Authors (including presenting author) :
Tsang WL (1), Ho YK (1), Yung HC (1), Mak WL (1), Chang ST (1), Wong KY (1)
Affiliation :
(1) Department of Surgery, United Christian Hospital
Introduction :
Knowledge deficit and a lack of attention can contribute to airway mismanagement. An institutionally supported and coordinated approach to the whole process of airway care significantly reduced the incidence of airway-related morbidity and mortality and shielded the institutions and health care professionals from medical liability.
Objectives :
(1) To review, discuss and recommend strategies to enhance the safety and quality of care for surgical patients with advanced airway, temporary tracheostomy and end tracheostomy; and
(2) To discuss and formulate internal references on advanced airway and tracheostomy care based on international recommendations, COC guidelines and departmental needs.
Methodology :
Throughout the years, the working group has achieved certain key milestones in quality airway care:
(1) Introducing novel airway care equipment
A number of novel airway care equipment including heated humidifier are introduced to the department so as to promote patient comfort, reduce mucus plug formation, prevent crusting in airway, maintain airway patency and ease the workload of frontline nursing staff.
(2) Standardizing bedside tracheostomy care practice
To standardize bedside tracheostomy care practice within the department, tracheostomy care order, tracheostomy sizing charts and quick reference on tracheostomy decannulation/capping procedure have been formulated for clinical use and easy reference.
(3) Accelerating emergency tracheostomy response
With reference from international recommendations and COC tracheostomy safety guideline and local experience, signages for both temporary tracheostomy and permanent tracheostomy have been adopted and implemented for clinical use. These signages aim to accelerate response of clinicians and frontline nursing staff to distinguish the type of tracheostomy that the patient has so as to effectively and efficiently provide appropriate treatment during emergency situations.
(4) On-the-job trainings
Detailed in-house trainings on both temporary and end tracheostomy management has been continuously delivered to frontline nursing staff and healthcare assistants.
(5) Patient Information Board
To alleviate both patients’ and relatives’ concerns and stress, a patient information board was developed and exhibited inside ward area.
Result & Outcome :
Positive feedbacks have been received from both senior management, surgeons and frontline nursing staff and healthcare assistants. Evaluations showed that staff awareness on tracheostomy safety and knowledge and skills on tracheostomy care have been significantly increased. Clinical units which lack appropriate infrastructure and trainings may result in adverse consequences. Making truly meaningful improvement is essential to maintain a safe, efficient and high-morale team.
