Abstract
Aims(1) To model the process of use and usability of pH strips (2) to identify, through simulation studies, the likelihood of misreading pH strips, and to assess professional’s acceptance, trust and perceived usability of pH strips.MethodsThis study was undertaken in four phases and used a mixed method approach (an audit, a semi-structured interview, a survey and simulation study). The three months audit was of 24 patients, the semi-structured interview was performed with 19 health professionals and informed the process of use of pH strips. A survey of 134 professionals and novices explored the likelihood of misinterpreting pH strips. Standardised questionnaires were used to assess professionals perceived usability, trust and acceptance of pH strip use in a simulated study.ResultsThe audit found that in 45.7% of the cases aspiration could not be achieved, and that 54% of the NG-tube insertions required x-ray confirmation. None of those interviewed had received formal training on pH strips use. In the simulated study, participants made up to 11.15% errors in reading the strips with important implications for decision making regarding NG tube placement. No difference was identified between professionals and novices in their likelihood of misinterpreting the pH value of the strips. Whilst the overall experience of usage is poor (47.3%), health professionals gave a positive level of trust in both the interview (62.6%) and the survey (68.7%) and acceptance (interview group 65.1%, survey group 74.7%). They also reported anxiety in the use of strips (interview group 29.7%, survey group 49.7%).ConclusionsSignificant errors occur when using pH strips in a simulated study. Manufacturers should consider developing new pH strips, specifically designed for bedside use, that are more usable and less likely to be misread.
Highlights
The use of pH strips is critical to clinical decision when using NG-tube for feeding
Whilst some authors admit that human errors in reading pH strips could affect patient safety [8], we identified only one conference paper [11] in which researchers discussed the likelihood of misreading the pH strip in clinical procedures
They perceived that obtaining an Usability study of pH strips for nasogastric tube placement aspirated sample is even harder (64.4%) compared to our findings in real clinical settings (45.7%) and those reported from other studies [2, 9]
Summary
The use of pH strips is critical to clinical decision when using NG-tube for feeding. Radio opacity of tubes is not always satisfactory [2], and more than 50% of tubes could either migrate from the stomach or be inadvertently removed by patients [2,3,4] after the x-ray has been taken These factors create uncertainty that can lead to repeat chest radiography, exposing patients to multiple radiation exposures and may delay the administration of feeding or medications[5]. The use of pH strips or x-ray (or a combination of these) is standard practice to confirm NG-tube placements, errors can occur during the confirmation process This may expose patients to high risks when the tube is in their lungs[6] instead of in their stomach
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