Otolaryngologists Reach Consensus on Standardized Care for Tracheostomy Patients

“Everyone participates in developing the policy on things like electronic medical records, tracheostomy care orders, tracheostomy change policy and tracheostomy troubleshooting scenarios,” he said, adding that they used a modified Delphi technique to ensure that the process was truly collaborative and not top down.

Another critical factor was ensuring that everyone’s role on the tracheostomy team was clearly defined, as well as performing ongoing assessments of what works and what doesn’t. Of key importance, he said, is appointing one person to act as coordinator, spokesperson and advocate for the tracheostomy care policy. “In our case, we hired a nurse practitioner to take on that role to educate ancillary staff on an ongoing basis,” he added. This addition, he said, has led to a significant improvement in the standard and efficiency of tracheostomy care, particularly percutaneous tracheostomy, at their institution (see “The Tracheostomy Nurse Practitioner,” p. 9). Since the standardized approach has been in place, the institution’s major complication rate is approaching zero, said Dr. Bhatti, and the minor complication rate has been reduced by one-fourth of what it was prior to implementation of the policy.

Dr. Bhatti said the consensus statement may provide some direction to institutions trying to develop and implement their own standard tracheostomy care approaches. According to Dr. Bhatti, the consensus statement can be useful if institutions ask, “What is our culture and how can we meld our policy with those recommended in the consensus statement so that it is feasible to implement on an ongoing basis?”

According to Dr. Mitchell, the statement highly encourages this approach. “The consensus statement is not institution specific, and having teams that take care of patients with tracheostomy is highly encouraged,” he said, adding that the statement makes suggestions to the team regarding the agreed requirements for looking after a patient with a tracheostomy. The goal of the consensus statement, he emphasized, is not to restrict or dictate care.