Management of Tracheostomy Emergencies: A Pilot Project to Minimize Subtle but Fatal Errors

Abstract Description

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Authors (including presenting author) :

TSANG WL, MAK WL, WONG KK, LAU SY

Affiliation :

Department of Surgery, United Christian Hospital

Introduction :

Tracheostomies and laryngectomies are common procedures in Head & Neck (H&N) surgical practice and as part of intensive care treatment. However, whether nurses are confident and competent to provide time-critical and decisive management on tracheostomy emergencies remain uncertain. While standardized care protocols are excellent tools to provide concrete references, structured trainings may augment capabilities of frontline nurses.

Objectives :

To preliminarily examine surgical nurses’ confidence and knowledge on tracheostomy care and the efficacy of a structured problem-based training on tracheostomy emergency care.

Methodology :

This project was a quality improvement initiative. It was a cross-sectional pre-post pilot study involving a convenience sample of surgical nurses participating in a structured training on tracheostomy emergencies. It involved an hour of hand-on experience of managing a manikin whose tracheostomy tube was occluded by mucus plugs causing respiratory distress followed by cardiac arrest. Their pre-post training confidence and knowledge levels were compared. They were also surveyed to obtain feedbacks about the training.

Result & Outcome :

15 surgical nurses within the department were recruited (80.0% RN, 13.3% APN, 6.7% NO; 80% H&N specialty; mean[SD] years of post-registration experience, 8.55[12.39] years). Their pre-training confidence level on tracheostomy emergency care was borderline ranging from 0/10 to 10/10 (mean, 5.0±2.62). 66.7% did not recognize the critical difference between a tracheostomy and a laryngectomy leading to suboptimal management of the emergency situations. 86.7% failed to identify various common tracheostomy terminology. Clearly, these hit the alarm worthy of attention. The training demonstrated good achievements in optimizing quality and safety of tracheostomy emergency care. It increased their knowledge in managing tracheostomy emergencies and distinguishing critical differences between a tracheostomy and a laryngectomy (both with 60% increase). All respondents rated the training as very helpful, with a mean[SD] rating of 9.87[.352] on a 10-point Likert scale. Hospitals which lack appropriate infrastructure and trainings may result in significant patient harm. Making truly meaningful improvement is essential to maintain a safe, efficient and high-morale team. Building on this framework, future projects are planned to collaborate with key stakeholders to improve the safety and quality of tracheostomy and laryngectomy care through preparing and motivating staff and clinical locations to implement simple but best practices to prevent predictable and amenable emergency situations from happening in the first place.