Safe Tracheostomy Care

Multidisciplinary team involvement is particularly relevant for the care of patients with tracheostomies and laryngectomies, as they tend to have more complex and evolving needs and a longer length of stay. In this video we see how The Royal London Hospital Trachy Team at Bart’s Health, led by Dr Helen Drewery, Consultant Anaesthetist, approaches the safe care of patient with tracheostomies.

A multidisciplinary team (MDT) approach to the care of patients with tracheostomies ensures that interventions are coordinated and results in improved outcome and length of stay.

The team typicallly comprises clinicians from the various specialties involved e.g. anaesthesia, ear, nose and throat (ENT), head and neck, speech and language therapists (SLT), physiotherapy, dietetics and nursing, from both the ward area and critical care outreach. The team composition can be adapted according to the patient’s evolving needs. Centres which have provided MDT approach in comparison to their own previous practice have experienced a reduced time to decannulation; when run in conjunction with regular teaching and audit of practice, it has resulted in lower rates of complications, such as blockage or displacement.

The Report by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) – On The Right Trach? (2014)[1] looked to identify areas for improvement in the care of patients who undergo a tracheostomy or a laryngectomy. Their website offers a number of resources outlining the best practice reccomendations generated by the report.

Simple interventions such as teaching and education tailored to the settings have been shown to have a great impact in improving tracheostomy care at a global level, as reported in these articles from Rwanda [2] and the UK [3], [4].

How is tracheostomy care organised in your workplace? Considering what you have learned so far in the course, how do you think care of tracheostomy and laryngectomy can be made safer for your patients? What simple measures can be adopted?

In this article you can find the multidisciplinary consensus recommendations for safe tracheostomy care during the COVID‐19 pandemic: the NHS National Patient Safety Improvement Programme (NatPatSIP).

References

1. Report by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) – On The Right Trach? (2014)[1]
2. ML Sandler, N Ayele, I Ncogoza, S Blanchette, et al. Improving Tracheostomy Care in Resource-Limited Settings. Ann Otol Rhinol Laryngol. 2019 Oct 21.
3. B McGrath et al. Evaluating the quality improvement impact of the Global Tracheostomy Collaborative in four diverse NHS hospitals. BMJ Qual Improv Rep. 2017 May 23;6(1)
4. P Twose P, G Jones, J Lowes , P Morgan. Enhancing care of patients requiring a tracheostomy: A sustained quality improvement project. J Crit Care. 2019 Aug 29;54:191-196.