New guideline improves adult tracheostomies

Reduces patient care delays, new Trach Team TOC

Situation: Salem Hospital needed a new hospital-wide guideline* for adult tracheostomies; this has been created, along with a new Trach Team.

Background: Despite using resources such as Lippincott ("Tracheostomy and ventilator speaking valve use" and "Tracheostomy discontinuation and decannulation”) and the creation of an order set, there continued to be inconsistencies regarding trach management/weaning across disciplines/providers.

This led to delays in care for patients in relation to cuff deflation, PMV trials, communication and dysphagia intervention, weaning, decannulation and suture removal. Beginning in earnest in late autumn 2024, an interdisciplinary trach team group was formed. The group consisted of providers (pulmonology and TRACS), RT, SLP and nurses.

This group created a tracheostomy guideline to address patient care in relation to the above-mentioned aspects of tracheostomies. This group also created a Trach Care Team, which will round weekly on all trach patients to ensure all aspects of tracheostomy care are reviewed and care plans are updated.

Assessment: The Tracheostomy guideline is completed and the format of the Trach Team standard work is now in a test-of-change (TOC). A smartphrase “trachteamrounds” is written, but as we progress, we invite suggestions for changes.

Recommendations:

1. The Trach Team rounds every Tuesday from 13:00 to 13:30. Intensivist #2 will be the lead provider. There is a set format for the rounding, with the provider introducing the case, then the RT, SLP and nursing providing their disciplines content. This will be done through a Microsoft Teams meeting with options for virtual or in the 4E-Multipurpose Room.
2. As mentioned, recommendations will be documented in a smartphrase called “trachteamrounds.”
3. Tuesday, April 1, was the first go-live TOC date.

* The Tracheostomy guideline will be available on The Hub under “Tools and Resources” and “Policies” once it’s approved by all stakeholders (Salem Health intranet access required). Watch for an update in Common Ground.