Authors (including presenting author) :
Leung WS, Leung KC, Cheung PY , Lee KL, Leung HY, Ngai TY
Affiliation :
Intensive Care Unit, Princess Margaret Hospital.
Introduction :
Tracheostomy is a life-saving procedure which is vital for preserving patent airway and facilitating the weaning of ventilator. ICU nurses deliver tracheostomy care in daily practice. Tracheostomy tube displacement or dislodgement was reported annually in the PMH ICU. As consequence of those events may be fatal or result in serious comorbidity. Practices change on tracheostomy cares are crucial in promoting more effective risk management and upholding the standard of care. A CQI project is conducted to improve and promote safe tracheostomy care in ICU and then extend to whole hospital.
Objectives :
1.To ensure safe and up to date practice on new born tracheostomy care. 2.To ensure and perpetuate the continuity of care from ICU to the general ward.
Methodology :
Critically review current tracheostomy care and identify possible risks to work up a safe journey on the tracheostomy care. - By adopting the philosophy of crew resource management, role delineation was applied in revising the nursing procedure guidelines on assisting in bedside tracheostomy insertion in ICU. - In revising nursing procedure guidelines on tracheostomy care, new-born tracheostomy was highlighted by literature review. Alert signage was also developed. - Based on HAHO guidelines, developed cue cards on emergency tracheostomy management. - Performed audit on revised guidelines to ensure compliance. - Provided ICU out-reach service for post-ICU discharged patient on tracheostomy care in general ward. -Collaborated with Q&S department to organize training workshops for the general ward nurses on tracheostomy care
Result & Outcome :
A.Two tracheostomy care guidelines were revised in ICU to meet international standard and service needs. 1. Assisting in Tracheostomy Insertion at Bedside 2. Tracheostomy Tube Care -Achieved 100% compliance in audit on deploying tracheostomy signage and complying with practice change on caring of the tracheostomized patients. B. An outreach service with 5 domains of cares is developed 1. Stoma Care 2. Tracheostomy Tube Securing 3. Tracheostomy Tube Cuff Pressure Monitoring 4. Humidification 5. Suctioning - From June to December 2018, 27 tracheostomized patients were followed up by ICU outreach team in 184 visits after discharge from PMH ICU. - No report of tube displacement or dislodgement noted. Among these patients, 9 of them were successfully removed.
Co-location with:
