Tracheostomy Education...It's Not Just for RTs Anymore

Abstract

Background: Tracheostomy management is an established skill within the respiratory therapists’ scope of practice. For registered nurses (RN), tracheostomy management can be a rarely used skill that fosters a lack of confidence. Literature review shows a lack of confidence influences the ability of the RN to provide effective tracheostomy management. A practice gap was identified in the areas of tracheostomy care, suctioning, and response to accidental decannulation. A simulation-based workshop was developed to improve RN confidence when caring for a patient with a tracheostomy.

Methods: The workshop registration was limited to four RNs to allow each learner hands-on implementation of tracheostomy management. The Respiratory Care Educator provided a demonstration for proper suctioning technique, tracheostomy care, management of accidental decannulation and supplies available to the learners were reviewed including the patient-specific emergency tracheostomy kit. A two-part simulation was facilitated utilizing a tracheostomy manikin and all of the supplies needed to respond to the two scenarios were available for use. Scenario one was response to routine trach care and suctioning. Scenario two was response to accidental decannulation. After completion of the simulations, the facilitators debriefed utilizing the Plus/Delta method.

Results: A pre/post survey utilizing a 5-point Likert scale was administered to each learner. The pre-survey showed 59% of participants (n = 22) reported somewhat disagree to strongly disagree to confidence replacing a tracheostomy after accidental decannulation and 27% of learners reported somewhat disagree to strongly disagree to familiarity of the contents of the emergency tracheostomy kit. 31% of learners reported low confidence providing routine tracheostomy care. The post-survey showed that 100% of participants felt confident replacing a tracheostomy after accidental decannulation and familiarity with the contents of the emergency tracheostomy kit. 94% of participants reported an increase in confidence when providing routine tracheostomy care. 87% of participants reported the ability to apply what they learned immediately on the job.

Conclusions: Simulation-based education increased RN confidence to care for a patient with a tracheostomy. The small class size allowed the participants to improve skills needed to provide routine tracheostomy care, manage decannulation, and increased familiarity with supplies available during an accidental tracheostomy decannulation situation.