This Signal relates to risks to anorexic and other patients given nasogastric feeds under restraint.
Nasogastric tubes are used commonly to deliver feeding formulas directly to the stomach. Previous National Reporting and Learning Service (NRLS) advice has focused on reducing harm caused by the misplacement of nasogastric feeding tubes, which is a substantive patient safety issue.
Restraining patients also poses risks and requires staff trained in safe holding and restraint techniques as well as basic life support skills.
Forced feeding of a patient is an intervention of last resort and is reserved for those patients with life threatening conditions. It is a highly specialised procedure, which needs to combine best practice in nasogastric feeding and restraint, and in mental health settings should only be done in the context of the Mental Health Act 1983 or the Children’s Act 1989.
A typical incident reads:
“Patient restrained by 3 people using PRICE technique to facilitate NG feeding. Lasted approx 2 hours (twice in one day).”
Following a trigger incident with staff reporting concerns about the methods for assisted feeding under restraint, further reports were reviewed. Up to May 2009, 78 incidents were identified. Most of these happened in mental health trusts, but four were in general acute settings.
Although patient details were not given for all, many appeared to relate to young people with eating disorders. The NRLS does not routinely receive reports from the independent sector, which provide many of these specialised services.
The NRLS wrote to some of the reporting organisations for more information and responses showed lack of clarity about procedures and joined-up policies on naso-gastric feeding and on restraint.
Concerns from review of incidents included:
- different restraining techniques used on frail patients (without necessarily having someone at head to ensure safe feeding)
- lack of compliance with best practice on naso-gastric feeding (eg failure to check the pH of aspirate is 5.5 or less before starting procedure)
- prolonged feeding (reports of up to two hours) and volume of fluids given
Could this happen at your organisation? Do you have policies on assisted feeding, which combine best practice in nasogastric tube placement and restraint?
Please contact us at firstname.lastname@example.org
Relevant to: Mental health
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