Educating Hospital Staff on Tracheostomy and Laryngectomy Care

Abstract

Background: and Aims: In 2015 our organization identified varying practices of care and education for our increasing adult population of surgically altered airway patients. The variances created inconsistencies in patient care and outcomes. With administrative support, a team consisting of an Otolaryngology physician, Quality and Safety Medical Director, representatives from Nursing, Speech Language Pathology, and Respiratory Therapy began to formalize a structured tracheostomy care pathway. The purpose of the pathway was to standardize all aspects of care in a safe and effective practice throughout the organization by creating practice guidelines and a specialized team educated in the management of caring for the tracheostomized patient. Methods: The pathway was implemented with over 750 staff members, utilizing clinical scenarios and simulation along with bedside competency validation. Clinical simulation included anatomy of the airway, resuscitation devices, manipulation of the different types of tracheostomy, lary tubes, filters, humidification needs; suctioning and airway clearance; documentation and bedside safety supplies. A bundled order set was established utilizing mnemonics to standardize room setup, bedside and travel safety supplies with an emphasis on patient education. A specialized team known as CATT, Care and Assessment of the Tracheostomy Team was established and comprised of designated Speech Language Pathologists and Respiratory Therapist. THE CATT educates providers, clinical staff and patients regarding care, tracheostomy tube changes, downsizing, voicing options, capping trials, and decannulation. Results: On average over 600 surgically altered airway visits are seen annually, the pathway was phased in beginning in 2015 and by 2018 results show that consistency in supporting the education of staff over 94.6% of patients receive discharge education which coincides with a noted reduction in tracheostomy related readmissions from 26 in 2015 to zero in 2018. Bedside safety supplies are monitored and documented as present each shift with a 99% compliance rate. Rapid Response Team calls for tracheostomy related events have also been reduced by 68.4%. Conclusions: Educating a large hospital staff at entry level for a tracheostomy program should not be overlooked. Providing a solid foundation for bedside care providers in understanding how to safely manage and care for a patient with an altered airway is beneficial to the overall outcomes.