Health Education England
It is recommended that Health Education England coordinates the development and publication of a national standardised competency-based training programme for nasogastric tube placement and confirmation by pH testing. The model may include simulation, observed practical assessment and ongoing competency assessment.
The competency-based training programme would need to be defined, developed, and tested using a human factors approach prior to any widespread implementation. The competency-based training programme will lead to a recognised accreditation which will be transferable across the NHS care providers in England.
NHS England and NHS Improvement
It is recommended that NHS England and NHS Improvement works with the Department of Health and Social Care and others, to identify the process by which the NHS can identify and commission necessary research to support improvements in patient safety. This would include research to confirm nasogastric tube placement.
British Standards Institute (BSI)
It is recommended that NHS Supply Chain and the British Standards Institution work together (engaging other system leaders as appropriate, such as the Medicines and Healthcare products Regulatory Agency and NHS England and NHS Improvement), to develop and publish an agreed standard to minimise the risks relating to human errors in the use of pH strips designed for testing human gastric aspirate at the bedside.
The standard should consider product design, regulatory standards, procurement practices and human factors engineering to provide a consistent approach that can be embedded within NHS Supply Chain product specifications.
NHS Supply Chain
It is recommended that NHS Supply Chain develops essential specifications to support the clinically-led procurement of devices to include devices to confirm nasogastric tube placement, for example, pH testing strips.
The essential specifications should set out a range of factors critical to inform the selection by NHS Supply Chain of a product including, but not limited to: clinical output requirements; design and ergonomics; human factors and intended use; and limitations on use and usability. Critically, these specifications should ideally be established in partnership across the healthcare system with clinicians, healthcare professionals and safety leads, while maximising best practice.
British Society of Gastrointestinal and Abdominal Radiologists
It is recommended that the British Society of Gastrointestinal and Abdominal Radiologists, working with Health Education England and the Society and College of Radiographers, develops and publishes a national standardised competency-based training programme for X-ray interpretation to confirm nasogastric tube placement.
The competency-based training programme will include the referral process for X-ray to confirm nasogastric tube position and the subsequent reviewing, recording and communication of the clinical evaluation of the X-ray findings prior to initiation of feed. The standards must meet the Ionising Radiation (Medical Exposure) Regulations IR(ME)R requirements.
The competency-based training programme will lead to a recognised accreditation for those qualified to clinically evaluate and record their findings, for example doctors, radiographers and advanced care practitioners. The accreditation certificate will be transferable across NHS care providers in England.