Prevention of post-operative pediatric tracheotomy wounds: A multidisciplinary team approach

McEvoy, Timothy P.; Seim, Nolan B.; Aljasser, Abdullah; Elmaraghy, Charles; Ruth, Brenda; Justice, Leslie; Begue, Sarah; Jatana, Kris R.

doi:10.1016/j.ijporl.2017.03.037

Cited by 18 publications

(22 citation statements)

References 8 publications

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“…Formalized multidisciplinary teams can reduce the incidence of tube-related pressure ulcers in pediatric patients [43]. Despite these efforts, pressure ulcers occur nearly 10% of all tracheostomies.…”

Section: Wound Carementioning

confidence: 99%

Update on Pediatric Tracheostomy: Indications, Technique, Education, and Decannulation

Fuller

Wineland

Richter

2021

Curr Otorhinolaryngol Rep

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Purpose of Review Tracheostomy in a child demands critical pre-operative evaluation, deliberate family education, competent surgical technique, and multidisciplinary post-operative care. The goals of pediatric tracheostomy are to establish a safe airway, optimize ventilation, and expedite discharge. Herein we provide an update regarding timing, surgical technique, complications, and decannulation, focusing on a longitudinal approach to pediatric tracheostomy care. Recent Findings Pediatric tracheostomy is performed in approximately 0.2% of inpatient stays among tertiary pediatric hospitals. Mortality in children with tracheostomies ranges from 10–20% due to significant comorbidities in this population. Tracheostomy-specific mortality and complications are now rare. Recent global initiatives have aimed to optimize decision-making, lower surgical costs, reduce the length of intensive care, and eliminate perioperative wound complications. The safest road to tracheostomy decannulation in children remains to be both patient and provider dependent. Summary Recent literature provides guidance on safe, uncomplicated, and long-term tracheostomy care in children. Further research is needed to help standardize decannulation protocols.

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Section: Wound Carementioning

confidence: 99%

Update on Pediatric Tracheostomy: Indications, Technique, Education, and Decannulation

Fuller

Wineland

Richter

2021

Curr Otorhinolaryngol Rep

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“…The interventions started with the initial insertion of a tracheostomy. According to McEvoy et al, 19 “to reduce the number of tracheostomy wounds… [the] wound care regimen begins in the operating room at the time of tracheostomy. Mepilex Lite is used around tracheostomy tube flanges and under the collar to protect the skin.” 19 The surgical teams adapted similar practices by placing a foam dressing under the tracheostomy plate upon insertion and prior to suturing it into place.…”

Section: Methodsmentioning

confidence: 99%

Tracheostomy Thursday: Journey of a Staff-driven COVID-19 Initiative to International Recognition

Gallagher

Torrieri

2022

Adv Skin Wound Care

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OBJECTIVE:To use evidence-based practice and an interprofessional approach to improve outcomes for adult patients with tracheostomies and enhance staff knowledge during the COVID-19 pandemic. METHODS:The core interprofessional Tracheostomy Thursday team included staff nurses, respiratory therapists, and nursing leadership who collaborated with surgeons and materials management staff at an urban academic medical center in New York, the epicenter of the COVID-19 pandemic in the US. The team implemented hospital-wide bedside rounds on all adults with tracheostomies. Skin and safety assessments were performed with peer-to-peer coaching. Data were collected and analyzed to understand areas of improvement. RESULTS:After 6 months of hospital-wide rounding, implementation of a bedside tracheostomy safety checklist, and a continued interprofessional approach, safety measures increased by 48%, and preventive dressing use increased by 24% with improvement in preventing tracheostomy-related medical device-related pressure injuries. The team's work was professionally recognized through institutional policy change, conference poster presentations, and Sigma's international excellence award. CONCLUSION: Bundling an interprofessional approach, staff education, bedside rounds, and standard preventive measures was key to the team's success. A bedside safety checklist fostered team communication and supported direct care nurses in managing individuals with a new tracheostomy.

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“…4 Skin and soft tissue injuries caused by pressure from a tracheostomy have been estimated to occur in 5.5% of total cases, and can be attributed to inadequate moisture management and pressure from the tracheostomy plate and ties. 1,[5][6][7] The literature suggests that there are several elements to a multi-interventional approach to this clinical problem, beginning with clinician awareness of TRPI risk factors. 7,8 Once teams are aware of the risk factors, proactive surveillance detects risk before TRPIs can form.…”

Section: Introductionmentioning

confidence: 99%

“…1,[5][6][7] The literature suggests that there are several elements to a multi-interventional approach to this clinical problem, beginning with clinician awareness of TRPI risk factors. 7,8 Once teams are aware of the risk factors, proactive surveillance detects risk before TRPIs can form. Standardized dressing and care protocols ensure consistent and reliable staff performance, and attention to pressure and moisture target the most common causes.…”

Section: Introductionmentioning

confidence: 99%

An Interprofessional Approach to Preventing Tracheostomy-Related Pressure Injuries

Urquhart

Savage

Danziger

et al. 2022

Adv Skin Wound Care

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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.

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Prevention of post-operative pediatric tracheotomy wounds: A multidisciplinary team approach

Cited by 18 publications

References 8 publications

Update on Pediatric Tracheostomy: Indications, Technique, Education, and Decannulation

Update on Pediatric Tracheostomy: Indications, Technique, Education, and Decannulation

Tracheostomy Thursday: Journey of a Staff-driven COVID-19 Initiative to International Recognition

An Interprofessional Approach to Preventing Tracheostomy-Related Pressure Injuries

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