3 or > misses No points rewarded
(N/A)
1-2 misses half points rewarded
No misses All points given
Score________/100 90-100-A 80-89- B 79-75- C 74 AND BELOW-Failed- requires remediation and recheck
Gathers equipment & checks order
Used 2 pt ID, Proper hand washing and set up equipment
Maintains a properly equipped field free from contamination
Proper explanation, Chin tuck position to help facilitate tube pass, positioning completed prior
Proper technique used to measure NG and mark made. Able to name anatomical sites appropriately (Tip of nose to tip of ear lobe to Xiphoid process)
water w/ straw, equipment,facial surgical history, and nare inspected prior to insertion
Tube lubricated. NG placement has 2 checks for proper insertion. Performs air bolus and discusses litmus paper and pH, Chest X-ray
NG tube secured to pt, performs "pants" tape split
Discusses Medication crushed or crushes appropriately
Patient identified, medication verified, Discusses medication that cannot be given per tube (can't be crushed-extended release, enteric coated); placement and patency of NG tube assessed, medication crushed, 15 cc H2O between medications, clamps tube between medication passes, flushes with 30 ml after all medications
Patient identified, placement assessed, patency checked, feeding administered, flushed with H2O after feeding.
Discusses residuals; residuals less than 250 or facility, return contents and flush tube appropriately; greater than 250 or facility policy, place continuous feedings on hold x 1 hour, do not administer bolus feeding, recheck
Verifies order for removal
Verifies patient, assesses placement. Instructs patient appropriately (hold breath to prevent possible aspiration), assesses for bowel sounds
Procedure, pt toleration of procedure, & assessment pre and post procedure