Implementation of Tracheostomy passport
Aim of my project is to improve education and communication with tracheostomy patients in the community. By implementing a tracheostomy passport with daily guidance and a log of tracheostomy tube changes. It aims to reduce the number of un-necessary hospital admissions for patient with a blocked tracheostomy tube, also encourage early discharge planning (1).
A literature search was conducted on tracheostomy care, passport and discharging a patient home from hospital. On reviewing the literature there was limited evidence for use of tracheostomy passports in hospital and community setting. However, ‘On the right Trach?’ (2) recommended tracheostomy insertion and tracheostomy tube data should be more clearly documented by use of a ‘passport’ for each patient. This has been reiterated in 2017 by the Cheshire and Merseyside critical care network clinical group, originally from the national tracheostomy safety project (3).
Further to the literature search an audit of patients with a tracheostomy in place who attended accident and emergency. 25 patients attended A&E with a tracheostomy or laryngectomy in a 12 month period, 50% of these patients had attended A&E with blocked tracheostomy/laryngectomy tube, 1 attended for a tracheostomy tube change and 1 attended for equipment. From the discussion with Multi-Disciplinary Team a draft passport was formed of prompts and information for carers/patients and health professionals.
Ongoing change in policy, equipment supplies and discharge process, though this has worked well with patients who have trialled the passport in communication, patient safety and care. Since implementing the passport we have successfully avoided admissions for patients with a potential blocked tracheostomy and available equipment in the A&E department.
It has shown it as improved communication, patient experience, service, support, reduced hospital admissions and early discharge planning for patients with a tracheostomy. This project has encouraged interdisciplinary working and networking with other local trusts. Developing a standard operating procedure; for early discharge planning for a patient with a tracheostomy, enhancing care and experience when attending the hospital, is the future for this project.
Lorna Smith, ENT Specialist Nurse - Lorna.Smith@whh.nhs.uk
1.Paul F. Tracheostomy care and management in general wards and community settings: literature review. Nursing in Critical Care. 2010;15(2):76-85
2.Wilkinson K, FreethH, Martin I. Are we ‘on the right trach?’ The National Confidential Enquiry into Patient Outcome and Death examines tracheostomy care. The Journal of Laryngology & Otology. 2015;129(03):212-216.
3.NTSP - UK National Tracheostomy Safety Project Home [Internet]. Tracheostomy.org.uk. 2017 [cited 1 September 2017]. Available from: http://www.tracheostomy.org.uk/