Transcript Region-wide Tracheostomy Training - NTSP

National Tracheostomy Safety Project
Brendan McGrath
University Hospital of South Manchester, Wythenshawe
National Tracheostomy Safety Project
Introduction
What is it?
• Accessible, multi-disciplinary, educational resources
for medical, nursing & allied health staff
• Simple algorithms for dealing with tracheostomy
emergencies
• Training package
– Web-based resources – ‘just in time’
– RCoA eLA e-Learning modules
– Optional courses (with simulation)
• Equipment standardisation
Why is it needed? NPSA data
• Over 5000 tracheostomies per year
• Over 600 tracheostomy incidents per year
• 60-70% of incidents result in some harm
– Depending on location
– 32 deaths reported in 2006/7
• Limitations of a voluntary reporting system1
1. Sari B, BMJ, 2007;334: 79-82
Why is it needed? Why us?
• 4 trachy-related deaths in Manchester ICU/HDU
• Prompted regional survey
• Research with NPSA1,2,3
– Recurring themes
• NAP 4 has picked up ICU Airway Incidents
• HM Coroner
1. Thomas & McGrath Anaesthesia. 2009 Apr;64(4):358-65,
3. McGrath & Thomas British J Anaesthesia 2010 (in press)
2.McGrath & Thomas PMJ. 2010 Sep; 86(1019): 522-5
Why is it needed?
• It is unacceptable for a patient with a
tracheostomy to come to harm due to
– A lack of staff education
• Eg not attempting standard oral airway manoeuvres in
an emergency with an obstructed trachy
• Confusion with laryngectomies
– A simple lack of equipment
What are you going to do in an
emergency?
Must be some guidance?
UK National Guidance to date
• NPSA 2005
– Highlighted need for appropriate staff & equipment
• ICS 2008
– Standards of care
• NPSA 2009 (never published)
– Safer practice notice
– Environment, risk assessment, training, equipment
• Other
– Individual UK Trusts (St George’s)
– International
The ICS guidance 2008
Review date July 2011
Emergency management section
What have we done?
Regional multi-site
multi-disciplinary
working party
Information resource
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On-line
Interactive
Comprehensive
‘One-stop shop’
Defining competencies
• What knowledge & skills are required to
– Insert tracheostomies
– Care for patients with a tracheostomy
– Manage tracheostomy emergencies
• Immediate emergency care
• Advanced interventions
• Allow us to target appropriate teaching
Simple bedside information
• Similar to ‘Nil by Mouth’ signs at the patient
bed-head
• This patient has
– A TRACHEOSTOMY
– A LARYNGECTOMY
– Essential information required by NPSA / ICS
• Simple emergency algorithms
Emergency Algorithms
• Working party
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Tested and refined over 3 years
Hi-Fi Simulation and Clinical roll-out
Version 10
Over 40 Faculty
Anaesthesia & Critical Care
ENT, MaxFax
Experienced & Specialist Nursing staff
Physiotherapy, Speech Therapy
Resus council UK
www.tracheostomy.org.uk
• Collate the existing and unpublished guidance
into a ‘one-stop-shop’ tracheostomy resource
• Invitation: comment or get involved
– www.tracheostomy.org.uk
– Email: [email protected]
– DAS and ICS websites
Thank you
www.tracheostomy.org.uk