Incidence and recognition of malnutrition on admission to hospital

Abstract

was significantly greater for nurses on medical wards (p¼0.02) and those with previous training in NG position checks (p¼0.01). A pH was assigned in all 72 observations of the pH 7 solution with a range of answers given: pH 3.5 (n¼1), pH 5.5 (n¼2), pH 6 (n¼47) and pH >6 (n¼22). Substantial intra-rater reliability was demonstrated (kappa¼0.77) with 84% exact agreement and 94% exact and adjacent agreement. There were no significant factors influencing intra-rater reliability. Overall intra-rater reliability is good, however there are issues with accuracy of pH readings. As bronchial secretions have a minimum pH of 6, exact agreement is required at this level. Underestimation , which occurred in 15% of readings (pH 1.6 and pH 4 solutions), may result in harm. Although this may be addressed by training, which improved accuracy in this study, other strategies may need to be adopted as only half of this cohort had been formally trained despite widespread teaching programmes across the trust. Further consideration should be given to the use of pH meters or lowering the pH threshold for feeding without x-ray, but this poses other issues including radiation exposure, delays in feeding whilst awaiting imaging and difficulties with x-ray interpretation.