Community nurses employed and trained to a high level of competency by a commercial homecare company conducted a further audit of NGT replacement using the NPSA guidance on gastric aspirate pH as the basis of their practice. A rigorous clinical governance programme underpins this activity including regular reassessment of competencies. All nurses recorded their cases prospectively using an in house audit system for 4 months from April, 2015. A total of 23 nurses undertook 181 NGT replacements (children 121; adults 60) in 74 patients (children 60; adults 14). These included 36 (20%) unplanned replacements (children 20/121[16.5%]; adults 16/60 [27%] P¼0.11 NS). The replacement settings were: home 160; nursing home 6; care home 7; respite care 1; school 5; child minders' care 2. The majority of children (75%) were under the age of 5 years. The specific risk assessment tool was used in 100% of cases and led to deferred replacement in 3 patients. There was 1 referral for CXR following failure to obtain a satisfactory pH immediately on discharge from hospital and before commencement of feeding. CXR demonstrated bronchial placement thereby avoiding a "never event". Despite concomitant acid suppressing treatments in many, gastric aspirates were found to have mean pH 3.08. An equivocal pH 5-6 gastric aspirate was found in only 11/181 (6%) but all yielded a pH<5.5 on later retesting with confirmation by a second competent observer. No CXR was requested for failure to obtain a satisfactory pH in accordance with NPSA recommendations. Failed replacement required hospital referral on 2 occasions (1%). Community NGT replacement can therefore be safely and successfully undertaken by appropriately trained nurses in accordance with NPSA guidance without recourse to expensive urgent returns to hospital for radiological assessment e which does not guarantee avoidance of "never events" of which none have occurred following 555 replacements in 227 patients in our 2 audits. References  Reducing the harm caused by misplaced nasogastric feeding tubes in adults, children and infants. National Patient Safety Agency; 2011 at www. nrls.npsa.nhs.uk/resources/type/alerts.  Cron N. Complete Nutrition 2016;16:50e2. Enteral Feeding and patient safety.
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