pH Testing for NG Tube Placement

Measure

Control

Monitoring

• Clinical educators will ensure compliance with the policy change

Continuous Improvement/ Evaluation

• Provide resources for staff
• Provide annual staff education

Goals

• Short-Term: Provide education on pH testing
• Long-term: Implement pH testing on all patients who require an NG tube

Targeted Populations

• Adult and pediatric patients needing an NG tube

Summary

• Communication and collaboration are key to making a change
• Research is essential to implement best practice

References

Define

Micro Essential Laboratory. (2013). pH strips. Retrieved from: https://www.microessentiallab.com/ProductionInfo/F60-WIDRG-000140-VPS.aspx

Peter, S., & Gill, F. (2008). Development of a clinical practice guideline for testing nasogastric tube placement. Journal for Specialists in Pediatric Nursing, 14, 3-11. doi: 10.1111/j.17.44-6155.2008.00161.x

Simons, S. R., & Abdallah, L. M. (2012). Bedside assessment of enteral tube placement: Aligning practice with evidence. American Journal of Nursing, 112, 40-46. doi: 10.1097/01.NAJ.0000411178.07179.68

Tho, P. C., MOrdiffi, S., Ang, E., & Chen, H. (2011). Implementation of the evidence review on best practice for confirming the correct placement of nasogastric tube in patients in an acute care hospital. International Journal of Evidence-Based Healthcare, 9, 51-60. doi: 10.1111/j.1744-1609.2010.00200.x

Turgay, A. S., & Khorshid, L. (2010). Effectiveness of the auscultatory and pH methods in predicting feeding tube placement. Journal of Clinical Nursin, 19, 1553-1559. doi: 10.1111/j.1365-2702.2010.03191.x

pH Testing for NG Tube Placement

Background

• Evidence-based research identified pH testing as best practice to verify nasogastric (NG) tube placement for all patient populations

Identify the Issue

• pH testing for NG tube placement is not current practice at Blessing Hospital (BH)
• Driving forces
• Support of Clinical Practice Council
• Patient safety

Improve

Analyze

Amanda Barlow, Jennifer Holliday, Diane Lahr, Jamie Lichtsinn

Implementation

• Collaborate with Clinical Practice Council and Laboratory
• Provide staff teaching on pH testing through annual CBL

Current Situation

• BH currently utilizes an auscultation method for verifying NG tube placement
• Necessary steps to implementation
• Education
• Funding

Scope

• Study of 85 acutely ill adults with NG tubes showed auscultatory method only identified 34.2% of correct placement 3
• Established evidence-based practice shows pH monitoring is superior to auscultation method 2,3,4,5
• pH testing is reliable for continuous monitoring of NG tube placement 2,3,4
• Positive patient outcomes found in:
• Critical care/high-risk patients 2,5

Problem Analysis

• Implementation of pH testing proposed to align practice with evidence
• Evidence-based practice supported pH testing
• Clinical Practice Council meetings were used to brainstorm ideas and possible limitations to the change:
• Cost ($47.85/300 strips) 1
• Timing
• Staff education

Execute Follow-Up Plan

• Ensure compliance with annual CBL for enforcing evidence-based practice for pH testing

Identify Improvement Options

• Reinforcement of policy regarding NG tube placement verification
• Implement pH testing by nurses and laboratory personnel
• Provide education to nursing staff and on benefits and implementation methods