A team from Leeds Teaching Hospitals NHS Trust is leading the national rollout of a new radiographer-led nasogastric tube position check pathway after their efforts showed long-term positive results. Here, the team discusses the need for such a pathway, how it has been shown to improve safety and how other Trusts can get involved.
Over 967,000 nasogastric (NG) tubes are purchased by the NHS each year.1 Less than one in 20 NG tubes are misplaced in the lung, however, failure to recognise this can lead to a never event.2 A ‘never event’ is defined as a ‘serious incident that… (is) wholly preventable’ and results in serious patient harm or death.3
Between 1 April 2014 and 31 March 2024, there were 270 misplaced NG tube-related never events recorded by the NHS in England.4 This has been recognised as a patient safety issue with six national patient safety alerts issued to healthcare providers between 2005 and 2016.1 Despite local systems being implemented and consistent effort from healthcare providers, incidents relating to misplaced NG tubes continue to occur.1
The Health Services Safety Investigation Body (HSSIB), formerly the Healthcare Safety Investigation Branch, is an organisation that investigates patient safety concerns across England to improve patient care. The HSSIB published a report in 2020 on incidents relating to misplaced NG tubes and identified radiographic misinterpretation of NG tube check radiographs as the leading cause of NG tube related never events.1 This is due to the lack of a standardised framework for assessing radiographic interpretation of NG tube radiographs.1
New national NG tube position check pathway
In 2024, a group of professional bodies including the Royal College of Radiologists, British Society of Gastrointestinal and Abdominal Radiologists, the Society and College of Radiographers, and Report and Image Quality Control (RAIQC), collaborated to create a new radiographer-led pathway for utilisation in NHS Trusts and Health Boards across the UK in order to reduce the number of NG tube related never events.
A standardised competency-based training programme was created by the project team and hosted on the web-based platform RAIQC. Here, radiographers are trained to provide contemporaneous radiographic interpretation and to act on their findings. This includes removal of misplaced tubes and arranging for ward staff to attend the department to advance tubes that are not sited far enough into the stomach to be considered safe. This eliminates delays and risk associated with waiting for misplaced tubes to be removed, and, once the tube is correctly sited, allows feeding to be initiated promptly.
Sharing experiences of the NG tube pathway
This collaborative position check pathway is based on an existing pathway from Leeds Teaching Hospitals NHS Trust, which has been in place for the past 11 years. Empowering the radiographer workforce by expanding their skillset and taking on greater responsibility has prevented further radiograph-related NG tube never events at this multisite Trust since the pathway’s inception.
Regular local audits over these 11 years have demonstrated an accuracy of 99% in the NG tube radiographic interpretation when compared to radiologist review, illustrating the importance of the radiographer workforce in reducing the number of patient safety incidents.
Radiographer training and empowerment to immediately evaluate and act on NG tube check radiographs has produced sustained prevention of patient harm.
The Leeds project team – with support from two radiologists from University College Hospital and Oxford University Hospitals who are involved with the RAIQC platform – is now leading the national roll out of this new radiographer-led pathway project, sharing their experience of utilising the pathway to support implementation at other hospitals.
New and potential site adopters are provided with governance documents and guidance for implementation and encouraged to attend weekly drop-in sessions hosted by the project team for mentoring and support.
Radiologists are key to getting this pathway implemented at Trust level. Any teams interested in adopting it in their service should liaise initially with their clinical lead and contact: [email protected].
Authors
Dr Sairah Razak
Radiology registrar
Gillian Roe
Extended imaging practitioner
Dr Damian Tolan
Project lead and consultant gastrointestinal radiologist
Leeds Teaching Hospitals NHS Trust
References
- HSSIB. (2021). Placement of nasogastric tubes. [online] Available at: https://www.hssib.org.uk/patient-safety-investigations/placement-of-nasogastric-tubes/investigation-report [Accessed 13 January 2024].
- Roe, G., Harris, K.M., Lambie, H. and Tolan, D.J.M. (2017). Radiographer workforce role expansion to improve patient safety related to nasogastric tube placement for feeding in adults. Clinical Radiology, 72(6), pp.518.e1–518.e7. doi:https://doi.org/10.1016/j.crad.2016.12.018.
- NHS Improvement. (2018). Never Events policy and framework: Revised January 2018. [online] Available at: https://www.england.nhs.uk/wp-content/uploads/2020/11/Revised-Never-Events-policy-and-framework-FINAL.pdf [Accessed 13 January 2025].
- NHS. (2024). NHS England » Never events data. [online] Available at: https://www.england.nhs.uk/patient-safety/never-events-data/ [Accessed 13 January 2025].
