Abstract：
BACKGROUND: Preterm infants require the use of nasogastric and orogastric enteral access devices (EADs) to provide nutrition and medications. Confirmation of the location of the tip of the EAD is essential to minimize complications. At the study site, EAD location was limited to verifying the centimeter marking at the lip/nares and nonevidence-based methods of visual observation of aspirate and auscultation.
OBJECTIVE: Implement an evidenced-based EAD placement confirmation protocol, and by 90 days post-education and implementation, achieve adherence of 90%.
METHODS: This quality improvement project implemented a nurse-driven evidence-based protocol for EAD verification. The intervention was based on the New Opportunities for Verification of Enteral Tube Location best practice recommendations. Prior to implementation, education sessions focused on insertion measurement technique and gastric pH measurement. Radiographs, insertion measurement technique, centimeter marking, and gastric pH measurement were used for EAD location confirmation. To determine compliance with the protocol, audits were conducted and questionnaires assessing current practice regarding EAD confirmation were administered pre- and postimplementation.
RESULTS: The protocol increased nursing knowledge regarding evidence-based EAD insertion and verification procedures, incorporated pH measurement into practice, and reduced use of auscultation for confirmation. Nursing adherence to the protocol was 92%.
CONCLUSIONS: This provides a model for how to successfully implement and achieve adherence to an evidence-based EAD placement confirmation nurse-driven protocol. Further research is needed to verify the effectiveness of the protocol and establish consensus on approaches specifically for the neonatal population.
OBJECTIVE: Implement an evidenced-based EAD placement confirmation protocol, and by 90 days post-education and implementation, achieve adherence of 90%.
METHODS: This quality improvement project implemented a nurse-driven evidence-based protocol for EAD verification. The intervention was based on the New Opportunities for Verification of Enteral Tube Location best practice recommendations. Prior to implementation, education sessions focused on insertion measurement technique and gastric pH measurement. Radiographs, insertion measurement technique, centimeter marking, and gastric pH measurement were used for EAD location confirmation. To determine compliance with the protocol, audits were conducted and questionnaires assessing current practice regarding EAD confirmation were administered pre- and postimplementation.
RESULTS: The protocol increased nursing knowledge regarding evidence-based EAD insertion and verification procedures, incorporated pH measurement into practice, and reduced use of auscultation for confirmation. Nursing adherence to the protocol was 92%.
CONCLUSIONS: This provides a model for how to successfully implement and achieve adherence to an evidence-based EAD placement confirmation nurse-driven protocol. Further research is needed to verify the effectiveness of the protocol and establish consensus on approaches specifically for the neonatal population.
摘要：
背景：早产儿需要使用鼻胃和口胃肠通路装置（EAD）来提供营养和药物。确认EAD尖端的位置对于最大程度地减少并发症至关重要。在研究现场，EAD位置仅限于验证唇/鼻处的厘米标记以及基于非证据的视觉观察和听诊方法。
目标：实施基于证据的EAD放置确认协议，到教育和实施后90天，达到90%的坚持。
方法：此质量改进项目实施了护士驱动的基于证据的EAD验证协议。该干预措施是基于肠内导管位置验证最佳实践建议的新机遇。在实施之前，教育会议的重点是插入测量技术和胃pH测量。射线照片,插入测量技术，厘米标记，和胃pH测量用于EAD位置确认。为了确定对协议的遵守情况，进行了审计，并在实施前后进行了评估有关EAD确认的当前实践的问卷。
结果：该方案增加了有关循证EAD插入和验证程序的护理知识，将pH测量纳入实践，并减少使用听诊进行确认。护理对方案的依从性为92%。
结论：这为如何成功实施和实现对基于证据的EAD放置确认护士驱动协议的遵守提供了一个模型。需要进一步的研究来验证该方案的有效性，并就专门针对新生儿群体的方法达成共识。
视频摘要标题：用于新生儿肠内进入设备放置确认的护士驱动协议。
目标：实施基于证据的EAD放置确认协议，到教育和实施后90天，达到90%的坚持。
方法：此质量改进项目实施了护士驱动的基于证据的EAD验证协议。该干预措施是基于肠内导管位置验证最佳实践建议的新机遇。在实施之前，教育会议的重点是插入测量技术和胃pH测量。射线照片,插入测量技术，厘米标记，和胃pH测量用于EAD位置确认。为了确定对协议的遵守情况，进行了审计，并在实施前后进行了评估有关EAD确认的当前实践的问卷。
结果：该方案增加了有关循证EAD插入和验证程序的护理知识，将pH测量纳入实践，并减少使用听诊进行确认。护理对方案的依从性为92%。
结论：这为如何成功实施和实现对基于证据的EAD放置确认护士驱动协议的遵守提供了一个模型。需要进一步的研究来验证该方案的有效性，并就专门针对新生儿群体的方法达成共识。
视频摘要标题：用于新生儿肠内进入设备放置确认的护士驱动协议。
