June 2020 Wound and Ostomy Journal Club
An Evidence-Based Interprofessional Collaborative Practice Approach to Decrease Tracheostomy-Related Pressure Injury
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Article 2: An Evidence-Based Interprofessional Collaborative Practice Approach to Decrease Tracheostomy-Related Pressure Injury.
ReplyDeleteThe advantages of this study was the extensive education initiative, teamwork and communication to prevent or treat tracheostomy related PIs. The inter-professional input from RNs, surgeons, and RTs contributed to the effectiveness of the study. Education delivery through to higher chain of command influenced medical staff, and material supplying each post-acute care setting with thee adequate materials such as foam fenestrated dressing heightened the prevention and reduction of current and future PIs. Ultimately, the evaluation and effectiveness and future sustainability of this study reduced and prevented PI in the tracheostomy population.
Describe the method used by the author of the study
Record audit from the entire patient population with a new or existing tracheostomy documentation; and direct observation ensuring proper fenestrated foam dressings beneath the tracheostomy plate, removal of sutures in 7 days, neutral head positioning and skin integrity inspections.
How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteIn comparison to the article, PSJMC's policy with tracheostomy care is to remove sutures 10 days after placement. The article suggests removing sutures by day 7 and utilizing fenestrated foam dressing for preventing pressure injuries. However, PSJMC's policy does not indicate the use of foam for tracheostomies. Most times, the split gauze is utilized for new tracheostomies and are less effective in preventing pressure injuries. Perhaps, making fenestrated foam dressing a standard of practice would help our facility reduce tracheostomy-related pressure injuries.
What are the advantages and disadvantages to the proposed recommendations in the article?
-The advantages of the proposed recommendations in this article include holding all staff members reliable in the prevention of tracheostomy-related pressure injuries. By utilizing an interprofessional, collaboratvive approach, all individuals within the care team are held responsible for ensuring preventative measures in reducing pressure injuries amongst tracheostomies. Effective communication within team members are emphasized and is useful in preventing sentinel/adverse events. The disadvantage of the proposed article include lack of availability of surgeons during the night shift which would hinder nurses from addressing issues regarding tracheostomies during their shift.
ReplyDeleteARTICLE 4: An Evidence-Based Interprofessional Collaborative Practice Approach to Decrease Tracheostomy- Related Pressure Injury.
1. What are the advantages and disadvantages to the proposed recommendations in the article?
In this article they used a framework IPO- inputs, processes and outputs. Where-in the inputs are based on the experience of the team members, difficulty of the task, and external factors such as time limitations; processes included communication and care coordination and outputs are measures in patient outcomes, quality, errors and over-all team performances. This is a very organized system that I appreciate. It creates a clear picture of results of interventions. It is advantageous to monitor the progress or decline of tracheostomy related pressure injury.
2. How does this research article compare to our practice, policy and or procedure?
In our hospital, we do not have this kind of framework in place although it might be of benefit. What we have is communication between respiratory therapist and bedside nurses assessing tracheostomy sites beginning the shift. Photos are obtained for records; Wound Care experts are consulted for recommendations of treatment. Foam dressings , trach care kits , etc. are all available in the unit for tracheostomy care. We have structured skin regimen care in place to treat tracheostomy-related pressure injury and its prevention.
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ReplyDeleteAn Evidence-Based Interprofessional Collaborative Practice Approach to Decrease Tracheostomy Related Pressure Injury
ReplyDeleteHow does this research article compare to our practice, policy and/or procedure?
The objective of this journal is to increase adherence to the program tracheostomy protocol and to decrease tracheostomy related pressure ulcers. Evidence based guidelines were developed with input from all disciplines and an inter-professional study was identified to educate all staff on preventing tracheostomy related pressure injury (TRPI). Tracheostomy care includes the use of fenestrated foam dressing to cushion and protect the skin, suture removal on day seven, and maintaining neutral head position. Compared to PSJMC policy on tracheostomy care, the following must be observed: Initial tracheostomy replacement is performed by the physician. A routine tracheostomy replacement into a healed stoma may be performed by a respiratory care practitioner (RCP) with a physician order. Tracheostomy sutures may be removed 10 days postoperatively. Trach stoma care is performed by a registered nurse each shift and as needed. We use Lyofoam Max-T, a fenestrated foam with each trach care. Tracheostomy tie changes are done daily and is a two person technique.
Describe the method used by the author of the study
An evidence-based guideline was developed with input from all disciplines. This includes the use of fenestrated foam dressing, suture removal by day seven, and maintaining neutral head position. Guidelines and interventions were then implemented on all relevant units. Representatives of each discipline disseminate the education to the peers. Education was conducted through daily huddles and bedside rounding. Evaluation of outcomes were done by wound ostomy nurses. The work group monitored incidents before and after guideline implementation on tracheostomy patients. Data was entered into an Excel spreadsheet. Before implementation, four of 101 had pressure injuries. During implementation, no pressure injury occurred and following implementation, one of 48 patients developed pressure injuries.
Describe the method used by the author of the study.
ReplyDeleteMembers from all relevant disciplines developed an evidence-based guideline consisting of 1)the use of fenestrated foam dressings, 2)suture removal by day 7, and 3)maintenance of the head in a neutral position. The information was disseminated to all members in surgery, respiratory therapy, nurses and doctors via direct discussion, daily huddles, bedside interprofessional rounding, as well as written guidelines, a poster and a document that must be signed. Staff feedback facilitated the process of dressings being stocked on all units as well as surgeons placing the dressing after creating the tracheostomy. The work group and WOC nurses monitored pressure injury (PI) incidence before and after implementation via Excel data.
Was the correct method used? Why or why not?
The correct method was used as evidenced by the fact 100% adherence to the protocol was followed by all staff and no new PIs were noted except for one injury noted to tight sutures. The strengths of the method were one that all disciplines communicated with each other and were involved in creating the guideline to ensure the best outcomes. In addition, a variety of teaching methods were used ranging from discussions to paper documents, addressing the fact that people learn and retain information via different learning modes. Another important aspect is that all staff including those implementing the protocol were given an opportunity for constructive feedback to streamline the process, as well as give all parties ownership of the process and thus make them more invested in a successful outcome.
What are the advantages and disadvantages to the the proposed recommendations I the article?
ReplyDeleteMedical device related pressure injuries such as tracheostomy are painful and costly but can be prevented by implementing prevention guidelines and evidence based practice. Inter-professional collaboration and communications enable each member of health care team understand their role in implementing prevention guideline, thereby promoting patient”s safety and delivering positive patient outcomes.
How does this research article compare to our practice policy and procedure?
PSJMC”s policy states tracheostomy sutures maybe removed 10 days postoperatively as compared to article”s recommendation of 7 days. Lyofoam Max T sterile fenestrated foam dressing and tracheostomy care kits and tracheostomy foam ties are available for tracheostomy dressing. Tracheostomy stoma care is performed byRN each shift and as needed . Tracheostomy tie changes are done by daily and by a two person technique,performed by RN and RCP. Documentation on dressing change and stoma assessment is done by RN in the assessment flowsheet each shift or dressing change. Wound RN consultations are done as needed for tracheostomy pressure injury related treatments.
An Evidence-Based Interprofessional Collaborative Practice Approach to Decrease Tracheostomy-Related Pressure Injury
ReplyDeleteHow does this research article compare to our practice, policy and/or procedure?
Evidence based practice in nursing provides the patient with the highest quality level of care. Combining the interprofessional approach between individuals, nurses, and clinicians, prevents communication failure that may be recognized as a root cause of sentinel events in a clinical setting. Compared to PSJMC policy and procedure, the research article differs regarding tracheostomy suture removal. PSJMC policy states removal at 10 days postoperatively, and the research article states removal at seven days, while maintaining a neutral head position, and utilizing a fenestrated foam dressing to protect and cushion the skin. By implementing these guidelines, it has resulted in the reduction of hospital-acquired tracheostomy related device-related pressure injuries (DRPI). PSJMC policy states that trach and stoma care should be provided daily by a RN, and as needed. Use of a Lyoform Max-T, fenestrated foam should be used with each trach care that is done. Using a two-person technique, a RN and RCP should provide the patient with daily tracheostomy tie changes.
What are the advantages and disadvantages to the proposed recommendations I the article?
The advantage of using evidence-based practice (EBP) in the proposed recommendations, is that patients will ultimately have better outcomes, while increasing patient safety. The article uses a problem-solving, approach to patient care, using teamwork and expertise to complete a task. The team works together to analyze the inputs, processes, and outputs. Disadvantages to the proposed recommendations to the article may include, cost for equipment or supplies, teaching for staff or online learning, review of policy that is currently in place, exhausting ostomy nurse and resources.
How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteAt PSJMC I do not recall any specific instructions on how to prevent tracheostomy related pressure injuries. While my unit receives few tracheostomy patients, those I have cared for I do not recall having seen any preventative foam dressings under the area beneath the device, nor instructing the patient to maintain a neutral head position. I do know that the skin underneath is inspected for breakdown every time trach care is performed. However, I think that the implementation of further standardized techniques to limit risk of skin breakdown could greatly benefit the few trach patients we have.
Discuss the limitations of the article: limited sample size, design flaws, and/or author bias.
The sample was a 450 bed teaching hospital that included a multi ethnic inner city population with units that varied between medsurg, telemetry and ICU. While this sample size is limited to a single facility, I was happy to see that it involved patients of different levels of care. The limitations, as discussed by the study itself, mainly focused on the fact that before the new interventions were implemented, these types of pressure injuries were not being reported. Therefore, there was no way to see if the incidence of pressure injury was reduced by the newly implemented standards.
1. Discuss the sample size used in the article.
ReplyDeleteAll patients with tracheostomy, 101, within the hospital including medical-surgical and intensive care unit, were included in the sample, which is a fair enough sample size within that particular hospital.
2. Discuss the limitations of the article; limited sample size, design flaws, and/or bias.
With the current guidelines, the staffs were diligently following their protocols. Prior to the implementation of current guidelines, the data were limited and has no exact incidence and prevalence of tracheostomy-related pressure injuries. Therefore, only generalization of decreased tracheostomy-related pressure injury could be stated.
Maryliza Chata, RN, BSN, CCRN