Objectives:
Physiotherapists of patients who have a tracheostomy in situ and who require rehabilitation are often uncertain around what equipment should be available to ensure maximal safety in the event of an emergency. Clinical guidelines and optional on-site training recommend that emergency equipment must accompany these patients at ALL times, and recommend additional equipment that must be accessible at their bedsides.
The objectives of this audit were:
To identify how aware inpatient physiotherapist at the survey site were of current clinical guidelines and the local policy.
To identify what current practice was in relation to equipment for during treatment and transport of the patient.
To identify any issues that may limit access to gym based rehabilitation.
Methods:
The St Georges Tracheostomy guidelines, the intensive Care Society standards and guidelines, and the local tracheostomy care guidelines were studied by the author.
A questionnaire was developed and administered to 25 staff members, including all staff grade physiotherapists and only senior inpatient physiotherapists.
Questionnaires were returned anonymously.
Date was distracted directly by the author
Results:
All 25 participants completed the questionnaire, each having experience of treating a patient with a tracheostomy. 15/25 staff were familiar with tracheostomy clinical guidelines with 52% of participants being aware of the local Tracheostomy Care Guidelines and 3/25 staff being aware of the St Georges Tracheostomy Guidelines.
24/25 participants had mobilised a patient with a tracheostomy on the ward, with 5 of these participants advising they brought the emergency equipment tray.
Less than half of staff had taken patients off the ward to assess on stairs with 1 person bringing the emergency tray.
72 % of participants reported having treated patients at gym level. 10/18 staff advised the porter on what equipment must accompany the patient, although most participants do expect the emergency equipment tray (14/18) and portable suctioning facilities(13/18) to accompany the patient on transport.
Equipment such as oxygen therapy, suctioning facilities and protective wear are often sourced from adjacent wards, the gym or the patients ward.
Concerns regarding the accessibility of suction equipment in particular were noted by 5 participants, sometimes resulting in patients being denied access to the gym.
Conclusion:
The findings advise that there was a lack of awareness of clinical tracheostomy care guidelines within the inpatient physiotherapy staff at the survey site, resulting in poor compliance with same.
There was a large variation in clinical practice in relation to what equipment accompanies a patient with a tracheostomy, with only small numbers of participants sourcing emergency equipment for treatments and for transport to the gym.
An absence of equipment accompanying a patient with a tracheostomy has the potential to drastically compromise patient safety in the event of an emergency.
A learning need was identified for the inpatient physiotherapy staff to familiarize themselves with tracheostomy care guidelines at area induction and to attend on-site training. Interventions were implemented to ensure the correct emergency equipment is available when treating patients with a tracheostomy.
References:
Intensive Care Society, (2014). Standards for the care of acute adult patients with a temporary tracheostomy; STANDARDS AND GUIDELINES. [online] London: Intensive Care Society. Available at: http://www.ics.ac.uk/ICS/guide... [Accessed 20 Oct. 2016].
stgeorges.nhs.uk, (2016). Tracheostomy Guidelines / St Georges Healthcare. [ online ] Available at: https://www.stgeorges.nhs.uk/gps-and-clinicians/clinical-resources/tracheostomy-guidelines/ [ Accessed 20. Oct 2016].
Ethical Approval:
Not required as this audit did not involve patient intervention.
