Challenges of de‐implementing feeding tube auscultation: A qualitative study.

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. Summary statement: What is already known about this topic? Auscultation is not an accurate method to identify feeding tube placement.Many critical care nurses continue to use the auscultation method (a low‐value, tradition‐based practice) to verify feeding tubes.Factors associated with de‐implementation of auscultation method for feeding tube verification are unknown. What this paper adds? Many nurses are aware that auscultation is not evidence based for adult feeding tube verification and are falsely comforted by hearing the whoosh sound (psychological bias).A combination of individual and organizational factors are barriers to de‐implementing auscultation of feeding tubes.Nurses seek guidance from leaders within their organization to facilitate de‐implementation, which is a necessary component of evidence‐based practice. The implications of this paper: A major challenge to de‐implementation of auscultation is the lack of valid bedside methods to assess feeding tube placement. Active involvement by organizational leaders will facilitate decision‐making to recommend a safe substitution for the auscultation method.Nurses expressed eagerness to incorporate evidence into their practice if they have adequate leadership support and the necessary resources to make practice changes.Formal intervention by organizational leaders is needed to promote de‐implementation of auscultation for feeding tubes. [ABSTRACT FROM AUTHOR]