Contemporary tracheostomy clinical management in respiratory wards: A continuous quality improvement program

Abstract

Introduction: Tracheostomy(T) is regarded as a “high-risk, low-incidence” care. Mismanagement leading to airway occlusion could be fatal. In nursing, T is introduced as airway management. More deeply knowledge like T tube or its emergency management are usually not included. The handover communication and observation were also found inadequate. Aims: The aims are to (i)improve handover communication and documentation and (ii)prevent complications and have the preparedness of in the management of tracheostomy emergency. Methods: The T care working process was reengineered in a systematic approach(Fig.1) carried out(1/5 to 31/12/2017) in respiratory wards. It included:(1)T records and observation chart for assessing and assisting the management of patients with complex health conditions;(2)Nursing care report for reminding and recording the intervention of T care provided;(3)Emergency workflow poster and bedside emergency equipment box for better airway emergency preparedness;(4)Regular training in indication and anatomy of T and the standard of care and emergency management. Result: There were 38 admissions of T cases during study period. Staff’s T knowledge and self-efficacy of performing T care were evaluated(N=31). Both of them showed with a great improvement with statistically significant (P Conclusion: The project could achieve the aims (i)&(ii).