Introduction
Recent sentinel events demonstrated incompetent tracheotomy care at frontlines in HA hospitals. Tracheostomy is used to sustain life by keeping patient’s airway patent. The investigation panel recommended to enhance staff’s awareness on different types of tracheostomy and management; as well as to improve handover communication. Spot check of Tracheal cuff pressure measurement was done in 2017 for 27 cases with 96.3% compliance in Department of M&G but also revealed inconsistency and suboptimal standard that posed great potential risk to both patient and staff safety.
Objectives
To achieve compliance to Guideline on Tracheostomy Care for Adult Patient (2016) Hong Kong: Hospital Authority. To standardize tracheostomy care and to enhance nursing standard in respiratory practice in the department.
Methodology
Based on HAHO Guideline, enhancement program was implemented in Department of M&G. Daily Inspection round with onsite respiratory nurse coaching starting from 2Q2017. Alert labels for tracheal tube securing method and tracheostomy kit at bedside are mandatory in all wards. Two ward-based identical Train-the-trainer lectures on Tracheal cuff pressure measurement were launched achieving 100% nurses training. From 1Q2018, Alert Signage for Permanent Tracheostomy must be placed at bedhead. In 2Q2018, eCare Plan on Tracheostomy care was developed. In 3Q2018, Quick audit tool was developed based on the essences reviewed after the above improvement actions. Hospital joint department Tracheostomy Workshops had been held in 4Q2018.
Results & Outcome
Great decreased 71.67 % (2Q2017 to 3Q2018) of overall frequency trend of alert triggers in daily ward inspection round. In 2Q2018 to 3Q2018, no alert on securing the tracheal tube; decreased alert from 6 to 1 in checking tracheal cuff pressure; decreased alert from 5 to 2 in patency of tracheal tube. In Oct 2018, Quick audit on tracheostomy care was performed in one snap shot in all M&G wards for all existing 12 real cases, overall compliance rate was 93.33%. Tracheostomy quick audit served as a regular clinical practice review and immediate refreshment, especially for junior nurses with inadequate clinical experience in high risk critical care, and more importantly to align nursing practice mandatory in the department. The result provided evidence based implications on tracheostomy care for ongoing evaluation of team effectiveness and could be generalized to all general ward settings that every nurses could be equipped as the auditor.
Co-location with:
