TRACHEOSTOMY MANAGEMENT TRACHEOSTOMY MANAGEMENT IN THE HOSPICE SETTINGIN THE HOSPICE SETTINGDR JESS BRIGGSDR JESS BRIGGSSPR PALLIATIVE CARESPR PALLIATIVE CARE

Kelly Keane, Ward Sister; Suzie Doe, practice Kelly Keane, Ward Sister; Suzie Doe, practice development; Dr Jo Rogers, Consultant Anaesthesia / development; Dr Jo Rogers, Consultant Anaesthesia /

ICUICU

THE PROBLEMTHE PROBLEM

• Increasing incidenceIncreasing incidence

• Greater patient survivalGreater patient survival

• New equipmentNew equipment

• Increased medical Increased medical specialisationspecialisation

• National guidance - NTSPNational guidance - NTSP

• NAP4NAP4

• Highlight educationHighlight education

IDEAL TRACHEOSTOMY IDEAL TRACHEOSTOMY MANAGEMENT:MANAGEMENT:

• EquipmentEquipment

• Personnel Personnel

• TrainingTraining

• ResourcesResources

• Appropriate Appropriate management for management for patient?patient?

THE REALITYTHE REALITY

SETTING OUT A PLANSETTING OUT A PLAN

• Aim: improve patient Aim: improve patient safety & practitioner safety & practitioner knowledge & confidenceknowledge & confidence

• Ideal vs realityIdeal vs reality

• Short term goalsShort term goals

• Team approachTeam approach

• Gaining supportGaining support

• Focus on educationFocus on educationVisualise Visualise outcomesoutcomes

IDENTIFYING RISKSIDENTIFYING RISKS

ReferrReferralal

WrongWrongTracheostomy Tracheostomy

tubetube

Active Active therapy therapy options options

IdentifyinIdentifyingg

High risk High risk factorsfactors

Staff fear Staff fear & &

perceived perceived limitationslimitations

EducatioEducationn

SupportSupportFocus on Focus on

basic basic skillsskills

AdmissionAdmissionss

Booklet &Booklet & trainingtraining

Referral Referral & &

admissioadmissionn

Equipment Equipment availability availability

& & emergency emergency managemenmanagemen

tt

Basic Basic safety safety

equipment,equipment, algorithm,algorithm,

trainingtraining

INDIVIDUALISED PATIENT PLANSINDIVIDUALISED PATIENT PLANS

• Right patient - right Right patient - right placeplace

• Referral checklistReferral checklist

• Admission detailsAdmission details

• Risk stratificationRisk stratification

• Proactive planningProactive planning

• Decision makingDecision making

• Senior involvementSenior involvement

WHAT IS ACHIEVABLE WHAT IS ACHIEVABLE

EMERGENCY SKILLSEMERGENCY SKILLS

• Focus on basicsFocus on basics

• Transferable skillsTransferable skills

• RepetitionRepetition

• Expert sessionsExpert sessions

• Mandatory TrainingMandatory Training

• Drop in sessions & Drop in sessions & maintenancemaintenance

EQUIPMENTEQUIPMENT

TRAINING DAYSTRAINING DAYS

• 150 (>90%) staff150 (>90%) staff

• Separate days for regional Separate days for regional traineestrainees

• Small groups (12 max)Small groups (12 max)

• Morning: basic knowledge, Morning: basic knowledge, individual used plans, individual used plans, decision making, emergenciesdecision making, emergencies

• Afternoon: workshops Afternoon: workshops

• Feedback:Feedback:

94% excellent94% excellent

6% good6% good

"Brilliant. Makes "Brilliant. Makes you more aware of you more aware of your actions in an your actions in an

emergency emergency situation and less situation and less overwhelmed on overwhelmed on

tackling a tackling a tracheostomy tracheostomy emergency."emergency."

"Before this study "Before this study day I was fearful of day I was fearful of

tracheostomies. tracheostomies. This study day has This study day has

made a big made a big difference and difference and made me feel made me feel

confident"confident"

THE FUTURETHE FUTURE

• Re-auditRe-audit

• Roll out locallyRoll out locally

• Expand?Expand?

WHAT WOULD I CHANGE?WHAT WOULD I CHANGE?

• Have end goal in mindHave end goal in mind

• Planning Planning

• Collecting evidenceCollecting evidence

• Funding Funding

• Broad teamBroad team

ANY QUESTIONS?ANY QUESTIONS?

THANK YOUTHANK YOU