Improving the proper placement of gastric tube in the neonatal intensive care unit: A quality improvement project in China

Abstract Background Previous studies have indicated that 44%–59% of neonatal nasogastric or orogastric (NG/OG) tubes were improperly positioned, which can lead to serious complications, including iatrogenic gastric perforations, aspiration pneumonia and other pulmonary diseases. Aim This study aimed to improve neonatal NG/OG tube placement from a baseline rate of 54.2%–70% within 4 months. Study Design A multidisciplinary team developed key drivers to guide interventions in this quality improvement (QI) project, which included the following: (1) standardizing neonatal NG/OG tube management based on evidence, (2) optimizing the standard operating procedure (SOP), (3) staff education and (4) data monitoring and real‐time feedback. The primary outcome measure was the percentage of proper NG/OG tube placement as assessed using x‐rays. Process measures included the rate of gastric pH testing documented at the time of NG/OG tube insertion, the concordance rate between the actual and labelled depth of the gastric tube in neonates and the knowledge rate of NG/OG tube management. Balancing measures were gastric bleeding and gastric perforation, which were associated with gastric tube placement, and the increased workload of neonatal intensive care unit (NICU) nurses, respectively. Control charts were used to track the time‐ordered data and detect special causes of variation. Results Throughout the QI period, a total of 284 neonates with 595 x‐ray films were reviewed. The proper placement rate of the NG/OG tubes increased from 54.2% to 77.3% after 4 months. The gastric pH testing rate at the time of insertion increased from 0% to 61.1%. The concordance rate between the actual and labelled depths of the gastric tube in neonates increased from 14.8% to 94.4%. Conclusions This QI project increased the rate of proper placement of NG/OG tube, the rate of gastric pH testing at the time of insertion, the concordance rate between the actual and labelled depth of the gastric tube and the knowledge rate of NG/OG tube management. Relevance to Clinical Practice Standardized NG/OG tube management and targeted nursing education are crucial for neonatal nurses to improve patient safety and quality of care. Interprofessional collaboration and leadership support enabled NICU nurses to implement interventions effectively. Continuous data collection and feedback facilitated the nursing team in identifying areas for further improvement, thereby maintaining high standards of NG/OG tube management practice and optimizing patient outcomes.