Disclaimer:
This blog entry reflects my personal professional experiences and insights and is written in line with the Nursing and Midwifery Council (NMC) Code (2018) and NMC guidance on the use of social media and media engagement. No patient-identifiable information is included. The views expressed are my own and do not necessarily reflect those of my employer. This content is shared in good faith to promote shared learning and professional dialogue within healthcare.

Ok, here is it:

Earlier last month, I submitted what I thought was a fairly robust draft policy for Wide-bore tube insertion for gastric emptying at our hospital. I had followed the standards laid out in the Royal Marsden Hospital  Manual of Clinical Nursing Procedures—often referred to as the “nursing bible” of nursing procedures — and cross-checked it with national guidance. The goal was clear: to improve consistency, safety, and accountability for Wide-bore tube insertion across the multidisciplinary team.

But as with many areas of clinical governance, drafting the policy was only the beginning of a much richer learning experience.

Infection Control’s Input: Seeing Gaps Through a Different Lens

After submitting my draft, the Infection Control Nursing Team reached out with detailed feedback. Rather than simply amending text, they invited me to walk through the step-by-step insertion process with them, sharing insights into practical infection control gaps they had observed in clinical settings.

Despite following the Royal Marsden’s guidance, there were notable omissions—especially concerning PPE use, management of high-risk scenarios such as aspiration, and post-insertion precautions. This highlighted a crucial point: even gold-standard references benefit from contextual interpretation and local peer validation.

📌 Evidence suggests that policies built without interdisciplinary consultation risk being incomplete or unfit for practical application (Spence & Woodhead, 2019). Peer review during policy development significantly reduces clinical variation and enhances safety (Mannion et al., 2021).

From Wide-bore Tubes to Gram-Negative Sepsis

Interestingly, this process led to a broader conversation. The infection control team explained that they’re increasingly involved in investigating gram-negative bloodstream infections (GNBSIs). A number of these infections were being traced back to biliary sources, including patients with cholangitis, cholecystitis, or post-procedural complications.

They asked if I could assist by offering insight into the clinical pathways and disease mechanisms behind these cases—helping them understand why biliary disease can become a direct route for bloodstream infection.

Why does this happen?

In conditions like cholangitis, bacteria ascend from the duodenum into the bile ducts—especially when there’s biliary obstruction from stones or malignancy. The bile ducts, normally sterile, become colonised by gram-negative organisms such as E. coli and Klebsiella. When inflammation increases intraductal pressure and vascular permeability, these bacteria can translocate into the bloodstream, causing sepsis.

📌 According to Public Health England (2020), around 30% of E. coli bloodstream infections are healthcare-associated and biliary or urogenital in origin. The NHS England “GNBSI Reduction Programme” prioritises cross-specialty collaboration to identify and eliminate sources of avoidable infection.

A Two-Way Street of Expertise

This encounter reaffirmed something essential: clinical policymaking should never occur in isolation. No matter how experienced we are in our field, interdisciplinary dialogue is what transforms guidance into excellence.

In this case:

• Nursing and procedural teams ensured that practice aligns with evidence and is operationally feasible.
• Infection control challenged us to think beyond the procedure and consider the systemic infection risks.
• Surgical and gastroenterology services remain central in understanding the patient journey and ensuring timely source control.

📌 The World Health Organization (WHO, 2021) highlights that integrated, multidisciplinary team (MDT) working is essential for improving patient outcomes and reducing avoidable harm—particularly in complex care pathways.

Final Reflections

I’m pleased to report that the NG tube policy has now been formally accepted – well almost, thanks to collaborative refinement and a willingness to learn. But more than the approval itself, it’s the dialogue and new working relationships that have had the most impact.

Sometimes, policy writing feels like a box-ticking exercise. But this experience reminded me that, when done right, it can be a gateway to something far more meaningful: shared learning, improved safety, and stronger professional communities.

References

Mannion, R., Davies, H. T. O., & Marshall, M. (2021). Clinical guidelines, governance, and the problem of implementation. Journal of Health Services Research & Policy, 26(3), 145–151.

Public Health England. (2020). ESPAUR Report 2020: English Surveillance Programme for Antimicrobial Utilisation and Resistance.

Spence, R. & Woodhead, T. (2019). Peer review in clinical policy development: benefits, pitfalls and best practice. BMJ Leader, 3(4), 112–116.

WHO. (2021). Patient safety: Global Action Plan 2021–2030. World Health Organization