National Gastrostomy survey

1. Your details

Name:
Hospital: (If there is more than one hospital in your trust, that you are including in your answers please state this)
Trust:
Position:
Email:

2. What is the approximate number of PEGs placed at your hospital last year?

3. Who inserts the PEG's at your hospital?

4. Which indications do you insert a gastrostomy for?

5. How long would you wait after a referral before you would consider inserting a PEG?

Comments:

6. At your hospital what is in place to determine who gets a PEG:

7. At your hospital do you have:

Please briefly describe what aftercare provision is available

8. What percentage of PEGs referred are refused?

Are there any conditions where there is a blanket refusal for PEG insertion?(Yes/No) - If Yes, please specify below what conditions)

9. What reasons for refusal are given?

10. Do you use prophylactic antibiotics prior to PEG insertion?

Yes
No

If Yes, please state what and when given.

11. How often is there a disagreement over whether a PEG should be inserted?

Comments:

12. Have you ever felt put under pressure to perform a PEG and if so who from?

Comments:

13. Is there a specific protocol in place for consent issues?

Yes
No

Please describe

14. Do you have access in your hospital to radiologically inserted gastrostomies (RIGs)?

Yes
No

Comments:

15. If yes are PEG insertions more common than RIG insertion in your hospital ?

Yes
No
About the same

Comments:

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