Clinical Procedures for Safer Patient Care
This article outlines essential protocols for safer patient handling and clinical procedures, specifically focusing on risk assessment and the management of nasogastric tubes. Proper Risk Assessment for Safer Patient Handling is critical for ensuring the safety of both the healthcare provider and the patient.
Risk Assessment for Safer Patient Handling
Before performing a patient-handling procedure, healthcare workers must evaluate their own ability and the specific needs of the patient. The following table summarizes the self-assessment questions every healthcare worker should ask.
| Category | Self-Assessment Questions |
|---|---|
| Training and Safety | Have I had the necessary training? Is my footwear appropriate? |
| Body Mechanics | Will I be able to maintain a neutral spine—no twisting or side bending—and use proper body mechanics? Can I use weight shift techniques? |
| Team and Technique | If I am in a team, who will be designated as the leader? Can I do no actual lifting? |
What additional patient risk factors should be considered? Healthcare providers must assess the patient’s cognitive ability to cooperate and follow instructions, patient muscle strength, ability to weight bear, and activity restrictions (e.g., non weight bearing orders). Furthermore, vision and hearing impairments, as well as language barriers, are risk factors when performing patient-handling procedures.
Managing Uncooperative Patients
If a patient suddenly becomes uncooperative during a transfer, the healthcare provider should: remain calm, lower the patient back to the surface they have come from, assess the situation, and ensure patient safety. It is also necessary to consider interdisciplinary reassessment and document the event on the care plan.
Nasogastric Tube Management and Clinical Procedures
A nasogastric (NG) tube is a flexible plastic tube inserted through the nostrils, down the nasopharynx, and into the stomach or the upper portion of the small intestine. Placement of NG tubes is always confirmed with an X-ray prior to use. NG tubes are used to deliver nutrients to the patient via a feeding pump or to remove gastric contents.
Safety Considerations and Care Measures
When working with people who have nasogastric tubes, remember the following care measures:
- Maintain and promote comfort: Ensure that the tube is securely anchored to the patient’s nose to prevent excess tube movement, and is pinned to the gown to avoid excessive pulling or dragging.
- Mouth care: Because one nostril is blocked, patients tend to mouth breathe, causing dehydration of the nasal and oral mucosa. Mouth care will help to relieve the dryness.
- Aspiration prevention: These patients should never be allowed to lie completely flat. The head of bed should always be raised 30 degrees or higher to decrease the patient’s risk of aspirating stomach contents.
Steps for Inserting a Nasogastric Tube
Checklist 78 outlines the steps for inserting a nasogastric tube. Always review and follow your hospital policy regarding this specific skill.
- Perform hand hygiene and gather supplies: This prevents the transmission of microorganisms.
- Visually inspect condition of patient’s nasal and oral cavities: Check for signs of infection or skin breakdown.
- Assess for the best nostril: Do this by occluding one side and asking the patient to sniff.
- Palpate patient’s abdomen: Check for distension, pain, and/or rigidity, and auscultate for bowel sounds.
- Assess level of consciousness: Patient must be able to follow instructions related to NG insertion to allow for passage of tube.
- Position patient: Sit the patient up at 45 to 90 degrees (unless contraindicated by the patient’s condition), with a pillow under the head and shoulders.
- Raise bed to a comfortable working height: This helps prevent biomechanical injury to the health care provider.
If the patient complains of abdominal pain, discomfort, or nausea, or begins to vomit, report it immediately, as the drainage flow is probably obstructed.