PTU-004 Percutaneous endoscopic gastrostomy care?– prospective evaluation of a simple teaching intervention in improving nursing knowledge and confidence

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Abstract

Introduction

Percutaneous Endoscopic Gastrostomies (PEG) for enteral tube feeding are commonplace - point prevalence 92 per million, 2010 1. PEG care needs to be delivered by skilled practitioners owing to the potential for complication. Anecdotally, we were concerned by a lack of nursing confidence pertaining to PEG care and subsequently saw opportunity for quality improvement.

Aim

To determine baseline levels of nursing knowledge and confidence pertaining to PEG care in our trust; and to develop, deliver, and evaluate the efficacy of a simple teaching programme in improving this baseline.

Method

Single centre prospective audit of 83 nurses spanning the medical care group (elderly medicine, gastroenterology, and acute medicine) at Whiston Hospital (September-December 2016). Data was collected using a basic safety screening questionnaire, which sought to establish whether common issues encountered could be dealt with appropriately and safely. This was re-audited following delivery of a teaching intervention.

Results

In the acute, post-insertion setting, baseline knowledge was sub-optimal. We identified 39% of staff potentially using PEG tubes too early, reduced to 6% post intervention. Knowledge regarding management of complications varied according to experience. Confidence in intervening in the acute setting was lacking. Just 33% of nurses would be confident in inserting a foley catheter to maintain tract patency in the event of dislodgement, improving to 72% post intervention. Teaching promoted knowledge of potential contraindications to re-insertion, such as an immature tract (improving from 20% to 88% post intervention). When faced with a blocked tube only 55% of nurses expressed confidence in intervening; post education, awareness of using warm water in this scenario rose from 34% to 70%. Baseline knowledge regarding PEG maintenance was acceptable; all nurses were aware of the need to regularly rotate the PEG and that a safe minimum angle of 30 degrees should be maintained during feeding. However, just 18% had heard of the Buried Bumper Syndrome.

Conclusion

Baseline knowledge pertaining to the care of the PEG fed patient, and confidence in managing common complications was lacking. A simple, tailored educational session successfully identifies gaps in knowledge, improves confidence, and could deter potentially dangerous behaviour. We hope that increasing the confidence of the workforce will translate into fewer complications, a reduction in the need for re-intervention, and an increased PEG lifespan. Ideally, we would like to extend our program into nursing homes to prevent unnecessary hospital admissions in this already frail patient population.

Disclosure of Interest

None Declared

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