Emergency tracheostomy management: Are we appropriately trained?
The aim of this audit was to assess the level of competency and adequacy of training, among the nursing staff in Royal Derby Hospital Intensive Care Unit and compare it to the national guidelines [1, 2]. The tracheostomy equipment availability, as well as the bedside presence of the emergency management algorithms were also assessed and compared to the national guidelines. Methods Bedside data collection was performed from 10 April 2017 to 24 April 2017. Twenty bedside assessments of appropriate equipment and algorithm leaflet availability were performed. Each nurse caring for an individual patient answered a 'competency questionnaire' regarding tracheostomy management during an Emergency. Their level of training as well as time intervals since the last training session were determined. Results All surveyed staff had in-house teaching and bedside training, 30% had a formal course and only 75% had a competency assessment. Time intervals since the last training were very variable, ranging from less than 1 year up to 18 years. All bedside elective and emergency equipment was available, except from the daily tracheostomy checklist. Bedside algorithms were not available in any of the 20 cases. Eighty percent of staff were not aware about the emergency management algorithms and 100% of them admitted their willingness to attend a refresher teaching session on emergency management of tracheostomy. Discussion Although training had been given to all nursing staff who looked after tracheostomy patients, the level of training was very variable and inconsistent. Nursing staff should keep skills and knowledge up to date through regular teaching sessions and competency assessments. Bedside emergency equipment was available at all times but completion of a daily tracheostomy checklist at the beginning of every shift can guarantee maintenance of safe practice. The algorithms should be coupled with bed-head signs, allowing essential information to be clearly displayed and immediately available to responders in an emergency, Including key details, the nature and date of the tracheostomy, method of forming the stoma and the function of any stay sutures. As a result of the audit finding, nurses' training has been reviewed, a regular teaching programme has been scheduled and a tracheostomy checklist has been initiated.