Multi-institutional quality improvement algorithm for home nasogastric tube care for neonates

• Published in: International journal of pediatric otorhinolaryngology Vol. 185; p. 112083
• Main Authors: Mitchell, Margaret B., Callans, Kevin, Erdei, Carmina, Patrizi, Siliva, Fiechtner, Lauren, Kelleher, Cassandra, Goldstein, Allan M., Lerou, Paul, Turcu, Rodica, Fracchia, Mary, Radano, Marcella, Dodrill, Pamela, Sorbo, Jessica, Hersh, Cheryl, Warren, Mollie, Hartnick, Christopher
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.10.2024
• Subjects: Aspiration; Dysphagia; Nasogastric feeding; Quality improvement; Quality improvement; Dysphagia; Aspiration; Nasogastric feeding
• ISSN: 0165-5876; 1872-8464; 1872-8464
• DOI: 10.1016/j.ijporl.2024.112083

High-risk neonates continuing to need enteral nutrition, but otherwise medically ready for discharge home from the NICU, are often offered ongoing hospitalization for nasogastric tube (NGT) feeding, versus discharge after placement of gastrostomy tube. Our group developed an interdisciplinary algorithm to support a third option—discharge home with enteral nutrition via NGT. Our objective was to develop a cross-institutional and interdisciplinary pathway to optimize outcomes for neonates discharged with NGTs. A program to support home NGT feeding use was created, “Passport Home Program,” based upon feedback from parents, nurses, speech-language pathologists, otolaryngologists, and neonatal intensivists, amongst others, spanning four hospitals across our health system. Standardized educational materials for caregivers of neonates requiring ongoing NGT feeding on discharge were created and consist of an in-hospital curriculum with specific competency thresholds, including demonstrating NGT replacement and confirmation with pH test strips. A discharge kit, including a QR code for a video reviewing safe techniques for home NGT placement, is distributed, along with support staff contact information. Members of an emergency department were trained in neonatal NGT replacement in case of issues after business hours. Each patient is followed in a dedicated outpatient multi-disciplinary clinic. This is an interdisciplinary and multi-institutional effort to standardize a pathway for neonates discharged home from the NICU with NGTs. This has the potential to lead to earlier discharge, better outcomes for patients and families, as well as lower costs. This best practice algorithm serves as an example pathway applicable across fields of medicine. •This is the first multi-institutional protocol for at-home NGT tube feeding.•This multi-disciplinary program includes providers from multiple specialties.•This protocol spanned four hospitals across one hospital system.•This program allowed our group to leverage the strengths of different hospitals.