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patient satisfaction questionnaire was then completed by 14 new patients
who were recently referred to the community nutrition support team in
their own homes and 35 existing long term HETF patients.
Overall the results showed 86% of patients felt adequately prepared for
discharge after receiving their pump training in hospital. Once at home
confidence in managing enteral feed at home increased, with an increase
of 22% caring for their own tube, 15% giving medications via their tube, 36%
flushing their tube, feeding via their tube, using their feeding pump and
obtaining further equipment if needed. The results highlighted ongoing
issues, that 63% of long term HETF patients had experienced soreness from
their tube site or a ‘mucky’tube site, 43% experienced problems with their
feeding pump and their tube falling out. 37% of long term HETF patients
reported to have had to attend A&E or been admitted to hospital due to any
issues with their tube feeding, on one occasion resulting in a 10-12 day stay
in hospital and in other cases patients going for days without feed. 20%
reported to have experienced a blocked tube. An overall satisfaction with
the care provided by the Dietetic service was observed with 77% of long
term HETF patients and 100% of recently referred HETF patients reporting
they were ‘very satisfied’with the care provided. Further work is needed to
support HETF patients when they experience issues with their feeding
tubes such as tubes falling out or becoming blocked.
1. Smith, T., Naghibi, M., Stratton, R., White, S., Zeraschi, S., Hughes, S.,
Small, M. and Scott-Townsend, P. (2018). BANS Report 2018 Home Enteral
Tube Feeding (HETF) in adults (2010-2015). [online] BAPEN. Available at:
https://www.bapen.org.uk/pdfs/reports/bans/bans-report-2018.pdf
[Accessed 13 Dec. 2018].
2. Gandy, J. (2014). Manual of dietetic practice. 5
th
ed. The British Dietetic
Association, pp.pg. 353 &354.
OC26
AUDIT OF FEASIBILITY OF PH USE TO CONFIRM NASOGASTRIC TUBE
PLACEMENT IN AN ADULT CRITICAL CARE SETTING
M. Dawson, L. Stokes, J. Bazely, A. Case, C. Goodman, S. Patel. University
Hospitals of Leicester, Infirmary Square, Leicester, LE1 5WW, England
The misplacement of nasogastric enteral feeding tubes (NGT) continues to
be a national patient safety issue. The National Patient Safety Agency
(NPSA) issued the first alert on this issue in 20 05 and 3 further alerts were
issued between 2011 and 2013. NHS improvement issued a further alert in
2016 due to continued deaths and severe harm from NGT misplacement
and a further letter to Chief Executives of NHS Trusts was sent in June 2018
to request that NHS Trusts review their processes as there continued to be
never events in this area [1e3].
Our hospital policy for confirming nasogastric tube placement is pH testing
as first line in all areas apart from adult critical care units where chest x-ray
(CXR) is recommended
The reason for a difference in practice was due to perceived difficulty in
gaining a gastric aspirate on adult critical care patient that would be in the
safe 0-5.5 range due to the regular use of proton pump inhibitors (PPIs) to
increase gastric pH and the routine use of continuous enteral feeding.
However, it was acknowledged that there was no evidence for this clinical
practice and anecdotal information suggests adult critical care units across
the country are starting to use pH testing as first line confirmation.
In order to provide evidence for adult critical care position on using CXR to
confirm NGT position and assess feasibility of using pH as a measure of
NGT placement confirmation, critical care dietitians commenced an audit
of pH values in adult critical care units in November 2018.
A total of 38 patients were audited (77% of target) across 3 hospital sites.
68.4% (n-26) were captured at initial tube placement. The results showed
that on 53.8% (n-14) occasions nurses were able to gain an aspirate and of
these 64.2% (n-9) of pH results were 5.5 or less. Five of these patients were
already on a PPI. Follow up pH checks were repeated up to 3 occasions on
each patient, giving a total of 59 times on 38 patients. In 84.7% of times (n-
50) an aspirate was able to be gained and in 38% (n-19) of pH results were
5.5 or less. It is of note that 10.5% (n-2) had had an enteral feed break for 2
or more hours and 10.5% (n-2) were not on a PPI. In 19% (n-5) there was
poor or non-existent documentation of the nasogastric tube position.
Following the audit it has been agreed that immediate improvement in
documentation of review of CXR with regard to NGT position is essential.
Critical care multidisciplinary group has recommended that CXR should
continue to be the method of choice for confirming nasogastric tube po-
sition, on the basis that difficulty in obtaining a gastric aspirate and such
low numbers of patients then having a pH of 5.5 or below on critical care
did not support a change in practice. It was acknowledged that a CXR
would be required anyway for all new critical care patients and so this
practice is not exposing patients to any additional CXR. The multidisci-
plinary group felt that the information obtained about a position of the
nasogastric tube on Chest X-Ray (CXR) gave far more detail than a gastric
pH would, therefore improves safety, as the CXR often shows that
advancement of the NGT is required. Further audit is recommended to look
at those patients on overnight NG feeds.
1. National Patient Safety Agency (NPSA) Never Events Framework 2009-
2010; guidance; Feb. 09. Available online at http://www.nrls.npsa.nhs.uk/
resources/collections/neverevents/?entryid45¼59859.
2. National Patient Safety Agency (NPSA) NPSA/2011/PSA002 Reducing the
harm caused by misplaced nasogastric feeding tubes in adults, children
and infants 2011.
3. National Patient Safety Agency (NPSA) NPSA/2012/RRR001 Harm from
flushing of nasogastric tubes before confirmation of placement. 2012.
OC27
DEALING WITH LOSS: FOOD AND EATING IN WOMEN WITH OVARIAN
CANCER ON PARENTERAL NUTRITION
Anne Marie Sowerbutts
1
, Simon Lal
2
, Jana Sremanakova
1
, Andrew R.
Clamp
1
,
3
, Gordon C. Jayson
1
,
3
, Antje Teubner
2
, Lisa Hardy
4
, Chris
Todd
1
,
4
, Anne-Marie Raftery
3
, Eileen Sutton
5
, Sorrel Burden
1
.
1
Faculty
of Biology, Medicine and Health and Manchester Academic Health Science
Centre, University of Manchester, M13 9PL, United Kingdom;
2
Salford Royal
NHS Foundation Trust, Manchester, M6 8HD, United Kingdom;
3
The
Christie NHS Foundation Trust, Manchester, M20 4BX, United Kingdom;
4
Manchester University NHS Foundation Trust, Manchester, M23 9LT,
United Kingdom;
5
Population Health Sciences, Bristol Medical School,
University of Bristol, Bristol, BS8 1UD, United Kingdom
Malignant bowel obstruction is a common complication of advanced
ovarian cancer. Patients with this condition can tolerate minimal oral
intake. They may be offered home parenteral nutrition to meet their
nutrition and hydration requirements. However food is more than a
vehicle for providing nutrients it has a central role in celebrations and
social activities. Food also provides a back drop to normal life with meal-
times giving a routine to days. Whilst parenteral nutrition can provide
nutrients patients need, it cannot replace the cultural and social aspects
food. This research addresses how patients related to food during the
period they were on home parenteral nutrition.
The study used qualitative methodology underpinned by phenomenology.
The study cohort consisted of 20 women with advanced ovarian cancer in
bowel obstruction receiving parenteral nutrition. Data was gathered
through in-depth longitudinal interviews; participants were each inter-
viewed up to 4 times and 39 interviews in total were conducted. In-
terviews were transcribed verbatim, analysed thematically using NVivo 11
and guided by the techniques of Van Manen.
Four themes were identified relating to food and eating. First: ‘The pa-
tients’oral intake’this theme considered any food or fluids that patients
were taking orally. Second: ‘Others eating’this theme investigated par-
ticipants’feelings when in the presence of other people eating. Third:
‘Sense of loss’this was the overwhelming response of participants to not
being able to eat. Fourth: ‘Strategies to cope with loss’looked at the
strategies participants employed to cope with not eating and how these
developed over time.
Parenteral nutrition is the only method meeting the nutritional re-
quirements of patients with malignant bowel obstruction. However, it
cannot replace the non-nutritive aspects of food and patients in this study
reported strategies to cope with, and adapt to, this loss, with varying de-
grees of success.
Abstracts / Clinical Nutrition ESPEN 35 (2020) 208e252220