(1st September 2015 – 30th April 2016)
Funded by: NIHR CLAHRC Evidence Based Transformation with the NHS theme, and Yorkshire and Humber Academic Health Science Network Proof of Concept Fund.

Nasogastric (NG) tubes (a tube passed through a patient’s nostril into their food pipe and then stomach, secured to the patient’s cheek with tape) are widely used in the NHS for adult and child patients to provide enteral feeds or medicines for patients who cannot swallow or tolerate feeds by mouth, or patients requiring intensive care/surgery.

There are patient safety concerns if a NG-tube becomes misplaced into the patient’s lung during insertion or moves out of the patient’s stomach at a later stage, which can result in serious consequences for the patient or even death if feeding occurs through a misplaced NG tube. The current procedure for testing correct placement of an NG-tube relies upon obtaining gastric aspirate for testing with pH paper, but only 65% success rates are reported for obtaining aspirate. Then X-rays are used to verify NG-tube position;  X-rays are costly and inconvenient for patients, and also subject to misinterpretation. Something better is needed.

Our research aimed to develop a different, innovative solution. Working in collaboration with two commercial partners we have successfully demonstrated our proof of concept and are now working towards the development of a new device for verifying the correct position of an NG-tube. This project builds upon our previous behaviour change work to improve NG-tube testing, and utilises our team’s expertise in device-development, user-centred design, and the implementation and adoption of innovative solutions in healthcare.

We have now secured funding from the Medical Research Council to take this work forward. More information on the next phase of this work can be found here.

For further information please contact Angela Grange at angela.grange@bthft.nhs.uk

Medical/health smartphone applications

The Team: Rebecca Lawton, Angela Grange, Victoria Robins, Serwaar McLean, Claire Coulson, Caroline Reynolds, Shoba Srinivasan, Sally Moore
Clinicians in the Trust brought to our attention the widespread and increasing use of medical smartphone applications among health professionals, and identified potentially dangerous design flaws and erroneous or misleading information in some applications. In response, we embarked on a series of interlinked pilot projects (aimed at categorising medical smartphone applications, investigating the extent of their use, and assessing their usability and safety) in preparation for a wider programme of work in this area.

• Moore, S., Anderson, J., & Cox, S. (2012). Pros and cons of using apps in clinical practice: smartphones have the potential to enhance care but, say Sally Moore and colleagues, healthcare apps are not regulated, making it hard for nurse managers to be certain that those available are accurate, reliable and safe. Nursing Management, 19(6), 14-17.
• Moore, S., & Jayewardene, D. (2014). The use of smartphones in clinical practice: Sally Moore and Dharshana Jayewardene look at the rise in the use of mobile software at work. Nursing Management, 21(4), 18-22.

E-Reconciliation

Project Lead: Gerry Armitage
We published work that demonstrated the novel role of a shared electronic health record (EHR) in medicines reconciliation. The pilot study informed the development of a controlled before and after study of e-reconciliation at Airedale NHS Foundation Trust where the EHR was introduced to reconcile patient’s medicines on hospital admission. We examined the value added to reconciliation through access to the EHR and identified the type, frequency and potential severity of medication discrepancies detected through the EHR compared to conventional methods.

• Moore, P., Armitage, G., Wright, J., Dobrzanski, S., Ansari, N., Hammond, I., & Scally, A. (2011). Medicines reconciliation using a shared electronic health care record. Journal of patient safety, 7(3), 149-154.

E-Consultation

Project Lead: Angela Grange
This study provided important evidence to the NHS about the impact of a complex demand management intervention (e-consultation) directed at specialists, whereby GPs seek clinical advice or review of their patients before referral. We previously demonstrated that e-consultation had the potential to significantly reduce hospital referrals in one clinical area and in one group of general practices. This study explored whether this benefit could be demonstrated to be more generalisable, as e-consultations have the potential to make a major contribution to reducing NHS costs and improving the quality of patient care.

• Stoves J, Connolly J, Grange A, Rhodes P, Wright J. Electronic consultation as an alternative to hospital referral for patients with chronic kidney disease: a novel application for networked electronic health records to improve the accessibility and efficiency of health care. Qual Saf Health Care. 2010 Oct;19(5):e54. Epub 2010 Jun 16.
• Lawton, R.J. Testing new devices to help prevent ‘misconnection’ errors in health care. J Health Serv Res Policy. 2010 Jan;15 Suppl 1:79-82.