The Science Journal of the American Association for Respiratory Care

2002 OPEN FORUM Abstracts

PRELIMINARY REPORT ON THE DEVELOPMENT OF A RISK-ASSESSMENT TOOL FOR THE PEDIATRAIC TRACHEOSTOMY PT.

Chris Hartling RRT, Karen Baldesare-Burton RN, RRT, Catherine Nelson RN, CCM, Primary Children?s Medical Center, Salt Lake City, Utah.

Background: Increasing numbers of pediatric tracheostomy (trach) pts are making the transition from the acute care setting to homes and extended care facilities (ECF). However, sending these pts home can increase their risk of injury or death from accidental decannulation. The level of care required outside the acute care hospital, e.g. ECF, home care or continuous in-home nursing care ought to be based, in part, on the risk of injury from decannulation. Therefore, we sought to develop an instrument that would quantify this risk.

Methods and Results: An expert panel was formed that included RT?s, MD?s & RN?s. They identified 8 dimensions of risk of injury from decannulation, each of which is to be scored at one of three levels (except the age of the trach, which is scored on two levels). Definitions for each dimension were developed. The score was tested on 25 medical records. Results indicated that additional refinement of the definitions was required, which was done. The table below lists the dimensions of risk and their definitions. A score of 1 through 23 is possible, with the higher score indicating higher risk.

Dimensions of Risk Score 1 Score 2 Score 3
Age of trach > six weeks < six weeks  
Trach dependency Can pass air through the upper airway without difficulty Can pass air through the upper airway difficulty Can pass no air through upper airway
Cognitive ability: as pertaining to trach care Able to learn and care for self Able to learn but not able to care for self Unable to learn or care for self
Communication Communicates independently Assisted communication Non-specific communication
Ventilation No ventilator Ventilator assisted Ventilator dependent
Oxygen needs No O2 needs Can maintain Sa02. >88% on RA Cannot maintain Sa02.> 88% on RA
Secretion mobilization Can identify and mobilize secretions independently Can identify the need to mobilize secretions, but needs assistance to suction or cough Cannot identify need, requires assistance to mobilize secretions.
Risk for decannulation Minimal risk Moderate risk High risk
Co-Morbidities/ Co-Disease None Non-contributory Life threatening

Speculation: Higher risk pts should require more intervention after discharge, e.g. extended care versus home care. Interventions like the need for in-home nursing care by RNs? versus LPN?s or others could be determined by the stratification of these patients into risk groups. Future research involves determining score accuracy by conducting inter-rater reliability studies and content validation by studying the relationship of this score to the post-discharge incidence of post-discharge decannulation and any resultant injuries. We plan to conduct these investigations.

OF-02-127

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