52 - A novel peer support mentor program and quality improvement intervention addressing feeding tube dislodgements for pediatric patients with G-tubes

Poster Number: 52
Publication Number: 52.253

Jan A. Schriefer, Golisano Children's Hospital at The University of Rochester Medical Center, Pittsford, NY, United States; Peter Juviler, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Mariah Erlick, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Marsha PULHAMUS, Golisano Children's Hospital at The University of Rochester Medical Center, Spencerport, NY, United States; Emily Ferro, URMC, Rochester, NY, United States; Kate Ostrander, Golisano Children's Hospital at The University of Rochester Medical Center, Canandaigua, NY, United States; Sarah Verna, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Derek Wakeman, Golisano Children's Hospital at The University of Rochester Medical Center, Rochester, NY, United States; Colleen Hill-Sober, Golisano Children's Hospital at The University of Rochester Medical Center, Rochester, NY, United States

Background: Pediatric patients with gastrostomy tubes (g-tubes) are seen in Emergency Departments (ED) across the United States for issues related to dislodgements and other concerns that families might have.  We tested an innovative approach to post-operative family support and care utilizing a family c-led quality improvement project for the highest risk children and their caregivers.

Objective: Our objective was to have the family mentor peer support program prevent g-tube dislodgements and ED visits for mentee families.

Design/Methods: Our institution has been using a quality improvement g-tube dislodgement prevention bundle for four years.  We built a program for primary caregivers of patients with feeding tubes to mentor families with newly inserted feeding tubes.  The mentee families were chosen using factors that place them at risk of g-tube complications or ED visits based on area deprivation index score.  Mentors are identified from our experienced primary caregivers of children with g-tubes.  Our primary intervention was training mentors who were matched to mentees based on lived experiences.  Mentors and mentees meet at least 3 times to provide support and education around caring for the g-tube and preventing dislodgements.  Using feedback from families, we upgraded our home emergency replacement kits with simplified supplies, improved packaging and care tips.  Survey questions were based on the validated SAGA-8 tool using a 5 point Likert scale.

Results: As seen in Figure 1, at the 1 month visit, families found the advice received from the mentor relationship helpful.  At 3 months, fewer families found the mentor advice helpful.  Caregivers in the g-tube mentor program reported high confidence taking care of the g-tube after insertion as seen in Figure 2.  The rate of g-tube dislodgement in the first 90 days after insertion was similar between children in the peer mentor program and those not in the program as seen in Figure 3.

Conclusion(s): Out novel parent peer support program holds promise for increasing self-efficacy for caregivers and reducing dislodgements in children with g-tubes.  Social determinants of health impact outcomes after pediatric gastrostomy and can be successfully addressed with peer support.  Our program seeks to address psychological needs of families to improve outcomes and reduce dislodgements.  Ultimately, it appears the program has mitigated some disparities brining high risk children with g-tubes closers to average risk for dislodgement as children in the program would have been expected to have more dislodgements.