Patients who require a nasogastric tube (NGT) could be at risk of developing nasal pressure injuries as a result of incorrect taping methods used to secure the NGT. The wrong taping methods can lead to skin breakdown and infection around the nasal area.In severe cases, patients may require plastic and reconstructive surgery.

At the National Heart Centre Singapore (NHCS), a team of nurses got together in early 2018 to look at ways to eliminate medical device-related nasal pressure injuries. Calling themselves the “Revivors” and led by Nurse Clinician Mirana Wu, the seven-member team conducted a survey among 150 nurses from NHCS inpatient wards to look into the common causes of nasal pressure injuries.

The team found that there was no standardised protocol and method for NGT taping. Mirana added, “The tape used was also excessively sticky and could cause skin injury when removed.” The team took up the challenge of finding the “ideal” medical tape to be used. They experimented with different tape materials, and eventually found a fabric tape that was soft and easily removable without compromising on adhesiveness. They went on study trips to other hospitals to learn the best taping method that would reduce pressure and risk of nasal pressure injury, and refined the shape of the tape for a more secure and comfortable fit. 

With their findings, the team rolled out a standardised NGT taping protocol utilising the new NGT tape prototype and method in the pilot wards. They worked with nurse champions from each ward to provide hands-on training on the correct taping method using a specially designed mannequin. The team also obtained feedback from the nurses to make improvements on the protocol. Posters were also put up at nurses’ stations for their reference. With the success of the pilot, the standardised protocol and new NGT taping method were officially rolled out to all NHCS inpatient wards in December 2018.

“The nurses found the new NGT taping method easier and faster to apply. It used to take up to two minutes to secure a nasogastric tube, but we have reduced the time to only 14 seconds,” said Mirana. “We’ve also had zero cases of medical device-related nasal pressure injuries since implementing this new protocol.” Presently, the team is working with a vendor to produce pre-cut tape to save time on manual cutting.

National Heart Centre Singapore

Recipient of the Singapore Health Quality Service Awards (SHQSA) 2020 Best Team Award - Clinical Practice Improvement Category