criteria for confirmation of intragastric placement with pH <5 were satisfied In 358/374 (96%). In 7, pH 5.5 was confirmed by a second observer.  In 2 when pH 6, repeat testing was satisfactory. In 1, protocol compliance was unclear. A pH of 7 was found but reverted to <5.5 on withdrawal of PPI (1). Failed NGFT insertion occurred in 5  requiring transfer to hospital. There were no referrals for radiological confirmation and no NGFT misplacements.

Conclusion: NPSA guidance is therefore a safe and practicable method for ensuring safe community NGFT replacement by appropriately trained staff even for multiple replacements, with no “never events” in this series.

Reference(s): 1. BANS report, 2011. http://www.bapen.org

 2. NPSA/2011/PSA002. http://www.nrls.npsa.nhs.uk/resources/?entryid45=129640&p=2

Disclosure of Interest: B. Jones Consultant for: Consultant to Nutricia LtdA. Jones Other: Employee, Nutricia LtdA. Evans Other: Employee, Nutricia Ltd

Keywords: Safe feeding