放射技师即时解读胸部 X 光片可提高儿童鼻胃管置管相关的患者安全性。
Immediate chest radiograph interpretation by radiographers improves patient safety related to nasogastric feeding tube placement in children.
机构信息
Clarendon Wing Radiology Department, Leeds Children's Hospital at the Leeds General Infirmary, Leeds, LS2 9NS, UK.
Department of Radiology, St James's University Hospital, Leeds, UK.
出版信息
Pediatr Radiol. 2021 Aug;51(9):1621-1625. doi: 10.1007/s00247-021-05032-9. Epub 2021 Mar 10.
BACKGROUND
Despite the publication of a national patient safety alert in 2016, inadvertent feeding through misplaced nasogastric tubes continues to occur, either through failure to review the radiograph, misinterpretation of it, or failure to communicate the results.
OBJECTIVE
The objectives were to determine whether training in a new pathway introduced to avoid these "never events" was followed and whether radiographer comments and prompt communication of results could reduce risk and improve patient safety in relation to nasogastric tube placement in children.
MATERIALS AND METHODS
Following radiographer training in interpretation of nasogastric tube position and use of a commenting proforma and communication pathway, we reviewed all radiographs obtained to check nasogastric tubes performed over a 13-month period in children 0-16 years of age. Then we assessed accuracy of the radiographer comments, adherence to the pathway, and any practice change in children with misplaced nasogastric tubes.
RESULTS
We reviewed 282 nasogastric tube check radiographs. For 262 radiographs (92.9%) the pathway was followed correctly. Of the total 282 radiographs, 240 (85%) were immediately reported using the standardised commenting proforma, and 235 radiographer comments were affirmed by the radiologist (97% accuracy, confidence interval 0.95-0.99). Of the immediately reported radiographs, 213 (88.8%) nasogastric tubes were considered to be safe for use. Four (1.7%) of the immediately reported nasogastric tubes were misplaced in a bronchus, and the report communicated to the clinical team resulted in removal or re-siting of the tubes.
CONCLUSION
Nasogastric tube check radiographs in children can be reported accurately by radiographers trained in their interpretation and the results promptly communicated to clinical staff, improving safety in relation to nasogastric tube placement in children.
背景
尽管 2016 年发布了全国患者安全警报，但通过放置不当的鼻胃管进行无意喂养的情况仍时有发生，原因可能是未查看 X 光片、对其解读有误，或未能传达结果。
目的
本研究旨在确定是否遵循了引入新途径以避免此类“不应发生的事件”的培训，以及放射技师的评论和及时传达结果是否可以降低与儿童鼻胃管放置相关的风险并提高患者安全性。
材料和方法
在对放射技师进行了有关解释鼻胃管位置和使用评论表格式以及沟通途径的培训之后，我们回顾了在 13 个月期间对 0-16 岁儿童进行的所有 X 光片，以检查鼻胃管的位置。然后，我们评估了放射技师评论的准确性、对途径的遵循情况以及在鼻胃管放置不当的儿童中实践的变化。
结果
我们共回顾了 282 份鼻胃管检查 X 光片。对于 262 份 X 光片（92.9％），途径得到了正确遵循。在总共 282 张 X 光片中，有 240 张（85％）立即使用标准评论表格式进行了报告，并且放射科医师确认了 235 张放射技师的评论（准确性为 97％，置信区间为 0.95-0.99）。在立即报告的 X 光片中，有 213 个（88.8％）鼻胃管被认为可以安全使用。立即报告的鼻胃管中有 4 个（1.7％）放置在支气管中，将报告传达给临床团队后，导致将管子取出或重新定位。
结论
受过解释 X 光片培训的放射技师可以准确地报告儿童的鼻胃管检查 X 光片，并及时将结果传达给临床工作人员，从而提高了儿童鼻胃管放置的安全性。
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