Enhancing knowledge translation through partnerships: an initiative to improve practice regarding nasogastric tube placement verification

Session Type
Engaging stakeholders and building partnerships
Chau JPC1, Tong DWK2, Lo SHS1, Chien WT1, Lam H3, Sze SYM4, Kwok M2, Chung JYM5, Lai P6, Choi KC1, Liu X1
1Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong
2Hospital Authority Hong Kong, Hong Kong
3Ruttonjee and Tang Shiu Kin Hospital, Hong Kong
4Shatin Hospital, Hong Kong
5Prince of Wales Hospital, Hong Kong
6Queen Mary Hospital, Hong Kong

Background The extent of evidence utilisation in practice depends on the priority of the chosen topic, the availability of evidence, the way it is adapted to specific local contexts, and implementation strategies. Numerous patient safety alerts have been issued regarding the placement of nasogastric tubes (NGTs) in hospital and community settings. Verifying NGT placement remains the most pressing issue and a priority area for quality improvement in clinical settings. Objectives and methods To support continuous quality improvement, advance priority research, and translate evidence into policy and practice, Cochrane Hong Kong, in collaboration with Nursing Section of Hospital Authority Hong Kong, has undertaken a project aimed at synthesising evidence and transferring knowledge about NGT placement verification. We conducted a systematic review to review the diagnostic accuracy of end-tidal carbon dioxide detection in determining inadvertent airway intubation and verifying correct placement of NGTs. Sixteen studies were analysed and the review suggests colorimetric capnometry and capnography may be of comparable diagnostic accuracy to radiography in their ability to differentiate between respiratory and gastrointestinal tube placement in critically ill adult patients. A prospective observational diagnostic study is currently underway in 21 acute, subacute, convalescent, and extended care hospitals (18 emergency departments, 13 intensive care units, and 8 general medical and geriatric wards) to assess the sensitivity and specificity of using capnography in detecting the correct placement of NGTs using the reference standards of radiography and measurement of aspirates for pH value. The sensitivity, specificity, positive predictive value, and negative predictive value of the capnography test will be calculated with reference to a combination of X-ray and aspirate pH test. Significance and Impact Misplaced NGTs have detrimental effects, and in most cases, NGTs are placed in the respiratory tract, which causes serious respiratory complications. Using the findings of this study, the Hospital Authority Hong Kong will update clinical practice guidelines regarding NGT placements in acute and rehabilitative settings. The purpose of this presentation is to illustrate how the research sector and health services (including frontline nurses, nurse consultants, nurse managers, and policymakers) can work together to strengthen collaborations in evidence synthesis and knowledge translation.