An Evidence Based Evaluation of Tracheostomy Care Practices

Melissa D. Dennis-Rouse RN BSN CEN Judy E. Davidson RN MS CCRN FCCM

Objectives
Discuss the reasons behind doing this evidence based project Review the methods used Discuss the results of the project

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

Methods
An evidence based approach was taken Organizational tracheostomy care policies were reviewed Literature review was done National experts were surveyed A geographical survey was done Vendors of tracheostomy supplies were interviewed

(each green triangle represents 1 source)

Internal Stakeholder Opinions

Expert (External) Opinion Qualitative Research Descriptive Research QuasiExperimental Research Randomized Controlled Trial Systematic Review of Research Meta-Analysis

Level of evidence

Methods (continued)
Subcategories related to tracheostomy care were queried:
Securing devices Sutures and their removal Type and choice of dressings Prevention of skin breakdown Frequency of care and role delineation and suctioning

Results
The stocked dressing was too large to fit under sutures Conflicting policies regarding tracheostomy care were found
None identified responsibility for performing care
Respiratory vs Nursing or time standards for care

Results
Skin maceration on the neck was found on multiple audits The type of tie was a problem Nurses and Respiratory Therapists were having difficulty providing tracheostomy care due to suturing technique and method of securing

Hunt for new more absorbent dressing

COPA fenestrated foam dressings were ordered.
RTs and RNs were educated about use and benefits if pt has excessive secretions.

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

Dressing cost comparison

Item Cost - Quantity Gauze sponge 4x4- $38.48 Case of 3000 Gauze Drain sponge fenestrated (for trach) 2x2 -$75.78 Case of 1400 Foam Sponges fenestrated (for trach) 3.5 x 3 $36.18 Case of 50

Conclusions
A list of practice changes were agreed upon by respiratory, nursing and medical staff New supplies were trialed Primary responsibility for tracheostomy care was shifted to the registered nurse Policies and procedures were revised Education was provided to staff

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References