An Evidence Based An Evidence Based Evaluation of Evaluation of

Tracheostomy Care Tracheostomy Care Practices Practices

Melissa D. Dennis-Rouse Melissa D. Dennis-Rouse RN BSN RN BSN CENCEN

Judy E. Davidson Judy E. Davidson RN MS CCRN FCCMRN MS CCRN FCCM

ObjectivesObjectives

• Discuss the reasons behind doing Discuss the reasons behind doing this this

evidence based projectevidence based project• Review the methods usedReview the methods used• Discuss the results of the projectDiscuss the results of the project

BackgroundBackground

• Adverse outcomes related to Adverse outcomes related to tracheal occlusion and peri-tracheal occlusion and peri-tracheal skin breakdown tracheal skin breakdown stimulated this reviewstimulated this review

MethodsMethods

• An evidence based approach was An evidence based approach was takentaken

• Organizational tracheostomy care Organizational tracheostomy care policies were reviewedpolicies were reviewed

• Literature review was doneLiterature review was done• National experts were surveyedNational experts were surveyed• A geographical survey was done A geographical survey was done • Vendors of tracheostomy supplies Vendors of tracheostomy supplies

were interviewedwere interviewed

Level of evidence Level of evidence (each green triangle represents (each green triangle represents

1 source)1 source)In

tern

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Sta

kehold

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Desc

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Quasi

-Experi

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Random

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Contr

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Meta

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Methods (continued)Methods (continued)

• Subcategories related to Subcategories related to tracheostomy care were queried:tracheostomy care were queried:

• Securing devicesSecuring devices• Sutures and their removalSutures and their removal• Type and choice of dressingsType and choice of dressings• Prevention of skin breakdownPrevention of skin breakdown• Frequency of care and role delineation Frequency of care and role delineation

and suctioningand suctioning

ResultsResults

• The stocked dressing was too The stocked dressing was too

large to fit under sutureslarge to fit under sutures

• Conflicting policies regarding Conflicting policies regarding

tracheostomy care were found tracheostomy care were found • None identified responsibility for performing None identified responsibility for performing

carecare• Respiratory vs Nursing or time standards for careRespiratory vs Nursing or time standards for care

Results Results

• Skin maceration on the neck was Skin maceration on the neck was found on multiple auditsfound on multiple audits

• The type of tie was a problemThe type of tie was a problem

• Nurses and Respiratory Therapists Nurses and Respiratory Therapists were having difficulty providing were having difficulty providing tracheostomy care due to suturing tracheostomy care due to suturing technique and method of securingtechnique and method of securing

Hunt for new more Hunt for new more absorbent dressingabsorbent dressing

• COPA fenestrated foam dressings COPA fenestrated foam dressings were ordered. were ordered. • RTs and RNs were educated about RTs and RNs were educated about

use and benefits if pt has excessive use and benefits if pt has excessive secretions.secretions.

• Recommend use of 3M skin barrier Recommend use of 3M skin barrier with foam to protect skin. with foam to protect skin.

Dressing cost Dressing cost comparisoncomparison

• Item – Cost - QuantityItem – Cost - Quantity• Gauze sponge 4x4-Gauze sponge 4x4- $38.48 Case of $38.48 Case of

30003000• Gauze Drain sponge fenestrated Gauze Drain sponge fenestrated

(for trach) 2x2(for trach) 2x2 -$75.78 Case of 1400-$75.78 Case of 1400• Foam Sponges fenestrated (for Foam Sponges fenestrated (for

trach)trach)

3.5 x 33.5 x 3 $36.18 Case of 50$36.18 Case of 50

ConclusionsConclusions

• A list of practice changes were agreed A list of practice changes were agreed upon by respiratory, nursing and upon by respiratory, nursing and medical staffmedical staff

• New supplies were trialedNew supplies were trialed• Primary responsibility for Primary responsibility for

tracheostomy care was shifted to the tracheostomy care was shifted to the registered nurseregistered nurse

• Policies and procedures were revisedPolicies and procedures were revised• Education was provided to staffEducation was provided to staff

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