OBJECTIVE: An interprofessional team known as the Tracheostomy SteeringCommittee (TSC) was established to prevent tracheotomy-related pressure injuries (TRPIs) and standardize practice for tracheostomy insertion and care of patients with tracheostomies. In addition to reducing the number TRPIs, the TSC sought establish an escalation process for all clinicians to raise concerns about the care and management of patients with tracheostomies. METHODS:This quality improvement initiative used the Define, Measure, Analyze, Improve, and Control framework with a pre-and postintervention design. The TSC created a TRPI-prevention bundle that included recommendations for protective foam dressing and skin barrier film use, suture tension, timing of suture removal, stoma care, offloading and positioning, escalation, documentation, and dual skin assessment. An electronic tracheostomy report was developed to track patients with a tracheostomy across the enterprise. RESULTS:A total of 289 patients had a tracheostomy during their inpatient hospital stay from January 2018 through December 2019. There was an observed a reduction in the daily rate of TRPIs by 50% with the use of the standardized TRPI-prevention bundle.CONCLUSIONS: Use of the bundle resulted in a significant reduction in the incidence of TRPI. Timely escalation of possible tracheostomy injuries or tracheostomies at risk enabled rapid intervention, likely preventing many injuries, and real-time feedback to clinicians reinforced best practices. Interprofessional collaboration is necessary to provide optimal tracheostomy care and ensure the best outcomes.

Background: Bedside dysphagia screening potentially identifies 60% of patients at risk for aspiration. Potential/actual stroke patients may not be identified prior to oral medications/food. Our previous dysphagia screening was challenging to use and as a result, many stroke cases were missed. Problem: Potential patients at risk for aspiration pneumonia were not being identified using a dysphagia screening. Interventions: A new dysphagia screening instrument was developed by an interdisciplinary team of nurses and speech language pathologists. Pilot reliability testing of the old tool indicated a reliability of 86%, while the new tool was found to be 95% reliable. Validity testing showed that the new dysphagia screening tool predicted patients at risk for dysphagia 96% of the time, while the old instrument predicted dysphagia only 88% of stroke patients. The new dysphagia instrument was implemented in 10/2014, and is now performed for all ED patients who have a non-contrast head CT.Current real-time auditing of core measures and reporting of compliance data is now in place with accountable parties, using concurrent chart review and real-time feedback to Nurse Managers for all missed cases Results/Conclusions: Compliance with dysphagia screening has risen from 84% in 9/2014 to 100% in 6/2015. Patients at risk for aspiration/aspiration pneumonia have been successfully identified using the new dysphagia screen and measures are implemented to prevent or treat high risk patients to improve outcomes. Most patients who developed aspiration pneumonia had been previously identified as failing the new dysphagia screen and these patients were maintained npo and placed on aspiration precautions. Mortality rates for inpatient stroke patients dropped by 73% in the 4 th quarter of 2014, fostering a #1 ranking for inpatient mortality, and top 5% in overall quality for 2014 when benchmarked with other academic medical centers participating in United Health Care (UHC) rankings. The new dysphagia screening instrument and monitoring practices has dramatically improved detection of patients at risk for dysphagia/potential aspiration, and has contributed to a significantly lower rate of inpatient stroke mortality.