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TRACHEOSTOMY MANAGEMENT IN THE HOSPICE SETTING DR JESS BRIGGS SPR PALLIATIVE CARE Kelly Keane, Ward Sister; Suzie Doe, practice development; Dr Jo Rogers, Consultant Anaesthesia / ICU
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THE PROBLEM Increasing incidence Increasing incidence Greater patient survival Greater patient survival New equipment New equipment Increased medical specialisation Increased medical specialisation National guidance - NTSP National guidance - NTSP NAP4 NAP4 Highlight education Highlight education
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IDEAL TRACHEOSTOMY MANAGEMENT: Equipment Equipment Personnel Personnel Training Training Resources Resources Appropriate management for patient? Appropriate management for patient?
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THE REALITY
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SETTING OUT A PLAN Aim: improve patient safety & practitioner knowledge & confidence Aim: improve patient safety & practitioner knowledge & confidence Ideal vs reality Ideal vs reality Short term goals Short term goals Team approach Team approach Gaining support Gaining support Focus on education Focus on education Visualise outcomes
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IDENTIFYING RISKS Referra l WrongTracheostomytubeActivetherapyoptionsIdentifying High risk factors Staff fear & perceivedlimitations EducationSupport Focus on basic skills Admissions Booklet & training training Referral & admission Equipment availability & emergencymanagement Basic safety equipment, algorithm, algorithm,training
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INDIVIDUALISED PATIENT PLANS Right patient - right place Right patient - right place Referral checklist Referral checklist Admission details Admission details Risk stratification Risk stratification Proactive planning Proactive planning Decision making Decision making Senior involvement Senior involvement
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WHAT IS ACHIEVABLE
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EMERGENCY SKILLS Focus on basics Focus on basics Transferable skills Transferable skills Repetition Repetition Expert sessions Expert sessions Mandatory Training Mandatory Training Drop in sessions & maintenance Drop in sessions & maintenance
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EQUIPMENT
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TRAINING DAYS 150 (>90%) staff 150 (>90%) staff Separate days for regional trainees Separate days for regional trainees Small groups (12 max) Small groups (12 max) Morning: basic knowledge, individual used plans, decision making, emergencies Morning: basic knowledge, individual used plans, decision making, emergencies Afternoon: workshops Afternoon: workshops Feedback: Feedback: 94% excellent 6% good "Brilliant. Makes you more aware of your actions in an emergency situation and less overwhelmed on tackling a tracheostomy emergency." "Before this study day I was fearful of tracheostomies. This study day has made a big difference and made me feel confident"
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THE FUTURE Re-audit Re-audit Roll out locally Roll out locally Expand? Expand?
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WHAT WOULD I CHANGE? Have end goal in mind Have end goal in mind Planning Planning Collecting evidence Collecting evidence Funding Funding Broad team Broad team
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ANY QUESTIONS? THANK YOU
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