ISQUA 2023 Abstract Submission

 

Topic: Patient safety& Quality Improvement

Reducing complications through educational program on PEG tube care and feeding management and care of the feeding tube using multimedia for ALS patients

N. K. Park*, 1, S. Y. Eum 1, I. Y. Kim 1, S.H. Kim 2, Y. R. Choi 2, W.A. Choi 3, M. S. Kim 3, Y. H. Youn 4, S. K. Lee 5, J. Y. Park 5

1Department of Nursing, 2Department of Nutrition and Food Control, 3Department of Rehabilitation, 4Department of Internal Medicine, 5Department of Pharmacy GANGNAM SEVERANCE HOSPITAL, YONSEI UNIVERSITY HEALTH SYSTEM, Seoul, Korea, Republic Of

 

Introduction to include: Most ALS patients lose weight due to muscular atrophy and contractile dysfunction of skeletal muscle, resulting in frequent accidental dislodging of PEG tube. The aim of this study was to reduce complications through educational program on PEG management and enteral nutrition specifically designed for ALS patients. Educational materials were created as both video clips and information leaflets.

 

Methods: 41 ALS patients before introduction of educational program were compared with 37 patients after the introduction. Educational materials include safe feeding methods and PEG tube dressing management. Monthly incidence of gastrointestinal complications, emergency room admission rate, and replacement rate due to accidental PEG tube detachment within 6 months of the group after the program were compared with those of pre-program patients.

 

Results: Overall, the educational program proved to be effective in all metrics. Monthly incidences of gastrointestinal complications before and after the educational program decreased from 18.2% to 9.6%. The rate of emergency room admission due to gastrointestinal complications decreased from 72% to 21%. Replacement rate due to gastric tubal defect within 6 months decreased from 58% to 10.5%. The medical staff's knowledge score through the questionnaire before and after leaflets and YouTube education increased from 73 to 90, and the knowledge score of patients and caregivers increased from 60 to 92.9. Video clips were posted on YouTube and has received a lot of responses. The YouTube has been viewed more than 33,000 times, and the video on gastrointestinal dressing got more than 16,000 views. The average cost of replacing the peritoneal fistula is 1.8 million won. Through Quality Improvement activities, the number of replacements of the peritoneal fistula decreased from 4.3 cases to 2.7 cases within 6 months, resulting in cost savings of 38.8 million won per year for patients.

 

Conclusions: Educational program provided in format of video, text, and images has been proven to reduce complications. We will continue to improve the safety of patients by complementing educational contents with opinions collected from patients, caregivers and medical staff.

 

References:

Jamil Shah, Abul Shahidullah, Stanlee Richards(2018). Reducing the unintended dislodgement of gastostomy tubes in a long-term acute care hospital : A QA/QI pilot Study. Gastroenterol Resl. 11(5), 369-373.

Laura H. Rosenberger, Timothy Newhook, Bruce Schirmer(2011). Late accidental dislodgement of a percutaneous endoscopic gastrostomy tube. Surg Endosc. 25(10), 3307-3311.

Patricia Sheean, M. Cristina Gonzalez, Carla M. Prado(2019). American society for parenteral and enteral nutrition clinical guidelines. ASPEN Clinical guidelines. 44(1), 12-43.

Rosa Burgos, Irene Breton, EmanuGilbar P.J. (2018). ESPEN guideline clinical nutrition in neurology. Clinical Nutrition. 37, 354-396.

Keywords: ALS(amyotrophic lateral aclerosis) , PEG management, YouTube, complications