in use in different clinical departments in Are you confident an organisation. nasogastric tubes or pH paper not meeting these safety-critical requirements have been removed from all areas? Competency-based Not all trusts appear to have created Are you confident the training training programmes, or levels of content of your local Training needs to training completion had not been training programme reflect all the routinely monitored and had lapsed. Some accurately reflects all the critical requirements incident investigations suggested that safety critical summarised in this trusts had seen training as unnecessary for requirements resource set. experienced or senior nursing staff, but summarised in this the risks of them continuing to use resource? incorrect techniques that predated the Are you confident that NPSA and NHS England alerts may be all clinical staff greater. (regardless of profession In some trusts there seemed to be an or level of seniority) who assumption that consultants did not confirm nasogastric tube require training in x-ray interpretation, but placement by pH or x-ray investigations have demonstrated that have been assessed as errors are made by consultants and not competent through just junior staff. theoretical and practical Some trusts appeared to assume that learning? newly registered nursing staff or junior doctors must already have had these competencies assessed in their training; this is not necessarily so. Are you confident there Some training programmes appeared is a process to monitor theoretical rather than assessing and review competency? competency. Organisations had not recognised that Can frontline staff easily Only having an up-to-date register of staff who identify staff who have radiologist have the appropriate competencies is key (and who have not) been from acute to ensuring nursing staff avoid asking assessed as competent hospital doctors not ‘on the list’ to confirm in the interpretation of nasogastric tube placement. x-rays for confirming Investigation reports describe medical nasogastric tube staff using the unsafe and outmoded placement? ‘whoosh test’ or giving incorrect advice to nursing staff in relation to obtaining and
in use in different clinical departments in an organisation. Are you confident nasogastric tubes or pH paper not meeting these safety-critical requirements have been removed from all areas? Competency-based training Training needs to reflect all the requirements summarised in this resource set. Not all trusts appear to have created training programmes, or levels of training completion had not been routinely monitored and had lapsed. Some incident investigations suggested that trusts had seen training as unnecessary for experienced or senior nursing staff, but the risks of them continuing to use incorrect techniques that predated the NPSA and NHS England alerts may be greater. In some trusts there seemed to be an assumption that consultants did not require training in x-ray interpretation, but investigations have demonstrated that errors are made by consultants and not just junior staff. Some trusts appeared to assume that newly registered nursing staff or junior doctors must already have had these competencies assessed in their training; this is not necessarily so. Some training programmes appeared theoretical rather than assessing competency. Organisations had not recognised that having an up-to-date register of staff who have the appropriate competencies is key to ensuring nursing staff avoid asking doctors not ‘on the list’ to confirm nasogastric tube placement. Investigation reports describe medical staff using the unsafe and outmoded ‘whoosh test’ or giving incorrect advice to nursing staff in relation to obtaining and Are you confident the content of your local training programme accurately reflects all the safety critical requirements summarised in this resource? Are you confident that all clinical staff (regardless of profession or level of seniority) who confirm nasogastric tube placement by pH or x-ray have been assessed as competent through theoretical and practical learning? Are you confident there is a process to monitor and review competency? Can frontline staff easily identify staff who have (and who have not) been assessed as competent in the interpretation of x-rays for confirming nasogastric tube placement? Only radiologist from acute hospital critical
78i_BOD_Board-Report-May-2017-Patient-Safety-Alert-NG-tube-feeding-2.docx