A compulsory electronic learning
module on the practice of image interpretation
was created for junior doctors with
input from senior clinical and radiology
staff and experienced medical educators.
After working through the module, clinicians
undertake a test and are required to
obtain a 100% pass mark before they are
allowed to interpret position-check X-rays.
A survey of junior doctors who had passed
the module found they were more confident
and more competent to interpret a
position-check X-ray for feeding.
We also addressed trust systems related
to NG tube use. Two different tubes were
being used at both hospital sites and the
most radio-opaque was chosen as
standard. Placement of NG tubes outside
normal working hours was stopped –
except in high-risk areas – by educating
staff; in the majority of cases, NG feeding
tube insertions could wait until the
morning. The priority of position-check
images in the radiology department was
increased so that positioning could be corrected
under X-ray guidance if necessary
before the patient returned to the ward.
Finally, the lack of documentation was
addressed by developing a standardised
NG feeding tube care plan (Fig 1) and an NG
feeding tube insertion sticker (Fig 2) to be
placed in the patient’s notes every time the
tube was inserted by senior nurses and the
dietetic department. These two measures
ensured there was always an accurate and