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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?
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
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
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"
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