An evidence-based evaluation of tracheostomy care practices

Area of Science:

• Medical Care
• Nursing Practice
• Respiratory Therapy

Background:

• Adverse outcomes including tracheal occlusion and peritracheal skin breakdown necessitated a review of current tracheostomy care practices.
• Existing organizational policies for tracheostomy care were found to be conflicting and lacked clear delineation of responsibilities.
• Issues were identified with securing devices, suture removal, dressing selection, and skin breakdown prevention.

Purpose of the Study:

• To evaluate tracheostomy care through an evidence-based practice approach.
• To identify specific problems and challenges in current tracheostomy care procedures.
• To implement practice changes to improve patient safety and care quality.

Main Methods:

• A comprehensive review of organizational policies and relevant literature was conducted.
• Surveys of national experts, geographical surveys, and interviews with vendors, physicians, staff, and patients were performed.
• Evidence was collected, scored, and supply costs were evaluated. New supplies were trialed.

Main Results:

• Skin maceration was a frequent finding during audits, linked to issues with tracheostomy ties and securing methods.
• Nurses and respiratory therapists reported difficulties with current care techniques and supplies.
• Conflicting policies and unclear role delineation for care provision were identified as significant problems.

Conclusions:

• Practice changes were agreed upon by multidisciplinary teams, including respiratory, nursing, and medical staff.
• New supplies were trialed and implemented to address identified issues.
• Primary responsibility for tracheostomy care was successfully shifted to the registered nurse, aiming to streamline and improve care delivery.