A Behaviour Chance Approach (ABC) to Implementing Safety Guidelines:
Members of the Evidence Based Transformation theme have developed and implemented a behaviour change approach that when applied to pH testing for correct naso-gastic tube placement demonstrated a reduction in staff use of x-ray during this procedure from 55-24%. The estimated net savings per participating hospital in the first year were £29,573 rising to £57,205 in subsequent years and £1m and £1.94m respectively across the region. This approach involves working with teams of health professionals to identify barriers to change and then develop a tailored intervention that specifically addresses these barriers. With support from senior management, the intervention is then delivered within the Trust. Based on our evaluation of this approach across four hospital Trusts, health economists were able to calculate the savings associated with the increase in pH testing for checking the correct placement of a nasogastric tube (NGT). This led to a reduction in the use of x-rays (an expensive way of verifying tube position that can be misinterpreted and lead to feeding in the lungs, a serious patient safety incident) from 55 to 24% of occasions when a naso-gastric tube was placed. We have now delivered behaviour change training to some 300 people from all the acute (as well as GP practices, care homes and community) Trusts in Yorkshire and Humber. Six behaviour change projects are currently being supported within the region through the Academic Health Science Network, Improvement Academy. NHS IQ have commissioned this behaviour change training at a national level to support the spread of this approach beyond Yorkshire and Humber.