2002 OPEN FORUM Abstracts
DEVELOPING A TRACH TEAM TO REDUCE THE INCIDENCE OF TRACHEOSTOMY TUBE COMPLICATIONS ON THE GENERAL MED SURG UNITS
Scott Thomas RRT, Theresa Bergquist RRT, Todd Smith BS RRT, Deb Ryan CCRN, JoAnn Munski RN, Randal Baker MD, BruceBonnell MD, James Hoogeboom DO. Spectrum Health, Grand Rapids, Michigan.
Background The Adult Critical Care QA data at our hospital revealed a problem with unscheduled returns of trach patients to the ACC units. In researching this topic we found several factors that contributed to these returns to the unit. Trach follow up was inconsistent once the patient left the ICU, variation of practice regarding downsizing, capping and decannulation and a general lack of knowledge of who is responsible for the trach care.
Methods A Trach Team consisting of RRTs and RNs was created with support of physicians. The goals of the team were as follows:
Develop standardized guidelines for downsizing and decannulation of tracheostomy tubes.
Standardized the tracheostomy tubes to be used in the hopital.
Develop a custom trach care kit.
Develop standing orders for the care of tracheostomies.
Revise the Policy and Procedures regarding tracheostomies.
Clarify the responsible physician when the patient has left the ICU
Carry out staff education on all the changes and procedures.
Results: There have been NO unscheduled returns to the Adult ICUs since the start of the trach team. Once the focus of the trach team was to facilitate downsizing and decannulation, 50% of patients had their trachs downsized and 30% were decannulated prior to transfer or discharge. For the decannulated patient, the average time from off positive pressure to decannulation was 7.5 days. Trach Length of Stay has decreased from 26 to 16 days after the Trach Team was developed.
Conclusions: The Trach Team has achieved all of its initial goals. This resulted in improved patient care and patient satisfaction along with cost savings for the hospital by eliminating the unscheduled returns of patients to the ICU due to trachesotomy issues.