A Set of Three Clues: Clear and Multifaceted Tracheostomy Care Guide with Integrated Record

Abstract Description

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Authors (including presenting author) :

Leung PNC(1)(2), So HM(1)(3), Chow MC(1)(4), Chan CC(1)(5), Ho CW(1)(5), Ng LMF(1)(6), Poon SWA(1)(6), Leung YP (1)(7), Cheung KH(1)(9), Lo WPJ (3), Ng SKS(4), Tsai MK(4), Tsoi SC (12), Chan SM(1)(8), Kwok LPN(1)(9)(10), Hui TPB(11)

Affiliation :

(1) Working Group on Tracheostomy Care, Nursing Services Division, HKEC (2) Quality & Safety Office, HKEC (3) Department of Intensive Care, PYNEH (4) Department of Medicine, PYNEH (5) Department of Surgery, PYNEH (6) Department of Medicine and Geriatrics, RTSKH (7) Department of Surgery, RTSKH (8) Nursing Services Division, PYNEH (9) Nursing Services Division, TWEH (10) Nursing Services Division, WCHH (11) Nursing Services Division, HKEC (12) Nethersole Clinical Simulation Training Centre, HKEC Training Centre for Healthcare Management & Clinical Technology

Introduction :

Active maintenance of a patent airway is a priority of patient with tracheostomy. It includes the daily quality care and safe emergency management. Nurses must have knowledge and competence in caring of patient with tracheostomy. HKEC hospitals aimed to standardize and enhance the practices and documentation on tracheostomy care to ensure patient safety.

Objectives :

1. Provide clear simple guide on daily and emergency management of patient with tracheostomy. 2. Promote the implementation of safe practice on tracheostomy care in daily and transitional care.

Methodology :

A Cluster Working Group on Tracheostomy Care was established in May 2017. Variations in daily tracheostomy care, documentation and handover communication were noted among HKEC hospitals. Therefore, we benchmarked the local practices against hospitals of the Hospital Authority and decided to prepare, a set of three clues, to increase staff alertness, convey clear and easily retrieval management plan on tracheostomy care. Firstly, a tailored “HKEC Care Alert Signage for Permanent Tracheostomy” was produced to increase staff alertness. Secondly, two different sets of multifaceted “Quick Guide and Management of Tracheostomy Tube-related Emergency Situations” were designed and clipped on the front page of individual patient’s chart board for reference with clear identification of permanent or temporary tracheostomy with colour coding. Thirdly, an integrated “Tracheostomy Record” explicitly documented the type of tracheostomy, temporary or permanent, indications and the management progress of tracheostomy tube. Patient with tracheostomy always required long-term care and rehabilitation; the “Tracheostomy Record” was carried with the patient during transfer within cluster hospitals for easy handover of management plan and speedy retrieval of information. To facilitate dissemination of the enhanced practice for tracheostomy care, scenarios on prompt and effective management of tracheostomy emergencies were also designed, demonstrated and video-taped. Then a Cluster Forum was organized to promulgate the updated practice on tracheostomy care.

Result & Outcome :

A Cluster Forum was held in Jan 2018 for launching the set of three clues. Video demonstrated the effective use of the set of three clues at emergency management of patient with tracheostomy tube obstruction in acute hospital, nursing handover when patient transferring to convalescent hospital for rehabilitation, and the daily nursing care. A total of 394 staff attended the forum with 76% of them returned their feedback. They appreciated the clear “Care Alert Signage”,“Quick Guide” and integrated documentation were easy to follow and practical in clinical situation. The way ahead, Working Group will evaluate the implementation, review the Nursing Care Plan and organize Train-the-Trainer Simulation Workshops to strengthen the practical skill of nurses in clinical and emergency situations.