190 - Continuing Polyethylene Glycol via Nasogastric Tube Overnight for Inpatient Bowel Cleanouts

Poster Number: 190
Publication Number: 190.143

Caroline Blakley, OU Childrens Hospital, Oklahoma City, OK, United States; Matthew Le, Oklahoma Childrens Hospital at OU Health, Oklahoma City, OK, United States

Background: Functional constipation is one of the most common conditions in childhood. When outpatient therapies have failed, patients are often admitted to the hospital for a bowel cleanout with polyethylene glycol (PEG) solution via a Nasogastric (NG) tube. The protocols regarding medication administration vary widely between hospitals. Until recently our institution ran PEG from 0600-2200, stopping overnight due to concerns for risk of aspiration. According to literature, aspiration with PEG is associated with misplaced NG tubes. Stopping this medication overnight possibly affects length of stay (LOS) and cost to families. The purpose of this Quality Improvement study is to change our protocol to be in line with the majority of other hospitals.  In doing this we also have the unique opportunity to assess if there is a significant decrease in LOS with running PEG continuously.

Objective: This project’s aim was to increase the percent of patients admitted for constipation with PEG run overnight from 0% to 75% by January 31st, 2022. Additional data was gathered to evaluate for a difference in LOS and cost between patients admitted to the hospital for bowel cleanout with PEG running continuously and patients with PEG discontinuing. Secondary outcomes include LOS, duration of PEG, use of IV fluids, and # of x-rays.

Design/Methods: A Process Flow Map was made and interventions targeting various steps were implemented using PDSA cycles. Primary and Secondary outcome data was collected using chart review.  Interventions included the new protocol going live with information sent via email to the gastroenterologists, hospitalists, and pediatric residents in February 2021. Next, the EMR order set was changed to automatically run overnight in September 2021. 

Results: Through these processes we were able to increase the percent of patients with PEG running overnight from 0% to 100% by December 2021. At this point in data collection only 25 patients qualify for the post intervention group. Comparing the pre and post groups, the LOS is down an average of 9hrs and duration of PEG time is down an average of 12hrs per person.Conclusion(s): With only two interventions our institution has been able to effectively change a protocol that has been in place for over a decade in less than one year. Not only is this new protocol in line with the majority of hospitals but also with a value-based care model. At this point we only have a small amount of data to analyze the effect of this change. We hope to continue to gather data and make future interventions to decrease the cost and time spent in the hospital for these patients.
Run Chart: Increasing Polyethylene Glycol Running Overnight