Authors (including presenting author) :
Karn KY (1), Lee KY (2)
Affiliation :
(1) Nursing Services Division, United Christian Hospital
(2) Community Nursing Service, United Christian Hospital
Introduction :
Nasogastric tube feeding provides the nutrient and hydration for the patient with swallowing problems. However, it may increase the medical support and reduce patient’s quality of life if they required prolonged tube feeding. Evidence shows that many patients had improved in their swallowing ability and successfully removed their nasogastric tube through an intensive dysphagia therapy. Thus, an innovative pilot program was launched in the Kowloon East Cluster Community Nursing Service Department (KEC CNS). It aims to ensure the patient’s nasogastric tube being able to remove safely while their nutrition could be maintained.
Objectives :
- To provide a weaning nasogastric tube (NGT) framework for community nurses (CNs)
- To enhance the communication network with Speech Therapist (ST) and Geriatrician on facilitating the weaning process of NGT patient
- To improve the quality of life for the patient with NGT
Methodology :
The program was launched from February 2023 to November 2024. Participants lived in Kwun Tong area either home case or residential care home for elderly (RCHE) case which were under the care of the United Christian Hospital (UCH) CNS and followed up by UCH Medical & Geriatric Department. Participants were assessed by UCH ST and recruited under the TWONGT program with the selection criteria: reason of insertion (i.e. dehydration/poor appetite) and swallowing reflex positive. CN would provide home visit to the participants according to the TWONGT care pathway. The participant’s condition should be kept monitored closely during their oral feeding and the trial would be stopped if the patient couldn’t tolerate and presented any complications e.g. choking, shortness of breath, cyanosis, etc. As the participant well tolerated oral feeding, CN would contact Geriatrician and removal NGT with prescription. Then, CN provided home visit for observation for a week more and closed case.
Result & Outcome :
21 participants were recruited totally. 7 of them were living at home while 14 of them were living at RCHE. The major reasons for NGT insertion were due to stroke (nearly 50%, n=10). 6 participants suffered from pneumonia, 3 participants were post COVID infection and 2 participants were post operations. 86% (n=6) of home cases and 50% (n=7) of RCHE cases were successful at NGT removal respectively. It was important that none of the participants required admission to Accident & Emergency Department due to the nutrition problem after removal of NGT. Furthermore, it reduced the home visit (at least once per month for each case) and the cost (each home visit provided by CN is nearly 1000 Hong Kong Dollars) by CN.
In conclusion, the positive outcomes of this program drive us to assist the patient by removing their NGT safely. As the program not only improves the patient’s quality of life but also reduces the medical burden of health care system. It is recommended to continue this Win-Win program, while also establishing the program to other hospitals on the way forwards.
