Association of Standardized Tracheostomy Care Protocol Implementation and Reinforcement With the Prevention of Life-Threatening Respiratory Events

Masood, Maheer M.; Farquhar, Douglas R.; Biancaniello, Christopher; Hackman, Trevor

doi:10.1001/jamaoto.2018.0484

Cited by 13 publications

(11 citation statements)

References 33 publications

(62 reference statements)

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“…The following definitive management of tracheostomy airway emergency by respiratory specialists should adhere to comprehensive multidisciplinary guidelines (Figure 4 ) (McGrath et al, 2012 ). Prior literature documents a significant knowledge gap among clinicians concerning airway emergencies and tracheostomy tube dislodgements (Masood et al, 2018 ; McDonough et al, 2016 ). The improvement in knowledge in the present study is therefore reassuring.…”

Section: Discussionmentioning

confidence: 99%

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Implementation of an evidence‐based accidental tracheostomy dislodgement bundle in a community hospital critical care unit

Jung

Grubb

Moser

et al. 2022

Journal of Clinical Nursing

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Background Tracheostomy dislodgment can lead to catastrophic neurological injury or death. A fresh tracheostomy amplifies the risk of such events, where an immature tract predisposes to false passage. Unfortunately, few resources exist to prepare healthcare professionals to manage this airway emergency. Aim To create and implement an accidental tracheostomy dislodgement (ATD) bundle to improve knowledge and comfort when responding to ATD. Materials & Methods A multidisciplinary team with expertise in tracheostomy developed a 3‐part ATD bundle including (1) Tracheostomy Dislodgement Algorithm, (2) Head of Bed Tracheostomy Communication Tool and (3) Emergency Tracheostomy Kit. The team tested the bundle during the COVID‐19 pandemic in a community hospital critical care unit with the engagement of nurses and Respiratory Care Practitioners. Baseline and post‐implementation knowledge and comfort levels were measured using Dorton's Tracheotomy Education Self‐Assessment Questionnaire, and adherence to protocol was assessed. Reporting follows the revised Standards for Quality Improvement Reporting Excellence (SQUIRE). Results Twenty‐four participants completed pre‐test and post‐test questionnaires. The median knowledge score on the Likert scale increased from 4.0 (IQR = 1.0) pre‐test to 5.0 (IQR = 1.0) post‐test. The median comfort level score increased from 38.0 (IQR = 7.0) pre‐test to 40.0 (IQR = 5.0) post‐test). In patient rooms, adherence was 100% for the Head of Bed Tracheostomy Communication Tool and Emergency Tracheostomy Kit. The adherence rate for using the Dislodgement Algorithm was 55% in ICU and 40% in SCU. Discussion This study addresses the void of tracheostomy research conducted in local community hospitals. The improvement in knowledge and comfort in managing ATD is reassuring, given the knowledge gap among practitioners demonstrated in prior literature. The ATD bundle assessed in this study represents a streamlined approach for bedside clinicians – definitive management of ATD should adhere to comprehensive multidisciplinary guidelines. Conclusions ATD bundle implementation increased knowledge and comfort levels with managing ATD. Further studies must assess whether ATD bundles and other standardised approaches to airway emergencies reduce adverse events. Relevance to Clinical Practice A streamlined intervention bundle employed at the unit level can significantly improve knowledge and comfort in managing ATD, which may reduce morbidity and mortality in critically ill patients with tracheostomy.

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Section: Discussionmentioning

confidence: 99%

“…Despite the dangers to the health and safety of patients with a fresh tracheostomy, a considerable knowledge deficit exists among clinicians managing airway emergencies (Masood, Farquhar, Biancaniello, & Hackman, 2018 ; McDonough et al, 2016 ). In addition, ATD is a common adverse event (Brenner et al, 2020 ).…”

Section: Relevance To Clinical Practicementioning

confidence: 99%

Implementation of an evidence‐based accidental tracheostomy dislodgement bundle in a community hospital critical care unit

Jung

Grubb

Moser

et al. 2022

Journal of Clinical Nursing

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“…Sınırlı sayıdaki çalışmalarda ise hastaların korku yaşadıkları ve trakeostomi bakımı için gerekli becerileri kazanamamaktan endişeli oldukları raporlanmıştır (33)(34)(35). Trakeostomi gibi cerrahi işlemlerden önce hastaların psikolojik hazırlığının önemi bilinmesine karşın, trakeostomi açılacak hastaların kritik durumları nedeni ile psikolojik yönden hazırlanmaya zaman olmadığını belirten çalışmalar mevcuttur (36,37). Çalışmamızda literatürde bazı araştırmaların işaret ettiğine benzer şekilde hastaların fizyolojik sorunlar ile psikolojik sorunlar da yaşadığı ortaya konulmuştur.…”

Section: Discussionunclassified

Hemşireler Trakeostomili Hastaların Bakımını Ne Kadar Biliyor? Nitel Bir Çalışma

Altınbaş¹,

Karaca²

2021

Balıkesir Medical Journal

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Bu çalışma yoğun bakım hemşirelerinin trakeostomili hasta bakımına ilişkin uygulamalarını belirlemek için yapılmıştır. Gereç ve Yöntemler: Nitel tipteki araştırma Ekim-Kasım 2019 tarihleri arasında Güneydoğu Anadolu Bölgesi'ndeki bir ilde yer alan bir Üniversite Hastanesi'nin Yoğun Bakım Ünitesi'nin 15 hemşiresi ile gerçekleştirilmiştir. Veriler tanıtıcı bilgi formu ve yarı yapılandırılmış görüşme formu kullanılarak toplanmıştır. Veriler, Giorgi'nin fenomenolojik yöntem analizi kullanılarak 4 aşamada değerlendirilmiştir. Bulgular: Katılımcıların yaşları 25-42 aralığında, 10'u kadın, yoğun bakım hemşiresi olarak çalışma yılı 1-15 yıl olup, tüm katılımcıların lisans mezunu olduğu, trakeostomili hastaların bakımı ile ilgili eğitim aldığı ve hasta güvenliği ile ilgili bir yayını/web sayfasını düzenli olarak takip etmediği görülmüştür. Katılımcıların trakeostomili hasta bakımına ilişkin görüşleri 2 ana tema ve 5 alt temadan oluşmaktadır. Ana temalar 1. Trakeostomili Hastanın Bakım Uygulamaları ve 2. Bakım Sırasında Yaşanan Sorunlar ve Çözüm Önerileri'dir. Trakeostomili Hastanın Bakım Uygulamaları ana teması Protokoller, Trakeostomi Öncesi Hasta Bakımı ve Trakeostomi Sonrası Hasta Bakımı olmak üzere 3 alt temadan oluşmaktadır. Bakım Sırasında Yaşanan Sorunlar ve Çözüm Önerileri ana teması Sorun Yaratan Durumlar ve Bakımı Geliştirmeye Yönelik Öneriler olmak üzere 2 alt temadan oluşmaktadır. Sonuç: Hemşirelerin trakeostomili hastanın bakımına ilişkin bilgilerinin temel düzeyde yeterli olup bakım uygulamalarının fizyolojik gereksinimler ile sınırlı kaldığı; hemşirelerin hastanın psikolojik gereksinimlerinin farkında oldukları ancak bu konu ile ilgili hemşirelik uygulamalarının ya hiç yapılmadığı ya da yetersiz kaldığı belirlenmiştir.

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“…Показаннями до хірургічного відновлення прохідності дихальних шляхів, зокрема -проведення трахеостомії, в онкохірургії голови та шиї є обтурація пухлинним утворенням дихальних шляхів [1]. Трахеостомія все ще широко використовується в практиці, але рівень інфекційних ускладнень залишається високим [2]. Існують різноманітні види технік трахеостомії, видів розрізу шкіри та підходу до трахеї, але жоден з них не має стовідсоткової переваги перед іншими, зокрема -щодо інфекційних ускладнень [3].…”

Section: вступunclassified

Evention of Infectious Complications of Tracheostomy in Patients With Head and Neck Cancer Pathology

Burjan¹,

Yurevich²,

Kuchmiy³

et al. 2022

Khark. Surg. Sch.

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Summary. Introduction. A tracheostomy is still widely used in the head and neck oncology practice, but the rate of infectious complications remains high. Goal. Optimization of the prevention and treatment of the tracheostomy complications in patients with oncological pathology of the head and neck based on taking into account the flora that is seeded from the tracheostomy. Materials and methods. The 1st stage of the study consisted in examining of the 100 patients after tracheostomies performed in the period 2018-2022 (planned — 76, emergency — 24). The age of the patients ranged from 40 to 70 years old. The indication for the tracheostomy was obstruction of the respiratory tract by a tumor process of the larynx and the laryngopharynx. All surgery operations were performed under the local infiltration anesthesia, according to the standard technique for the permanent tracheostomy. At the 2nd stage, the proposed methods of the postoperative management of the patients to prevent the infectious complications were evaluated: processing of the cannula with a combination of 0.01 % solution of the miramistin with 10 mg of the chymotrypsin or a combination of 0.5 % s olution of the dioxidin and 10 mg of the chymotrypsin. Results and their discussion. At the 1st stage of the study, various complications were detected, but in all cases there were infectious complications. Most often, after 7 days, Pseudomonas aeruginosa was cultured from the trachea, followed by Acinetobacter baumannii in 2nd place. The use of 0.02% chlorhexidine solution to process the cannula was not effective. The flora that is cultured determines the antiseptic agent that should be used to process the cannula. Conclusions. 1. Infectious complications after the tracheostomy are inevitable due to disruption of the natural path of air movement. 2. The flora sown from the tracheostomy cannula within 14 days after the tracheostomy is diverse. 3. It is advisable to use double-lumen tracheostomy cannulas, the inner part of which should be processing with the antiseptics depending on the flora found in the tracheal contents. 4. The combination of the 0.01% miramistin solution with 10 mg chymotrypsin for the cannula processing is effective against P. aeruginosa. A combination of 0.5% dioxidin solution and 10 mg chymotrypsin is effective against S. aureus, A. baumanii and K. pneumoniae.

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Association of Standardized Tracheostomy Care Protocol Implementation and Reinforcement With the Prevention of Life-Threatening Respiratory Events

Cited by 13 publications

References 33 publications

Implementation of an evidence‐based accidental tracheostomy dislodgement bundle in a community hospital critical care unit

Implementation of an evidence‐based accidental tracheostomy dislodgement bundle in a community hospital critical care unit

Hemşireler Trakeostomili Hastaların Bakımını Ne Kadar Biliyor? Nitel Bir Çalışma

Evention of Infectious Complications of Tracheostomy in Patients With Head and Neck Cancer Pathology

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