Facility: Ward/Emergency Department: MRN: Gastric Tube inserted Time: (24 hour Date: Indications for Nutritional needs Rehydration insertion Administering medications Decompression of the stomach Adverse outcome/s for Yes No Not documented patient If so, please indicate type of adverse event: Documentation Was the following documented in the child’s progress notes / nursing care plan Yes No Not documented Type/Size of tube Yes No Not documented External length of tube at nostril Yes No Not documented Aspirate obtained pH Yes No Not documented pH of aspirate Number Not documented Attempts at insertion Confirmation of Placement Placement confirmed by: Yes No Not documented pH indicator strip Yes No Not documented X-ray or Ultrasound Yes State Which Other method Post insertion, observations documented on specific observation chart i.e. SPOC, Yes No Not documented EDSPOC, SNOC, eMR Placement re-confirmed prior to the Yes No Not documented administration of fluids or medications If continuous feeds, was placement Yes No Not documented reconfirmed at least once per shift Comments: Name of Auditor: Designation: COMPLETING THE AUDIT TOOL
Facility: Ward/Emergency Department: MRN: Gastric Tube inserted Time: (24 hour Date: Indications for insertion Nutritional needs Administering medications Rehydration Decompression of the stomach Adverse outcome/s for patient Yes No Not documented If so, please indicate type of adverse event: Documentation Was the following documented in the child’s progress notes / nursing care plan Type/Size of tube External length of tube at nostril Aspirate obtained pH of aspirate Attempts at insertion Yes No Not documented Yes No Not documented Yes No Not documented Yes pH No Not documented Number Not documented Confirmation of Placement Placement confirmed by: pH indicator strip X-ray or Ultrasound Other method Yes No Not documented Yes No Not documented Yes State Which Post insertion, observations documented on specific observation chart i.e. SPOC, EDSPOC, SNOC, eMR Yes No Not documented Placement re-confirmed prior to the administration of fluids or medications Yes No Not documented If continuous feeds, was placement reconfirmed at least once per shift Yes No Not documented Comments: Name of Auditor: Designation: COMPLETING THE AUDIT TOOL
audit-tool-nasogastric.docx