TPT 6.16 Evaluating patient experience of nasogastric tube insertion in acutely admitted surgical patients: Phase 1 of a quality improvement project

Abstract Objective To assess baseline patient experience of nasogastric tube (NGT) insertion and to justify the use of oral and nasal local anaesthetic in phase II of this project. Methods Phase 1 of this quality improvement project (QIP) was conducted on acute surgical patients needing NGT insertion admitted within an urban tertiary care hospital for four consecutive weeks. A patient questionnaire incorporating Likert-scale items and a numerical rating scale was developed to allow quantitative interpretation of patient-reported experience. Data were collected retrospectively following insertion and summarised descriptively using frequencies, percentages, and median or mean scores to establish baseline experience. Results All 12 patients in study cohort reported the procedure as uncomfortable: 33% somewhat uncomfortable and 67% very uncomfortable. The mean pain score was 6.5/10, corresponding to severe discomfort. Procedural difficulties and adverse effects were common: four required multiple attempts at insertion, seven experienced gagging or vomiting, and five reported coughing. Eight patients (67%) indicated that being offered a topical local anaesthetic spray would have improved tolerability. Conclusion Phase 1 of this QIP successfully demonstrates that NGT insertion without local anaesthetic is associated with universally reported discomfort, high pain scores, and frequent gagging, vomiting, or multiple insertion attempts. Most patients expected that topical local anaesthetic spray would have improved the experience. Given the low risk profile of Lidocaine spray in the throat and nose, Phase 2 of this QIP will replicate the survey with patients that have accepted Lidocaine prior to insertion to evaluate whether routine use improves patient experiences.