Safe nasogastric tube management at North Cumbria trust

A report published by the Care Quality Commission (CQC) has found the insertion and management of nasogastric tubes are ‘safe, effective and well-led’ at North Cumbria University Hospitals NHS Trust.

An inquest from January 2017 examined two patient deaths relating to misplaced nasogastric tubes, prompting the CQC to begin an inspection in July. Inspecting medical, surgical, paediatric and intensive care wards at the Cumberland Infirmary in Carlisle and West Cumberland Hospital in Whitehaven, the CQC found that there had been no serious incidents regarding nasogastric tubes since April 2015 and that procedures were also compliant with national best practice guidance.

The CQC recommended the trust to ensure the proposed new nasogastric insertion record for patient care plans is more detailed and contains more guidance as well as a summary of the reasons why the patient has one.

Dr Rod Harpin, medical director at the trust, said: “We have rightfully spent a lot of time reflecting on the learning for the whole organisation following the deaths of two of our patients in order to ensure this does not happen again. We are pleased that the CQC has recognised the amount of work the Trust has undertaken in order to improve our nasogastric care management, processes and policies. However, the work does not stop here and all of our staff are committed to continuing to make further improvements in safety for our patients.”

The two patients died, in 2012 and 2015 respectively, after the insertion of a nasogastric tube into the patients’ lungs resulted in the patient developing aspiration pneumonia. The pneumonia in each patient developed as a result of the nasogastric tube being placed in such a way as to enter the opposite lung instead of the stomach.

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