Appropriateness of administration of nasogastric medication and preliminary intervention

Abstract

A utilization study was performed in a 2200-bed tertiary care teaching hospital. Data mining was performed on all nasogastric medication prescriptions for patients hospitalized in 2011. Nurses were interviewed by questionnaire. A PDCA (Plan-Do-Check-Act) cycle was used for continuous quality improvement. The proportion of patients with nasogastric tubes (NGT) was 3.2%. A large number of medical orders (n = 6261) involved nasogastric medications with a package insert particularly noting that they should not be crushed or opened (group 1) or medications without a specific formulation recommendation in the package insert but having evidence discouraging NGT dosing (group 2). Of the nasogastrically administered sustained-release or controlled-release formulations, a sustained-release sodium valproate tablet formulation was the most prescribed drug and a sustained-release 2.5 mg felodipine tablet was prescribed with the highest proportion of NGT dosing [NGT/(NGT + oral) = 12.3%]. Among the nasogastrically administered enteric-coated formulations, a myrtol-standardized enteric-coated capsule formulation was the most prescribed drug and a pantoprazole tablet formulation was prescribed with the highest proportion of NGT dosing [NGT/(NGT + oral) = 19.3%]. Proportions of NGT dosing for amiodarone and carbamazepine (group 2) were 4.8% and 6.3%, respectively. The percentage of nurses with adequate knowledge about pharmaceutical dosage formulations was 60%. The rate of answering correctly as to whether medications in group 1 could be crushed or opened was only 30%. Awareness of evidence discouraging NGT dosing of medications in group 2 was zero. Most nurses (90%) left physicians and pharmacists with the entire responsibility for knowledge and decision-making concerning route of drug administration. After a 3-month preliminary intervention, irrational medical orders involving nasogastric administration of medications in group 1 were successfully abolished. The rate of answering correctly as to whether medications in group 1 could be crushed or opened increased to 100%. This utilization study indicates poor awareness concerning nasogastric administration of medication on the part of physicians and nurses, and preliminary intervention measures were efficient in improving knowledge through team cooperation and effort.

Solid oral medications' suitability for use in enteral feeding tubes

“…Although this study did not aim to evaluate the prevalence of drug administration via FTs, the findings demonstrated that at least one‐third of the ICU patients needed medications to be altered for enteral administration. This result was not surprising because Zhu et al found that in a Chinese 2200‐bed tertiary care teaching hospital, almost half (48%) of the 1686 ICU patients needed medication administration through FTs 3 . These numbers show the relevance of accurate information and the need for special training among health care professionals in ICUs concerning medication administration via FTs.…”

Quality improvements in decreasing medication administration errors made by nursing staff in an academic medical center hospital: a trend analysis during the journey to Joint Commission International accreditation and in the post-accreditation era

“…Meanwhile, the inpatient pharmacy also conducted many quality improvement programs, such as preventing near misses related to look-alike or sound-alike medications; enhancing medication management and use of high-alert medications; reducing the kinds and quantities of medications stored outside of the pharmacy; shortening the period of time from writing stat (ST) physician orders to medication administration; standardizing the rule associated with skin tests and contraindications concerning cross allergy; 10 , 11 and promoting the awareness of rational nasogastric administration. 12 …”

Medication administration errors made by nurses reflect the level of pharmacy administration and hospital information infrastructure

“…The depth, breadth and efficiency of cooperation between nurses, pharmacists and information engineers are pivotal to medication safety (Zhu et al . ). Appropriately labelled information in combination with a barcoding system has greatly improved medication administration safety in our hospital.…”