Ward skills lacking for tracheostomy care, warns major review
Many ward nurses have been left without the skills and knowledge to care for patients that undergone tracheostomies, potentially putting lives at risk, a report has warned.
A range of concerns, including a lack of training for staff on general wards, were highlighted last week by the National Confidential Enquiry into Patient and Outcome and Death. It gathered data from all hospitals that perform tracheostomies in the UK, except for Scotland.
“I was really surprised at how much we weren’t doing correctly”
NCEPOD highlighted the crucial role of nurses in providing ongoing care for tracheostomy patients, but found many did not have the right training to provide it, or deal with common emergencies. More than a quarter of hospitals did not give staff training on dealing with a blocked airway, while only around half offered training on difficult tube changes.
Catherine Plowright, a consultant nurse in critical care at Medway Foundation Trust, was one of the expert group involved in the NCEPOD review. She said the findings affected “nurses at every single level in an acute organisation”, from the “moment a patient has a tracheostomy put in, to the moment that tracheostomy comes out”.
NCEPOD found at least 12,000 were carried out each year – many in critical care wards as opposed to operating theatres. The review team had been taken aback at the sheer number of tracheostomies undertaken in critical care, said Ms Plowright.
Their report also revealed widespread problems with the care of tracheostomy patients, with good practice followed in only around 40% of cases. The most common issues related to the management of cuffed tracheostomy tubes, monitoring and taking people off tubes.
“I was really surprised at how much we weren’t doing correctly,” said Ms Plowright. “We’re putting in tracheostomy tubes that for a lot of patients are not the right ones, not the right size, not the right length, not the right type.”
She warned these kinds of errors, plus poor ongoing and aftercare, could lead to patients needing further procedures, a prolonged hospital stay and in the worst cases death.
In particular, the report highlighted the dangers of unplanned or night time discharges from critical care for patients with a new tracheostomy or one that has just been removed.
The NCEPOD report called for trusts to provide mandatory training on tracheostomy care and said all bedside staff must be competent in recognising and managing complications.
Ms Plowright said: “There will be some education around tube sizes needed… but there are training packages out there, so we just have to do it.”
She added: “Taking the tubes out is almost as important as putting the tubes in. Critical care outreach nurses have a key part to play with patients out on the general wards.”
Read the full NCEPOD report – Tracheostomy Care: On the Right Trach?