Trach Management Protocol

1. Trach Management Protocol “No Trach Left Behind” A Guide to improved patient care Joel Ray RRT Harborview Medical Center Seattle, WA

2. Objectives • Comments in the literature that support using a “Trach Protocol”. • Why Harborview benefits from a protocol • Order sheet review • Overview of Trach Management Protocol (TMP) algorithm. • Future goals

3. Heffner July 1999 John E. Heffner, MD Department of Medicine University of South Carolina • “……..For most medical centers and hospitals (community or academic), the most important task is to organize a group of interested, multidisciplinary people to come up with a guideline or practice protocol”. Respiratory Care: July 1999 VOL 44 No 7

4. John E. Heffner, MD Department of Medicine University of South Carolina “..........The exact elements of the protocol are perhaps less important than having a protocol in place that can be monitored and adjusted on the basis of monitored results”. Respiratory Care: July 1999 VOL 44 No 7

5. April 2005

6. Kent Christopher MD RRTDepartment of MedicineUniversity of Colorado “The tracheostomy tube decannulation process is well suited for therapist-implemented protocols”.

8. Objectives • Comments in the literature that support using a “Trach Protocol”. • Why Harborview benefits from a protocol • Order sheet review • Overview of Trach Management Protocol (TMP) algorithm. • Future goals

9. How Many Trachs a Year? • October 2006 thru October 2007 324 trach patients

10. Who does the trachs at HMC? • Surgery ( 3 teams ) Surgical, percutaneous • Otolaryngology (OTO) surgical • Oral Maxillofacial Surgery (OMFS) surgical • Neuro Critical Care (NCCS) Primarily percutaneous

11. Challenges of variability • Services performing trachs have differing management styles. • Care plans aren’t consistent. • Therapist skill level varies

12. Common problems • Sutures in too long • Inexperienced residents performing first trach change • Variable physician knowledge or follow through

14. Current trach practices • Trach Team: 1) Meets every Tuesday for one hour 2) Consists of RT, Speech Path, Clinical RN Educator 3) the month of January averaged over 20 trachs a meeting

15. Common denominator of HMC trach patients?

16. Respiratory Therapy

19. Getting Started

20. What’s next?

21. Home stretch