Escalation Plan to Promote Nasogastric and Orogastric Tube Policy Adherence and Patient Safety

BACKGROUND: Healthcare organizations have implemented specific policies regarding patient care to ensure patient safety and reduce patient harm. In 2023, an estimated 80,0000 preventable medical deaths could have been avoided by following organizational policies. Patient safety is paramount, so nurses must adhere to current policies. Evidence-based practice has guided the development of these policies and has been implemented to promote patient safety. Nurses caring for patients with nasogastric (NGT) and/or orogastric tubes (OGT) need to practice appropriate care according to their facilities’ policies to prevent unintended harm.

LOCAL PROBLEM: The setting for this project was a medically diverse children’s hospital located in the metro Atlanta area. Before this project was implemented, there were no formal reeducation initiatives to improve policy adherence. Research studies indicate that implementing a formal reeducation plan for nurses enhances policy adherence. This project focused on the verification and placement of NGTs/OGTs. The purpose of this project was to ensure nurses provide the safest patient care and to increase policy adherence by 40%.

METHODS: The Evidence-Based Practice Improvement (EBPI) model was used to guide this project. A scripted re-education tool was utilized during implementation, and clinical decisions throughout the project were made using PDSA (plan-do-study-act) cycles.

INTERVENTIONS: Bedside re-education was provided using a pre-scripted tool to nurses who did not properly document two NGT/OGT placement verifiers. RESULTS: A 2% increase in policy adherence was observed after completing the project. This is significantly below the target project goal of a 40% increase; however, implementation data showed 88.2% compliance. Therefore, a 40% increase was unrealistic. There was a decrease from 1% to 0% in misplaced NGTs/OGTs.

CONCLUSION: Implementing bedside reeducation had a positive impact, both clinically and statistically, on improving policy compliance and reducing the number of misplaced NGTs/OGTs. To maintain this increase in policy adherence, providing ongoing education for nurses is essential.