Verification Methods of Nasogastric and Orogastric Tubes: Improved Patient Outcomes through Nurse Adherence to Practice Guidelines
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Although there are various methods that are used to confirm the placement of nasogastric (NG) and orogastric (OG) tubes prior to the administration of any substance, there is none that is used universally and with certainty of safety. Unreliable and contradictory methods for confirming tube placement ultimately leads to misplaced tubes and causes considerable adverse events including pneumonia, lung collapse, and fatality. In adult patients within a northcentral Ohio community hospital, greater than 18 years of age, requiring the placement of an NG or OG feeding tube [P], how does implementation of a systems-wide approach to update adherence guidelines for the most reliable NG and OG tube verification practices prior to the administration of tube feedings, medications, or H2O boluses based on EBP literature [I] compare to the current practice [C] in increasing adherence of updated practice guidelines, increasing the identification of misplaced NG and OG tubes, and decreasing adverse events to patients [O] over a three-month time frame [T]? Evidence suggests that auscultation of air bolus, visual inspection of gastric aspirate, water bubbling, litmus paper, ultrasonography, capnography/capnometry, bilirubin testing, and enzyme testing are unreliable methods to utilize for verification of initial NG and OG tube placement; while, pH measurement of gastric aspirate ≤ 5.5 is a reliable method and radiographic confirmation remains the gold standard. The Johns Hopkins Nursing Evidence-Based Practice Model was utilized to guide the development and implementation of this evidence-based practice project. The current NG and OG tube practice guideline was revised based on synthesis of evidence and the revised NG and OG tube practice guideline was implemented throughout this community hospital. The adherence, misplacement rate, and adverse event rate of NG and OG tubes were measured over a three-month time period pre- and post-revised practice guideline implementation. The sample consisted of 230 insertions of NG or OG tubes pre-implementation and 236 insertions post-implementation. Adherence rate to practice guidelines increased from 0.0% pre-implementation to 92.7% (p = .000) post-implementation. Identified NG and OG tube misplacements increased from 7.1% pre-implementation to 14.6% (p = .005) post-implementation. Identified adverse events caused by misplaced NG and OG tubes decreased from 1.9% pre-implementation to 1.5% (p = .703) post-implementation. The revised practice guideline for NG and OG tube verification not only significantly improved nurse adherence and the identification of misplaced NG and OG tubes, but also decreased the rate of adverse events caused by misplaced NG and OG tubes. It is recommended that healthcare practitioners and facilities become aware of the consequences of inaccurately positioned NG and OG tubes caused by improper NG and OG tube verification practices.