Implementation of a Standardized Gastrostomy Tube Discharge Bundle for Neonates

Abstract

Problem: Surgical placement of a gastrostomy tube (g-tube) is indicated in pediatric patients who are unable to obtain nutrition by mouth. While a g-tube is an accepted method of long-term enteral nutrition support, post-operative complications occur. A 52-bed level IV NICU cared for 79 infants requiring surgical g-tube placement. Over the same year, 35% of those patients (n=28) visited the Emergency Department (ED) for g-tube complications (dislodgment, irritation dermatitis and leaking), and 15% (n=12) scheduled unplanned outpatient clinic appointments. There is currently a lack of standardized g-tube education accompanied by a nursing knowledge deficit for appropriate caregiver education. Purpose: The purpose of this quality improvement project is to implement and evaluate the effectiveness of a standardized g-tube discharge bundle and electronic health record education title in the Neonatal ICU to prevent unnecessary ED and/or outpatient clinic appointments for g-tube complications. Methods: Staff nurses were trained and knowledge, skills and attitudes were assessed at the conclusion of each educational session. The G-tube Discharge Bundle resided at the bedside of all g-tube patients and the accompanying educational checklist was completed in its entirety by bedside nurses prior to discharge or transfer. Caregiver knowledge was assessed with return demonstration and/or verbalization of understanding. Results: The project revealed that no participant presented in the ED with a g-tube complication within the first two months post-discharge and no scheduled or unplanned outpatient clinic appointments. Conclusions: Caregiver preparation for patients with gastrostomy supports successful discharge and transition to home. The standardized evidencebased g-tube discharge bundle addresses the importance of family-centered care while improving satisfaction among caregivers and health care providers.