Managing patients with a tracheostomy in acute care

Implications of dedicated tracheostomy care nurse program on outcomes

PURPOSE

Tracheostomy is a common occurrence in intensive care units (ICU), and a greater number of tracheostomized patients are shifted from ICU to non-critical areas. Tracheostomy care needs a multidisciplinary approach, particularly involving the nurses, and complications such as tube blockage, infection, and bleeding can be prevented by good bedside nursing. The aim was to study the impact of dedicated tracheostomy care nurse program on outcomes of tracheostomized patients.

METHODS

A tracheostomy care nurse program was improvised by the critical care physicians, with the objective of improving care of tracheostomized patients, wherein nursing staff from noncritical areas were selected for training purposes. The training included evidence-based knowledge and hands-on training. After a written assessment and a skill test, they were certified as 'Tracheostomy Care Nurse.' At least one of the tracheostomy care nurses was supposed to be responsible for tracheostomy care in specific wards. Comparative data of two periods, a pre-intervention period from January 2011 to November 2011 and a post-intervention period from December 2011 to October 2012, were analyzed.

RESULTS

During the pre-intervention period, of 82 tracheostomized patients, 28 (34.15 %) had complications including 20 (24.39 %) readmissions to the ICU. During the post-intervention period, 107 patients had a tracheostomy, of which 7 (6.54 %) had complications with only 2 (1.87 %) readmissions, which was significant (p < 0.05). Decannulations nonsignificantly increased during the post-intervention period (25 vs. 16 %, p > 0.05). The average length of hospital stay (ALOS) decreased from 36 to 27 days (p < 0.05).

CONCLUSION

The support of a specialist tracheostomy nurse can decrease complication rates and readmissions to the ICU and reduce ALOS.

Evaluation of the role of a specialist tracheostomy service. From critical care to outreach and beyond

The impact that a new specialist tracheostomy service, designed specifically for the care of patients with tracheostomies, was assessed in terms of type of tracheostomy tube used, time to first tube change, time to decannulation, and incidence of tracheostomy related complications in a teaching hospital with no on-site ear, nose, and throat facility. A total of 170 patients were studied. After service implementation, fewer patients (17.6%, n = 21) were discharged from the intensive treatment unit to the wards with tracheostomy tubes compared with the first group (39%, n = 20) (p = 0.006), and the number of tracheostomy related complications on the wards were significantly reduced (p = 0.031).