Model for best practice: nurse practitioner facilitated percutaneous tracheostomy service.

Abstract

Context: In 2007, a tracheostomy nurse practitioner role was created to facilitate the percutaneous tracheostomy service that was established in 2005 at an urban academic tertiary care facility. The purpose of the tracheostomy nurse practitioner's role was to provide comprehensive care to tracheostomy patients.

Objective: To determine whether the addition of a tracheostomy nurse practitioner to the percutaneous tracheostomy service improves (i) standard of care (ii) efficiency of care, and (iii) patient outcomes.

Design: Retrospective electronic patient record and chart review comparing data before and after the addition of a tracheostomy nurse practitioner to the percutaneous tracheostomy service.

Methods: A total of 110 patients who underwent percutaneous tracheostomy in 2006 and 2008 (n = 55) were randomly selected for the study. Data were collected regarding standard of care, efficiency (n = 55) of care, and patient outcomes.

Setting: Urban, academic, tertiary care medical center

Outcome measures: Standard of care: (1) use of tracheostomy screening tool, 2) obtaining consent, 3) completeness of consent with patient's name, date, time, and signatures of patient/family, provider and witness, 4) performance of timeout, 5) use of tracheostomy postoperative order set, 6) documentation of a procedure note in the chart, and 7) and documentation of operative note in electronic patient record), efficiency of care: timeliness of the service, and patient outcomes: intensive care unit and hospital length of stay, and documented complications.

Results: Between 2006 and 2008, there were statistically significant improvements in 4 of 7 measures of standard of care, use of a tracheostomy screening tool, completeness of consent (documentation of time when consent was completed and presence of signature of witness), performance of time outs, and use of postoperative order set. Between 2006 and 2008, there was also a statistically significant improvement in timeliness of the service. However, there were no significant differences in the three patient outcome measures before and after the addition of the service.

Conclusions: The nurse practitioner facilitated tracheostomy service significantly improved standard of care and efficiency. Relevance to Nursing: Nurse Practitioner facilitated tracheostomy service is an innovative approach to managing tracheostomy patients. The role of the advanced practice nurse as described in this study can be adopted by other institutions to improve the standard of care and efficiency of care.