The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

EVALUATION OF MULTI-DISCIPLINARY GUIDELINES AND A DEDICATED RESPIRATORY THERAPIST ON THE CARE OF PATIENTS WITH A TRACHEOSTOMY

Neila Altobelli1, Le Tanya Taylor1, Gloria Mendez-Carcamo1, Susan LaGambina2, Marian Jeffries3, Susan Gavaghan3, June Williams4, Matthew Hutter5, Suzanne Sokal6, Tessa Goldsmith4, Dean R. Hess1



Background: We have observed that the tracheostomy care of patients is fragmented after ICU discharge. The purpose of this project was to evaluate a program designed to improve the care of these patients.

Methods: Using a consensus approach, a multi-disciplinary team was convened to implement improvements in the care of patients with a tracheostomy. This team developed an algorithmic pathway to guide the care of these patients and clinically validated it at the bedside. A mechanism was developed whereby the algorithm and resources are sent by email each day to the clinical nurse specialist and nurse manager of every unit with a patient who has a tracheostomy. On a weekly basis, clinicians from respiratory care, speech/language pathology, and nursing meet to discuss the tracheostomy care of patients on the general care units. Finally, the respiratory care department was reorganized so that a small group of respiratory therapists are primarily responsible for the care of patients with a tracheostomy on the general care units. To evaluate this program, we assessed the aggressiveness of tracheostomy care for a period before (4/1/2006 to 9/30/2006) and a period after (4/1/2007 to 9/30/2007) implementation of the program. The following combined endpoint was identified to reflect the aggressiveness of care: tube downsize, use of speaking valve, and/or decannulation.

Results: Before full implementation of the program, 65/79 (82%) patients met the endpoint, whereas 82/87 (94%) met that endpoint after implementation of the program (P = 0.03). Unfortunately, this was not associated with a change in the rate of decannulation (33% before, 34% after).

Conclusion: Our program resulted in an improvement in the combined endpoint of tube downsize, use of speaking valve, and/or decannulation. However, this did not result in a greater rate of decannulation. Further work is needed to identify obstacles to decannulation and to develop strategies to increase the rate of decannulation. Although we did not study this specifically, we have had numerous anecdotal reports of the resourcefulness of the tracheostomy team by nurses and physicians.