An Interprofessional Approach to Preventing Tracheostomy-Related Pressure Injuries

Abstract

OBJECTIVE: An interprofessional team known as the Tracheostomy SteeringCommittee (TSC) was established to prevent tracheotomy-related pressure injuries (TRPIs) and standardize practice for tracheostomy insertion and care of patients with tracheostomies. In addition to reducing the number TRPIs, the TSC sought establish an escalation process for all clinicians to raise concerns about the care and management of patients with tracheostomies. METHODS:This quality improvement initiative used the Define, Measure, Analyze, Improve, and Control framework with a pre-and postintervention design. The TSC created a TRPI-prevention bundle that included recommendations for protective foam dressing and skin barrier film use, suture tension, timing of suture removal, stoma care, offloading and positioning, escalation, documentation, and dual skin assessment. An electronic tracheostomy report was developed to track patients with a tracheostomy across the enterprise. RESULTS:A total of 289 patients had a tracheostomy during their inpatient hospital stay from January 2018 through December 2019. There was an observed a reduction in the daily rate of TRPIs by 50% with the use of the standardized TRPI-prevention bundle.CONCLUSIONS: Use of the bundle resulted in a significant reduction in the incidence of TRPI. Timely escalation of possible tracheostomy injuries or tracheostomies at risk enabled rapid intervention, likely preventing many injuries, and real-time feedback to clinicians reinforced best practices. Interprofessional collaboration is necessary to provide optimal tracheostomy care and ensure the best outcomes.

Tracheostomy Thursday: Journey of a Staff-driven COVID-19 Initiative to International Recognition

“…Limited personnel resources along with prioritization and triage of care created the risk of sutures remaining past 7 days. If sutures are in place for longer than the recommended time, clinicians are empowered to escalate concerns to the covering surgical team for prompt removal 17 . To help with timely suture removal, the covering team was alerted to help assist with removal and prevent skin breakdown.…”

“…If sutures are in place for longer than the recommended time, clinicians are empowered to escalate concerns to the covering surgical team for prompt removal. 17 To help with timely suture removal, the covering team was alerted to help assist with removal and prevent skin breakdown. Because of the high patient volume, a variety of surgeons performed tracheostomies, and at times, it was difficult to determine who had inserted the tracheostomy because of the increased number of patients and their varied locations throughout the hospital.…”

Tracheostomy Thursday

“…If sutures are in place for longer than the recommended time, clinicians are empowered to escalate concerns to the covering surgical team for prompt removal. 17 To help with timely suture removal, the covering team was alerted to help assist with removal and prevent skin breakdown. Because of the high patient volume, a variety of surgeons performed tracheostomies.…”

Response to “An Interprofessional Approach to Preventing Tracheostomy-Related Pressure Injuries”

“…We read with great interest the recent quality improvement initiative by Urquhart et al, 1 focused on preventing tracheotomy-related pressure injuries (TRPIs). The authors addressed an important gap in tracheostomy research, and we are encouraged to see that with the TRPI-prevention bundle, the daily rate of TRPIs decreased by 50%.…”