The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

THE IMPLEMENTATION OF THE ADULT TRACHEOSTOMY TEAM: A QUALITY IMPROVEMENT PROJECT

Sally Brewer1, Sally Whitten1, Chris Hirsch1, Nicole Manchester2, Sonja Orff-Ney2, Danielle Tabor2, Micheline Chipman2, Darlene Realou2, Jean Fecteau2, John Dziodo1; 1Pulmonary and Critical Care Medicine, Maine Medical Center, Portland, ME; 2Department of Nursing, Maine Medical Center, Portland, ME

Background: At our facility tracheostomy patients are managed on multiple inpatient units by their primary medical or surgical teams. Policies and staff education regarding tracheostomies was unit specific. Our hypothesis was that by standardization of practice and training we will see a decrease in trachesotomy related complications and delays in decannulation. Initial indications of success will include increasing the confidence level of bedside staff in dealing with tracheostomy issues. Method: Nurses and physicians were surveyed to determine their perceived levels of competence when caring for the patient with a tracheostomy. A review of available tracheostomy supplies was conducted. We standardized bedside emergency equipment. We created a multidisciplinary team for the purpose of standardizing tracheostomy care and staff education throughout the institution. The multidisciplinary team, consisting of advanced level respiratory therapists and nurses, performed weekly rounds on all adult tracheostomy patients. Utilizing evidence based practice, weekly recommendations are made in the patient’s chart. A database was created to analyze the desired outcomes. A follow up staff survey was administered to assess the value of a standardized education model and weekly ‘trach rounds’. Results: The survey identified lack of consistent staff education, lack of consistent, easily accessible tracheostomy care supplies, and variable medical management in regards to downsizing and removal of the tracheostomy by physician groups as barriers to best practice. The team created and implemented a standardized education program to all nursing units who care for tracheostomy patients. The supply of in-stock tracheostomy supplies was reduced from 120 different types of tracheostomy tubes and accessories to 63. Conclusions: The follow up staff survey revealed a statistically significant improvement in the perceived value of the tracheostomy team. Database review suggested no statistical improvement in shortening the time to tracheostomy downsize and decannulation. Time to initial trachesotomy placement, initial downsize, and decannulation were consistent across service areas. As an unintended benefit, the standardization of in stock tracheostomy supplies has resulted in an estimated annual cost saving of $4200.00 Sponsored Research - None

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