Tracheostomy Care Management

The setting for this evidence-based practice project is an ambulatory care clinic at a tertiary care center in the Middle-East North Africa (MENA) region. Home healthcare options in the country are limited, and providing care at home for children with tracheostomies was not an expectation for families. Historically, families would bring their children to the clinic to tend to all tracheostomy concerns, performing few cares or troubleshooting few issues at home. This added an increased pressure to an already over-booked ENT ambulatory care clinic. Especially during COVID, where all patients needed to received COVID swabs and await results before able to attended appointment times.

Our multidisciplinary team comprises an otolaryngologist – head and neck surgeon, a clinical nurse, a tracheostomy nurse practitioner, respiratory therapist, dietician, and a speech and language practitioner. Our team provides inpatient care and outpatient follow-up for new and chronic tracheostomy patients. Multidisciplinary tracheostomy care team, standardized tracheostomy protocol and policies, family empowerment are the keys in improving quality care for these patients.

Purpose: The purpose of this project is to
• Improve the competence of families in providing home tracheostomy care, including daily cares, troubleshooting and emergency response.
• Decrease the number of outpatient clinic visits for children with tracheostomies.
•    Improve quality of life for patients and families.

Description: The ENT team developed an education program, taking into account the religious norms and cultural considerations of the patients and families in the region. Parents/caregivers were initially assessed for their level of understanding and their individual capabilities. Parent/caregiver teaching included daily tracheostomy care and suction, tracheostomy insertion, use of silver nitrate to address granulation tissue, and responding to emergency situations including tube blockage and emergency tracheostomy change. Parents had to achieve an average of 3 successful demonstrations independently to be signed off as competent. The length of training was average of 2-4 weeks pre- and post-surgery, as it was tailored to meet individual training needs of parents/caregiver.

Evaluation/outcome: 54 out of 61 of our patients are now trained. Instead of coming every 4-6 weeks in clinic, patients are now coming only once every 3-6 months for routine follow-up. Only 5 of our patients are still coming to our clinic for routine monthly change. Very good feedback was received from families about their ability to effectively provide tracheostomy care management at home, and parents felt empowered in managing tracheostomies independently. Average monthly visit for tracheostomy clinic decreased 71.3%, from 61 down to average 17.5 monthly visits, which saves and average of 32.6 hours clinic time per month. Only 1 out of 61 patients had a complication after discharge, with parents unable to reccanulate at home. The patient reported to emergency with no serious complication.

This project demonstrates the feasibility of parental involvement in home tracheostomy care in this region.