Improving tracheostomy care for ward patients

Abstract

The number of patients with a tracheostomy being cared for in the ward setting has increased recently as intensive care clinicians use this procedure to aid early weaning from mechanical ventilation. As a result, ward staff are providing the specialist care required by patients with a tracheostomy more frequently. This article describes how the outreach team and the critical care practice development nurse in one trust collaborated to identify, develop and implement strategies to ensure that patients with a tracheostomy in the ward setting would be cared for by an educated and supported team of nurses.

Tracheostomy care and management in general wards and community settings: literature review

“…Despite the large amount of international publications relating to tracheostomy care and management, research in this area is limited (Lewis and Oliver, 2005; Tobin and Santamaria, 2008), particularly regarding tracheostomized patients in general wards (NHS QIS, 2007). A few publications relate to tracheostomized patients discharged from ICU, but these mainly offer guidance on care, or relate to liaison nurses who provide support on various aspects of critical care.…”

“…Although this study involved a small sample in one institution, it highlighted the need for further research to improve tracheostomy practice and the uptake of guidelines. It is important to note however that some areas within the same institution may use different tracheostomy protocols and guidelines, and some areas may be unaware of such resources, particularly if they only care for tracheostomized patients occasionally (Lewis and Oliver, 2005). Furthermore, although local polices and tracheostomy guidelines may be available, some nurses may not access these due to staff shortages or time constraints (Fokke and Coulter, 1999).…”

“…However, tracheostomy practice varies within areas where patients are transferred from ICU (Heffner, 2008). In some areas, ward staff may seek advice from ICU colleagues (Haines and Coad, 2001), while others have enlisted the support of liaison nurses, critical care outreach teams or ENT specialist nurses to provide education and facilitate supervised tracheostomy practice (Russell, 2000; Lewis and Oliver, 2005). A few areas may have dedicated follow‐up services for tracheostomized patients, and this may involve providing education, performing cough and swallow assessments and planning decannulation (Norwood et al , 2004; Arora et al , 2008; Tobin and Santamaria, 2008).…”

“…Most tracheostomized patients are decannulated prior to ICU discharge (Engoren et al , 2004; Stelfox et al , 2008), but some patients require the tracheostomy beyond the acute phase for secretion and airway management (Haines et al , 2001; Barnett, 2005, 2008), and others may require a permanent tracheostomy (Garner et al , 2007). Consequently, more tracheostomized patients are being nursed in general wards and the community (Haines et al , 2001; Docherty and Bench, 2002; Lewis and Oliver, 2005), and staff within these diverse settings are expected to provide safe and effective tracheostomy care (Phillips, 2005).…”

Improving tracheostomy management through design, implementation and prospective audit of a care bundle: how we do it

“…A better outcome measure of improved tracheostomy‐care may be the ability to show a reduction in the median period from tracheostomy insertion to decannulation, as utilised by Lewis et al. 9 …”