Reducing NGT feeding under restraint & co-designing meal support
Research type
Research Study
Full title
Learning from a positive deviant and exploring the boundaries of co-design: investigating a reduction in naso-gastric tube (NGT) feeding under physical restraint and co-designing meal support in a specialist eating disorder inpatient unit
IRAS ID
331081
Contact name
Glenn Robert
Contact email
Sponsor organisation
Kings College London
Duration of Study in the UK
3 years, 0 months, 1 days
Research summary
Naso-gastric tube (NGT) feeding under physical restraint is a lifesaving intervention in eating disorders treatment. It involves physically restraining patients who refuse treatment and administering a liquid feed via a tube passed through nose to stomach. Though sometimes essential, it is a restrictive intervention which can be traumatic for all involved. This research project was developed from an on-site quality improvement (QI) project designed to reduce NGT feeding under physical restraint at a child and adolescent inpatient eating disorder unit. A new NGT feeding policy drastically reduced the incidence of NGT feeding under restraint from a pre-policy high of 56 incidences in one month, to 2 incidences in 6 months. While the numbers of restraints reduced, the impacts on treatment and recovery are not fully understood. For example, to understand if these changes have led to improvement there is a need to investigate other inpatient outcomes, e.g., weight gain, length of stay, and incidence of self-harm. In this fellowship, data collected via quantitative (service and patient records), and qualitative (ethnographic observation and interviews) methods will be used to examine how this policy change impacted patients, staff and families. Findings will be used to design local guidelines which (1) support clinicians to provide care that complies with the Mental Capacity Act’s principle of least restrictive practice (2) support replicable and scalable improvement in care in other eating disorder services (3) address gaps in existing guidance.
This fellowship also addresses the interrelated issue of dining room support. Staff highlighted that if restrained feeding is to be limited, there is a need to better support inpatients to voluntarily consume food. To achieve this, unit staff and researchers will co-design new guidance for dining room support with parents/carers and two patient groups: (1) current inpatients (2) former inpatients progressing well in their recovery.
REC name
Wales REC 5
REC reference
24/WA/0228
Date of REC Opinion
26 Nov 2024
REC opinion
Further Information Favourable Opinion