Managing patients with tracheostomies: Demonstrating our value and striving for high quality care. Ioan Morgan – Highly Specialist Physiotherapist Claire Cahoon – Highly Specialist Speech and Language Therapist.

The Service Based on the Regional Hyper-Acute and Rehabilitation Unit, Northwick Park Hospital, Harrow Level 1 complex specialised rehabilitation service commissioned by NHS England 24 beds primarily for patients with severe complex physical, cognitive, and communication disability, including those in prolonged disorders of consciousness → highly dependent Increasing numbers of patients with tracheostomies over past 12 months

National Context Increased prominence of tracheostomy care - NCEPOD report ‘On The Right Trach’ (2014) and National Tracheostomy Safety Project Published guidelines / care information about tracheostomy management are typically orientated towards patients in acute care. However, our population presents a different set of challenges. There is also little/no published data regarding outcomes in this population. Sign off copy goes here

Current Practice on RHRU Weaning is current led by SLT / PT Nursing staff implement weaning guidelines and make on- line decisions on a daily basis but do not take an active role in decision making process / overall management planning. Decreased confidence among the junior therapy team when working with this population Use of standard documentation – used for all tracheostomy patients throughout the hospital. Sign off copy goes here

Striving for high quality care and measuring our outcomes The evidence gap in the literature, together with observations made at “ground level” led us to: a)Implement a service improvement project b)Develop a system to measure our outcomes Sign off copy goes here

Service improvement project Established tracheostomy working party with key stakeholders Created a weaning guideline for the RHRU patient group Qualitative data collection via learning needs questionnaires to all therapy and nursing staff Review of current documentation used on unit – new documentation developed. Audit of the service against national guidelines (NCEPOD)

Measuring our outcomes Data collected using excel spreadsheet over 11 month period (n = 34) The vast majority of our patients are admitted to the unit with either no history of previous weaning or weaning trials conducted in SLT/PT sessions only. We have achieved decannulation in 65% of patients. Statistical analysis completed by Zi-Wei Liu, Specialist Registrar ENT

Outcomes Sign off copy goes here

Outcomes Sign off copy goes here

Outcomes Sign off copy goes here

Outcomes Sign off copy goes here Effective model of AHP leadership working resulting in: Successful, timely decannulation of complex, long term tracheostomy patients Cost savings in ongoing care Improved inter-professional collaboration (immediate and wider MDT) Our work is in line with key recommendations from NCEPOD report demonstrating safe and effective practice

Where next? Outcome data to be presented at British Academic Conference of Otolaryngology on – recognition that our work is recognised as being innovative in its field. Gain feedback re: weaning protocol – qualitative and quantitative. Implement the use of the new working forms to the department and review. Collaboration with other units. On-going data collection and publication.