Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Authors (including presenting author) :
Cheng BW, Man HK, Fook SM, Chan ML, Kwan WS, Chan HY
Affiliation :
Department of Surgery, Shatin Hospital
Introduction :
The Department of Surgery at SH provides extended care services for neurosurgical and surgical patients, including those with tracheostomy tubes. Patients with tracheostomy tubes are under the care of the neurosurgery team, and many of them are vegetative or confused. Providing appropriate care for patients with tracheostomy tubes is of utmost importance, especially in emergency situations. From September 2022 to January 2023, there were three incidents related to the dislodgement or pulling out of tracheostomy tubes by patients. It was necessary to take appropriate action to minimize these emergency situations, as they may cause desaturation and even be fatal for tracheostomized patients. After reviewing the existing practices, strategies aimed at providing safe care were established.
Objectives :
-Minimize the rate of tracheostomy tube dislodgement.
-Enhance the knowledge and competence of staff in handling emergency situations involving patients with tracheostomy tubes.
Methodology :
-Enriching the related knowledge of ward nurses, especially those who recently joined, through educational talks on tracheostomy care and emergency procedures. Regular talks will be conducted twice per year.
-Reviewing the existing equipment, including the emergency kits set and tracheostomy tube holders:
1.Increasing the number of emergency kits sets available from 1 to 2 for each ward. These kits contain equipment, such as spare tracheostomy tubes, for use in emergencies, particularly during patient escorts.
2.Adopting a new brand of tracheostomy tube holder that is more durable and less prone to over-stretching. The new holder is colored shocking blue, making it more noticeable and facilitating easier observation.
-Seeking expertise support for patient care by arranging regular on-site support from the NTEC Nurse Consultant (ENT NC). Monthly rounds for patients with tracheostomy tubes by the NTEC ENT NC were also initiated.
Result & Outcome :
Reuslts:
1.There were no incidents related to tracheostomy tube dislodgement reported from January 2023 to January 2024.
2.All 27 ward nurses (all surgical wards) agreed that they felt confident in handling patients with tracheostomy tubes, even in emergency situations. The provided education talks delivered up-to-date knowledge that proved to be highly useful.
Outcomes: In conclusion, the implementation of strategies aimed at providing safe practices for patients with tracheostomy tubes in the Department of Surgery at SH has yielded positive results. The rate of tracheostomy tube dislodgement incidents has been effectively minimized, with no reported incidents from January 2023 to January 2024. The initiatives to enhance staff knowledge and competence have been successful, including educational talks and regular training sessions. Improvements in equipment, such as increased availability of emergency kits and the adoption of a durable tracheostomy tube holder, have contributed to better patient care. The provision of on-site support by ENT NC and monthly rounds for tracheostomy patients has further enhanced safety. Overall, these measures have instilled confidence in the ward nurses, ensuring the effective management of patients with tracheostomy tubes, particularly during emergency situations.
