National Tracheostomy Safety Project Brendan McGrath University Hospital of South Manchester, Wythenshawe

National Tracheostomy Safety Project Introduction

What is it? Accessible, multi-disciplinary, educational resources for medical, nursing & allied health staff Simple algorithms for dealing with tracheostomy emergencies Training package – Web-based resources – ‘just in time’ – RCoA eLA e-Learning modules – Optional courses (with simulation) Equipment standardisation

Why is it needed? NPSA data Over 5000 tracheostomies per year Over 600 tracheostomy incidents per year 60-70% of incidents result in some harm – Depending on location – 32 deaths reported in 2006/7 Limitations of a voluntary reporting system 1 1. Sari B, BMJ, 2007;334: 79-82

Why is it needed? Why us? 4 trachy-related deaths in Manchester ICU/HDU Prompted regional survey Research with NPSA 1,2,3 – Recurring themes NAP 4 has picked up ICU Airway Incidents HM Coroner 1. Thomas & McGrath Anaesthesia Apr;64(4):358-65, 2.McGrath & Thomas PMJ Sep; 86(1019): McGrath & Thomas British J Anaesthesia 2010 (in press)

Why is it needed? It is unacceptable for a patient with a tracheostomy to come to harm due to – A lack of staff education Eg not attempting standard oral airway manoeuvres in an emergency with an obstructed trachy Confusion with laryngectomies – A simple lack of equipment

What are you going to do in an emergency?

Must be some guidance?

NPSA 2005 – Highlighted need for appropriate staff & equipment ICS 2008 – Standards of care NPSA 2009 (never published) – Safer practice notice – Environment, risk assessment, training, equipment Other – Individual UK Trusts (St George’s) – International UK National Guidance to date

The ICS guidance 2008 Review date July 2011 Emergency management section

What have we done? Regional multi-site multi-disciplinary working party

Information resource On-line Interactive Comprehensive ‘One-stop shop’

Defining competencies What knowledge & skills are required to – Insert tracheostomies – Care for patients with a tracheostomy – Manage tracheostomy emergencies Immediate emergency care Advanced interventions Allow us to target appropriate teaching

Simple bedside information Similar to ‘Nil by Mouth’ signs at the patient bed-head This patient has – A TRACHEOSTOMY – A LARYNGECTOMY – Essential information required by NPSA / ICS Simple emergency algorithms

Emergency Algorithms Working party – Tested and refined over 3 years – Hi-Fi Simulation and Clinical roll-out – Version 10 – Over 40 Faculty Anaesthesia & Critical Care ENT, MaxFax Experienced & Specialist Nursing staff Physiotherapy, Speech Therapy Resus council UK

Collate the existing and unpublished guidance into a ‘one-stop-shop’ tracheostomy resource Invitation: comment or get involved – – – DAS and ICS websites

Thank you