Interprofessional G-Tube Class Sarah Simental, MS, RD, CNSC - - PowerPoint PPT Presentation

Interprofessional G-Tube Class

Sarah Simental, MS, RD, CNSC Stephanie Sanborn, MS, RD, CSP

Objectives

The Interprofessional G-Tube class at CHLA is a class for patients, parents, and caregivers to learn about what a gastrostomy tube is and how to care for it. Objectives:

• Understand the need for an Interprofessional/comprehensive G-Tube class

at CHLA

• Discuss methods for implementing the Interprofessional G-Tube class
• Understand the various disciplines’ roles within the class
• Discuss the beneficial outcomes and cost-savings for the hospital

Introduction

• A high rate of readmissions due to gastrostomy tube was identified through

a needs assessment performed

• 197 readmissions within 1 year related to gastrostomy tube issues
• In order to reduce readmissions and improve patient care outcomes, it was

determined that the best approach would be an interprofessional patient family education initiative

• Intregration of the GetWell Network and a specialty GT class was

developed

• The interprofessional team includes the following:
• Clinical Nurses
• Bedside RNs assist families with GetWell Network
• Clinical RN present to perform teaching during GTube class
• Registered Dietitians
• Child Life Specialists (CLS)
• Dysphagia Therapists (SLP/OT)
• Social Workers

GT Education Pathway

• When a patient is identified as needing a feeding tube (or will possibly

require one), the family is instructed to watch the G-Tube video on the GetWell Network

• The video was developed by caregivers at CHLA as an informative

video; can be viewed as often as needed

• Family (or any potential Caregivers) are then signed up for the G-Tube class
• All family members, patients, siblings, caregivers are invited
• Encouraged to have at least 2 caregivers to attend and learn care
• Anyone who previously received a G-Tube and requires a refresher can also

sign-up for the class

• Including anyone identified by other medical providers that requires

further education

G-Tube Class

• Two classes are offered every Tuesday/Friday
• AM class is offered in English
• PM class is offered in Spanish (both live/phone interpreters utilized)
• Other languages needed are pre-arranged and fit into one of the

classes

• Each class is about 3 hours long
• Limited number of participants are allowed to keep class size small and

interactive

• In addition to lecture type learning, participants are able to practice skills

using mannequins

G-Tube Class

Registered Dietitian

• Define and introduce the G-Tube
• Review various feeding regimens
• If families/caregivers have specific questions related to their child,

they are directed to speak with the floor/unit RD responsible

• Review necessary equipment and methods for obtaining all necessary

equipment/supplies

• Review safe formula preparation and administration
• Review flushes and hydration

G-Tube Class

Social Work

In Home Support Services (IHSS) 866-512-2857 888-944-4477 Shift Nursing contact your insurance provider Home and Community Based Alternatives 213-897-6774 916-552-9149 Regional Center (http://www.dds.ca.gov/RC/RCZIPLookup.cfm) Lanterman 213-383-1300

• Eastern 626-299-4700

Harbor (Torrance) 310-540-1711

• San Gabriel/Pomona 909-620-7722

South LA 213-744-7000

• Westside 310-258-4000

North Los Angeles 818-778-1900 Out of Home Placement LA DWP/Edison Medical Utility Assistance

G-Tube Class

OT/SLP Introduce and define the role of the Dysphagia Team Introduce and define oral aversion

• Facilitating oral interest
• Providing positive oral experiences

Review oral motor development

• Why is oral stimulation important
• What tools can help you provide stimulation for older

children Discuss disuse atrophy Review Tummy Time and how to continue to implement when the child has a G-Tube

G-Tube Class

Child Life

• Discuss the role of child life specialists in supporting

and educating patients and families learn and cope with medical experiences

• Review developmental milestones pertinent to age
• f patients and siblings
• How the G-tube can impact his/her

development

• Understanding and participating in care
• Importance of medical play
• Explain the G-tube to siblings and patients
• Address their concerns
• Families are given a handout about development and

medical play to be a reference as patient grows

G-Tube Class

Clinical Nurses (RN)

• Review the various G-Tube types
• Mic-Key, Corflo, Pezzar
• Discuss home care and maintenance of the tubes
• Review troubleshooting for any issues that may be encountered
• Provide hands-on practice with the actual tubes and care

Additional education provided:

• Additional teaching is provided by bedside RNs as needed
• DME Pharmacies also provide bedside teaching with the caregivers if the

patients are discharged home with feeding pumps

Outcomes

One year after implementation of G-Tube class, an 84% decrease in GT related readmissions was noted Sustained improvement with a 90% decrease in GT related readmissions

• ver 2 years as compared to baseline year

20 40 60 80 100 120 140 160 180 Baseline Year 1 Year 2

Number of GT Related Readmissions

Number of GT Related Readmissions

Bedside GT Teaching (3 disciplines) Inter-professional GT Class

$124,800 yearly (est.) $15,808 yearly Implementation of the Inter-professional GT class generated an estimated 87% cost savings at CHLA

• Bedside GT teaching (including 3 disciplines) costs an estimated

$124,800/year

• Inter-professional GT class costs $15,808/year

Outcomes

Questions??