Managing patients with tracheostomies: Demonstrating our value and striving for high quality care....
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Transcript of Managing patients with tracheostomies: Demonstrating our value and striving for high quality care....
![Page 1: Managing patients with tracheostomies: Demonstrating our value and striving for high quality care. Ioan Morgan – Highly Specialist Physiotherapist Claire.](https://reader030.fdocuments.net/reader030/viewer/2022032523/56649d815503460f94a665c4/html5/thumbnails/1.jpg)
Managing patients with tracheostomies: Demonstrating our value and striving for high quality care.
Ioan Morgan – Highly Specialist PhysiotherapistClaire Cahoon – Highly Specialist Speech and Language Therapist.
![Page 2: Managing patients with tracheostomies: Demonstrating our value and striving for high quality care. Ioan Morgan – Highly Specialist Physiotherapist Claire.](https://reader030.fdocuments.net/reader030/viewer/2022032523/56649d815503460f94a665c4/html5/thumbnails/2.jpg)
The Service
Based on the Regional Hyper-Acute and Rehabilitation Unit, Northwick Park Hospital, Harrow
Level 1 complex specialised rehabilitation service commissioned by NHS England
24 beds primarily for patients with severe complex physical, cognitive, and communication disability, including those in prolonged disorders of consciousness → highly dependent
Increasing numbers of patients with tracheostomies over past 12 months
![Page 3: Managing patients with tracheostomies: Demonstrating our value and striving for high quality care. Ioan Morgan – Highly Specialist Physiotherapist Claire.](https://reader030.fdocuments.net/reader030/viewer/2022032523/56649d815503460f94a665c4/html5/thumbnails/3.jpg)
National Context
Increased prominence of tracheostomy care - NCEPOD report ‘On The Right Trach’ (2014) and National Tracheostomy Safety Project
Published guidelines / care information about tracheostomy management are typically orientated towards patients in acute care. However, our population presents a different set of challenges.
There is also little/no published data regarding outcomes in this population.
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Current Practice on RHRU
• Weaning is current led by SLT / PT
• Nursing staff implement weaning guidelines and make on-line decisions on a daily basis but do not take an active role in decision making process / overall management planning.
• Decreased confidence among the junior therapy team when working with this population
• Use of standard documentation – used for all tracheostomy patients throughout the hospital.
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![Page 5: Managing patients with tracheostomies: Demonstrating our value and striving for high quality care. Ioan Morgan – Highly Specialist Physiotherapist Claire.](https://reader030.fdocuments.net/reader030/viewer/2022032523/56649d815503460f94a665c4/html5/thumbnails/5.jpg)
Striving for high quality care and measuring our outcomes
The evidence gap in the literature, together with observations made at “ground level” led us to:
a) Implement a service improvement projectb) Develop a system to measure our outcomes
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Service improvement project
• Established tracheostomy working party with key stakeholders
• Created a weaning guideline for the RHRU patient group
• Qualitative data collection via learning needs questionnaires to all therapy and nursing staff
• Review of current documentation used on unit – new documentation developed.
• Audit of the service against national guidelines (NCEPOD)
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Measuring our outcomes
• Data collected using excel spreadsheet over 11 month period (n = 34)
• The vast majority of our patients are admitted to the unit with either no history of previous weaning or weaning trials conducted in SLT/PT sessions only.
• We have achieved decannulation in 65% of patients.
• Statistical analysis completed by Zi-Wei Liu, Specialist Registrar ENT
![Page 8: Managing patients with tracheostomies: Demonstrating our value and striving for high quality care. Ioan Morgan – Highly Specialist Physiotherapist Claire.](https://reader030.fdocuments.net/reader030/viewer/2022032523/56649d815503460f94a665c4/html5/thumbnails/8.jpg)
Pre-admission weaning history
None (13)SLT/PT trial (12)One-way valve (6)Cuff deflation (4)
Outcomes
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Weaning outcomes
Decannulation (22)poor secretion management (6)continued weaning (3)subglottic stenosis (1)Tracheal granulations (1)medical deterioration/death (1)
Outcomes
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Outcomes
Sign off copy goes hereImpairment Activity Participation Distress0
0.5
1
1.5
2
2.5
3
Changes in tracheostomy outcome scores (TOMs) from ad-mission to discharge
(higher score indicates improvement)
ImpairmentActivityParticipationDistress
TOM
Sco
re C
hang
e
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Outcomes
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Effective model of AHP leadership working resulting in:
• Successful, timely decannulation of complex, long term tracheostomy patients
• Cost savings in ongoing care• Improved inter-professional collaboration (immediate and
wider MDT)
Our work is in line with key recommendations from NCEPOD report demonstrating safe and effective practice
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Where next?
• Outcome data to be presented at British Academic Conference of Otolaryngology on 9.7.15 – recognition that our work is recognised as being innovative in its field.
• Gain feedback re: weaning protocol – qualitative and quantitative.
• Implement the use of the new working forms to the department and review.
• Collaboration with other units.• On-going data collection and publication.