The Science Journal of the American Association for Respiratory Care

2005 OPEN FORUM Abstracts

TITLE: DEVELOPMENT OF A STANDARDIZED INTERDISCIPLINARY METHOD FOR TRACHEOSTOMY TUBE WEANING

Authors: Rebecca Evans, CRT, Cheryl Wagoner, MS, CCC-SLP

Institution: Madonna Rehabilitation Hospital

Location: Lincoln, Nebraska

BACKGROUND: The number of individuals surviving respiratory failure and distress has increased with medical advances. There has been a steady increase in the number of patients requiring tracheostomy tubes and mechanical ventilation upon admission to this 254-bed rehabilitation hospital. The number of patients admitted with tracheostomy tubes has increased 436 percent over the last four years and the number of patients requiring mechanical ventilation upon admission has increased 670 percent. Many of the patients admitted also have multiple comorbidities. The purpose of this presentation is to introduce a flow chart for standardizing an interdisciplinary approach to attain safe, efficient tracheostomy tube weaning.

METHOD: The Respiratory Therapy and Communication Disorders departments collaborated to develop an objective decision-making tool guiding initial evaluation through decannulization. The instrument provides a step-by-step protocol for each prospective discipline to follow. The facility is a freestanding rehabilitation hospital with a long- term acute rehabilitation hospital (LTACH), acute rehabilitation unit (ARU), and subacute rehabilitation unit (SAR). The tool emphasizes the team approach and collaboration between the Licensed Respiratory Therapist and Speech/Language Pathologist with guidelines for joint evaluations with discipline-specific responsibilities. Based on the initial assessment a patient plan of care is designed.

RESULTS/CONCLUSIONS: Use of the tool provides a consistent, standardized approach to tracheostomy weaning which is applicable to patients with a variety of diagnoses as well as in a wide range of medical settings. The approach serves to improve patient outcomes including increased tracheostomy tube weaning, decreased number of ventilator and tracheostomy days, and decreased length of hospital stay. A case presentation of a patient successfully weaned from mechanical ventilation and an artificial airway will demonstrate the successful collaboration of the Licensed Respiratory Therapist and Speech Language Pathologist.

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