Semester

Summer

Date of Graduation

2024

Document Type

Problem/Project Report

Degree Type

DNP

College

School of Nursing

Committee Chair

Billie Vance

Committee Co-Chair

Marian Longstreth

Committee Member

Freda White

Abstract

Problem: At a large academic medical center located in the northeastern United States, nasogastric tubes (NGT) were traditionally secured with tape. The institutional policy was nonspecific with no written procedure. The inconsistent use of nasal bridle securement devices (NBSD) and predominant use of tape has the potential to lead to a high rate of NGT dislodgement.

Background: NGT complication and dislodgement rates range from 2%-36% (Gimenes et al., 2019). Stabler et al. (2018) report 29%-63% NGT dislodgement rates in critically ill patients. Patients with intracranial hemorrhage dislodge NGTs in 25% of patients (Rahman et al., 2022)

Available Knowledge: Based on literature, NBSD use reduces NGT dislodgement rates. NGT dislodgement results in medication and nutrition delays, higher healthcare costs, and increased length of hospital stay.

Project Aims: The overarching purpose of this project was to increase the use of NBSD.

Purpose: Evaluate the use of NGT securement use of tape versus NBSD and associated dislodgement rate. Revise and update the organizational NGT securement policy and develop a NBSD insertion procedure. Update electronic health record (EHR) to include a linked NBSD order with NGT insertion order. Train 50% of nurses on each participating unit on NBSD insertion.

Plan for Implementation: Lewin’s change theory guided the project.

Plan for Evaluation: An evaluation plan to clarify the project objectives and goals. Process, outcome, and balancing measures were implemented, collected and observed.

Results: The policy was updated and NBSD procedure was created with associated EHR orders. There was a small increase in the utilization of NBSD, while usage of tape remained

consistent.Although nurses received education, many still experienced discomfort while inserting NBSDs.

Conclusion: There was a reduction in number of NGT dislodgement utilizing NBSD on comparison to the consistent use of tape with NGT. Consequently, the utilization of NBSD has the potential to reduce healthcare expenses, shorten the duration of hospital stays, and minimize complications associated with NGT dislodgement.

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