Congress Abstracts 2004

51

A TRACH IS NOT A TRACH ANYMORE! MANAGEMENT OF TRACHEOSTOMIES IN THE ONCOLOGY PATIENT POPULATION. Alice Pons, RN, BSN, and Mikaela Olsen, RN, MS, OCN^®, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD.

Tracheostomies can be placed in oncology patients for a variety of reasons. Prolonged mechanical ventilation, airway compromise, and airway protection from aspiration, edema, coma, paralysis, and tumors are some examples. Life-threatening complications related to tracheostomies include cannula obstruction and accidental decannulation. Other potential complications include infections, bleeding, pneumothorax, tracheal stenosis, and granulations. Maintaining knowledge and competencies related to tracheostomies in the inpatient and outpatient oncology settings is critical to ensuring that patients with these devices are safe.

The types of tracheostomies encountered from patient to patient can vary greatly. Without a strong knowledge base regarding types, functions, tracheostomy enhancements, care and maintenance, troubleshooting, and emergency management, serious adverse events can occur. Two sentinel events occurred at this institution related to tracheostomies. Root cause analysis of the events was completed showing a deficiency in knowledge related to tracheostomy management, recent advancements, and emergency management.

Using the Plan, Do, Study, Act process, a safety program was developed. The goal was to increase staff knowledge and increase safety regarding tracheostomies. This rapid cycle review process promoted a planned practice change within two months of the event. Staff received education via a 45-minute presentation, a video, and a competency-based skills checklist. Each staff member was observed demonstrating predefined skills necessary for tracheostomy management.

Pre- and post-test measures of staff knowledge were obtained. Annual competency based training is now a standard for all oncology nurses who encounter tracheostomies. This presentation will highlight the necessary components of a comprehensive program for oncology nurses caring for tracheostomies. It will include a thorough review of the different tracheostomies, their management, and recent advances to include percutaneous tracheostomies and speaking valves. The unique aspects of tracheostomy management in the oncology patient will be a focus. Event case studies will be used to demonstrate problems encountered in oncology patients and specific interventions employed to ensure patient safety. Oncology nurses who work with tracheostomies can benefit from thorough education, annual updates, and competency training to ensure safety with these devices.