title: Radiographer workforce role expansion to improve patient safety related to nasogastric tube placement for feeding in adults.
abstract: OBJECTIVE
  To determine whether the active involvement of radiographers in nasogastric tube (NGT) management at a large multisite healthcare institution can contribute to risk reduction regarding feeding through misplaced NGTs.
  
  
  METHODS
  Despite national guidance in the National Health Service advising on safe practice to confirm NGT position, a number of "never events" (feeding through misplaced NGT) continue to occur due to misinterpretation of the check radiograph. Practice change was introduced, including all plain film radiographers providing contemporaneous comments on NGT position on the check radiograph. The success of the system was assessed to determine the accuracy of radiographer comments against the reference standard of the radiologist report to see whether the system has helped reduce the number of "never events".
  
  
  RESULTS
  During the first 27 months post-implementation, 4,675 check NGT radiography examinations were analysed. Two hundred and twenty-seven examinations were excluded due to absent or incomplete radiographer comments. The accuracy of the radiographer comments was 98.5% (95% confidence interval [CI]: 97.7-99.5%), sensitivity 97.4% (95% CI: 96.3-98.3%), specificity 98.9% (95% CI: 98.5-99.2%), positive predictive value 96.8% (95% CI: 95.6-97.7%), and negative predictive value 99.1% (95% CI: 98.8-99.4%).
  
  
  CONCLUSIONS
  After focused training, radiographer comments are a safe, sustainable, and workable solution offering an effective solution for image misinterpretation issues relating to NGT "never events". This should be considered for wider implementation in healthcare.
authors.affiliation: Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals Trust, Beckett Street, Leeds, LS9 7TF, UK. Electronic address: gillsmurray@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Roe
authors.affiliation: Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals Trust, Beckett Street, Leeds, LS9 7TF, UK.
authors.forename: K M
authors.initials: KM
authors.lastname: Harris
authors.affiliation: Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals Trust, Beckett Street, Leeds, LS9 7TF, UK.
authors.forename: H
authors.initials: H
authors.lastname: Lambie
authors.affiliation: Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals Trust, Beckett Street, Leeds, LS9 7TF, UK.
authors.forename: D J M
authors.initials: DJM
authors.lastname: Tolan
mesh_terms: D000328:Adult; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000379:methods*; D019300:Medical Errors / Q000517:prevention & control*; D061214:Patient Safety; D058996:Quality Improvement; D011871:Radiology; D000078329:Workforce