An institution-wide tracheostomy rounding team: Initial caregiver perceptions

Quinton, Brooke A; Tierney, William S.; Bryson, Paul C.; Bribriesco, Alejandro; Gillespie, Colin T.; Hopkins, Brandon D.

doi:10.1016/j.amjoto.2021.103367

Cited by 3 publications

(6 citation statements)

References 12 publications

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“…Similar care management processes found in the literature include tracheostomy rounding teams or tracheostomy review services. 12,14 Quinton et al 12 noted an improvement in overall quality and provider comfort with a rounding team but did not focus on clinical outcomes. In addition, Southcott et al 14 found staff reported improved knowledge and confidence but identified minimal improvements in clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…3 Studies have shown decreased complications using a formal care management process with specially trained nurses to manage patients with a tracheostomy. 3,12 Utilizing a clinical nurse specialist (CNS) or specially trained nurse to oversee the formal care management process and manage these patients provides the bedside nurses with a clinical resource and ensures the standard of care is maintained. The purpose of this project was to implement a CNS-driven formal care management process to improve care of patients with a tracheostomy.…”

mentioning

confidence: 99%

“…Complications such as occlusion, bleeding, pressure injury, and infection can be prevented with high-quality bedside nursing 3. Studies have shown decreased complications using a formal care management process with specially trained nurses to manage patients with a tracheostomy 3,12. Utilizing a clinical nurse specialist (CNS) or specially trained nurse to oversee the formal care management process and manage these patients provides the bedside nurses with a clinical resource and ensures the standard of care is maintained.…”

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confidence: 99%

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Clinical Nurse Specialist Tracheostomy Management Improves Patient Outcomes

Richardson

Girardot

Powers

et al. 2023

Journal of Nursing Care Quality

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Background: Patients with a tracheostomy are a low-volume, high-risk population with long lengths of hospital stay and high health care costs. Problem: Because of the complex nature of caring for patients with a tracheostomy, it is essential to provide a standardized care approach with ongoing monitoring to optimize outcomes. Approach: A pre/postimplementation design was used. A formal tracheostomy care management process using clinical nurse specialists (CNSs) was implemented. Outcomes: Between April 2019 and December 2020, this process resulted in a significant reduction in time between tracheostomy placement and discharge, from 16 to 12.9 days (P = .02). Reductions were also seen in length of stay and incidence of tracheostomy-related pressure injuries. Conclusions: This project shows that a CNS-led care management process can improve patient outcomes. These improvements in patient outcomes resulted in a significant cost savings to the organization.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Clinical Nurse Specialist Tracheostomy Management Improves Patient Outcomes

Richardson

Girardot

Powers

et al. 2023

Journal of Nursing Care Quality

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“…Within the current health care environment, initiatives that can reduce the demands placed on hospital staff carry substantial advantages in the larger context of patient care. [20][21][22] Specifically, airway maintenance and safety, patient and caregiver training, and patient use are simplified when HMEs are substituted for CEHSs. Furthermore, unlike with CEHSs, HME setup is simple, does not require electricity, and does not restrict patient movement.…”

Section: Discussionmentioning

confidence: 99%

“…The use of HMEs in lieu of CEHSs simplified the postoperative care process and, although not specifically and directly measured in this study, appears to decrease the workload on nurses and RTs. Within the current health care environment, initiatives that can reduce the demands placed on hospital staff carry substantial advantages in the larger context of patient care 20‐22 . Specifically, airway maintenance and safety, patient and caregiver training, and patient use are simplified when HMEs are substituted for CEHSs.…”

Section: Discussionmentioning

confidence: 99%

Adoption and Utilization of Heat and Moisture Exchangers (HMEs) in the Tracheostomy Patient

Kearney,

Norris,

Bertelsen

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveManagement of tracheostomized patients typically involves a conventional external humidification system (CEHS). CEHS are noisy, negatively impact patient mobility, and increases costs. Additionally, they prevent phonation and the ability to cough. Alternatively, heat and moisture exchange (HME) devices have been used in laryngectomized patients. We present an institutional quality improvement project exploring the use and efficacy of an HME device following tracheostomy.MethodsHealth care professionals and stakeholders from multiple disciplines were identified: otolaryngology, nursing, administration, case management, and speech‐language pathology. The focus was on an otolaryngology acute care nursing unit. Protocols for product acquisition, nursing education, care flowcharts, and discharge planning were established. Efficacy was assessed by tracking patient pulmonary status, nursing notes, and questionnaires.ResultsSeventy‐one tracheostomized patients were enrolled. Two patients (2.8%) were unable to tolerate the HME. There were no complications from mucous plugging or respiratory distress. Eighty‐nine percent of nursing staff surveyed preferred the use of an HME device over CEHS, particularly for ease of patient mobility. Additional favorable findings were patient satisfaction, cost savings, reduced noise, communication, and ease of discharge education and planning.DiscussionReplacing CEHS with HMEs provides distinct advantages, with a positive impact on patients, family members, and health care personnel. Resistance to changing from the traditional standard of care was alleviated with education, focused training, and positive outcomes.Implications for PracticeThese data indicate that an HME device is safe and offers advantages to both patients and nurses over traditional CEHS.

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