Challenges of de-implementing feeding tube auscultation: A qualitative study

Abstract

Aim: This qualitative study explored de-implementation of feeding tube auscultation practice in adult patients by critical care nurses.

Background: Despite years of evidence suggesting inaccuracy and harm, auscultation (air bolus method) continues to be used by the majority of critical care nurses to verify small-bore feeding tube placement in adults.

Design: This descriptive qualitative study used thematic analysis with telephone interview data.

Methods: Fourteen critical care nurses from four stratified groups within the United States (by hospital type and auscultation practice) participated in telephone interviews.

Results: Two major themes of individual influence and organizational leadership emerged from the data. Categories identified key components required for auscultation de-implementation.

Conclusions: Nurses feel obligated to follow hospital policies and expressed less accountability for their own practice. Organizational leadership involvement is recommended to facilitate de-implementation of this tradition-based, low-value practice and mitigate harm events.

Keywords: auscultation; critical care; de-implementation; evidence-based practice; implementation science; leadership; nursing; organizational culture; qualitative research.