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Standard Protocol for Trach Care for CHN

Term 8 EVBD

Charing Ho

on 18 July 2012

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Transcript of Standard Protocol for Trach Care for CHN

Protocol for Tracheostomy
Care for CHNs
in the Community Conclusion AOA By Maria Gonzales, Moe Arbab Hesari,
Charing Ho, Amelia Claassen, David Kang,
Rosie Sidhu & Bin Dai Outline Introduction to Raven Song
Why did we pick this topic?
Hypothesis/ PICOT
Literature Review
Class Discussion
Nursing Implications
Questions Raven Song Community
Health Centre Welcome to... What do we do? Home Visits,
Wound Care,
Chronic Disease Management,
Palliative Care,
and much more! Why did we choose this topic? P : I : C : O : Adult clients with tracheostomy at home Having a standardized nursing protocol Not having a protocol Decreased the number of complications and improve clients safety while receiving tracheostomy care Providing a standardized nursing protocol for tracheostomy care in the community will improve client safety and decrease complications. Hypothesis PROS CONS and (cc) photo by medhead on Flickr ... of Having a Protocol in the Community? What are the... Potential Complications Limitations Lack of research on topic.
Some HCPs believe that it takes away their autonomy/ decision making ability.
In the community, it is difficult to monitor nursing practice. - Research Limitations - Mosby's Unable to access policy outside of agency
Limited number of computers available
Require individuals to have computer skills
Some CHNs are not very willing to work with Mosby's Why is long term or permanent tracheostomy required? Respiratory support
Upper airway obstruction
Impaired swallow reflex (Bowers & Scase, 2007) Wound infection
Hypergranulation to stoma
Chest infection
Aspiration (Bowers & Scase, 2007) Clients need tracheostomy care in the community
RT vs Nursing tracheostomy care protocols
RT's workload
Role of home care nurses Health unit protocols
A standardized VCH tracheostomy care policy & protocol are needed
Three things CHNs need. Literature Review Why do we need a Protocol? Promote clinical excellence and research based practice.
Allow the CHNs to select the terms that best apply in a particular situation to achieve highest quality of client care. Lack of a clear and standardized protocol for CHNs.
Aim to provide safe and efficient delivery of care. (Ireton, 2007; Paul, 2010; Jones, Lunney, Keenan, & Moorhead, 2010) (Paul, 2010) (Nolan et al., 1998; Paul, 2010) What do VCH CHNs have in terms of policies for care for adults with tracheostomy at home? VCH does not have a protocol! Accessing Policies Why Mosby's? Vancouver Coastal Health Before Mosby's guideline manuals.
RCH only site using Mosby's.
The licensing agreement all of FH.
Difference: "Reference only," "RCH Protocol," "FHA procedure" Mosby's: yearly subscription by FHA.
On U.S. server, include demo videos, illustrations, & diagrams.
Regional project - Able to update 8000 nurses.
FH edit Mosby's to reflect Canadian Scope of Practice. Why did FH chose Mosby's? Procedure reference tool.
Almost 1000 nursing skills
Mosby's references
Goals: To standardize healthcare skills/procedures, achieve accreditation goals across FHA & be able to update efficiently. (Fernihough, 2012) Accessing Policies Fraser Health VCH's PolicyNet Advantages Available 24/7 via the intranet.
Policy proposal review contains 3 levels
committee for different areas (ie. one for residential, acute, community)
Can be accessed via FH intranet. Disadvantages Not regularly updated
ie. references come from Potter & Perry, 7th edition
No specific policy implementation team. Policies, guidelines, and references are dispersed throughout the intranet.
Lack standardized policies in some areas (ie. Home care)
Instead, guideline are provided that are also very difficult to find online. Disadventages Cont' Why is having a protocol important to CHNs? Can reduce stress, anxiety, and confusion.
Can help maintain skills & confidence of the CHNs.
CHNs may feel more competent in making decision & identifying clinical issues knowing they are providing evidence-based practice by following the protocol. (Paul, 2010) (Russell, 2010) (Ireton, 2007; Cadogan, Franzi, &Osterweil, 1999; Levin & Lewis-Holman, 2011) Client Safety? CHNs will see stable clients once a month and prn.
It is up to the client to arrange adequate care for the rest of the time.
B.C. has a program called "Choice in Supports for Independent Living (CSIL)."
The cost of the program was $1,459,970 in 2007. (B.C. Ministry of Health Services, 2008) Client Safety? Bucky (2007) found that teaching should be made in a part of protocols.
Proper training of care givers is essential to client safety
Brooks, Gibson, & DeMatteo (2008) from Ontario found proper training of care givers in tracheostomy care resulted in a reduction of re-hospitalisation by 43%. Training VS Competency? (Jones, Lunney, Keenan, & Moorhead, 2010) Leads to better communication, better efficiency in client care. (Jones, Lunney, Keenan, & Moorhead, 2010) Lastly... Nursing Implications for Future Practice There will be:
consistent, competent and safe nursing practice in the community.
a reliable reference for clients and other CHNs to use.
assurance that clients/caregivers will practice evidenced based procedures. More Nursing Implications All the facilities will have access to policies.
Will allow transferable nursing skills throughout the health authorities.
Reduce legal ambiguity. Having a standardized nursing protocol in the community is very important.
Ensure CHNs are using evidenced-based practice with providing client care.
Ensure client/ primary care taker will receive proper and standardized teaching from CHNs. Reference B.C. Ministry of Health services. (2008). Choice in supports for independent living (CSIL) program review. Retrieved from http://www.health.gov.bc.ca/library/publications/year/2008/CSIL_Review_2008.pdf
Brooks, D., Gibson, B., & DeMatteo, D. (2008). Perspectives of personal support workers and ventilator-users on training needs. Patient Education & Counseling, 71(2), 244-250.
Bowers, B., & Scase, C. (2007). Tracheostomy: facilitating successful discharge from hospital to home. British Journal of Nursing , 16(8), 476-479.
Bucky, T. (2007). Managing the airway of the home care patient. American Association for Respiratory Care Times , 31(9), 30-36.
Cadogan M.P, Franzi C, & Osterweil D. (1999). Utilization of standardized procedures in skilled nursing facilities: the California experience... Use of standardized procedures in long-term care. Retrived from http://web.ebscohost.com.ezproxy.langara.bc.ca:2048/ehost/detail?vid=11&hid=107&sid=6800c65e-3f2c-42b4-96f7-f49fcde96a23%40sessionmgr113&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=c8h&AN=1999015802 Hewison, A. (2008). Evidence-based Policy: Implications for nursing and policy involvement. Retrieved June 16, 2012 from http://ppn.sagepub.com/content/9/4/288
Ireton, J. (2007). Tracheostomy suction: a protocol for practice. Paediatric Nursing, 19(10), 14-18.
Jarachovic, M, Mason, M, Kerber, K, & McNett, M. (2011). The role of standardized protocols in unplanned extubation in a medical intensive care unit. Retrieved from http://web.ebscohost.com.ezproxy.langara.bc.ca:2048/ehost/detail?vid=12&hid=107&sid=675bb109-8761-486d-8707-b28849138d24%40sessionmgr115&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=c8h&AN=2011203391
Jones, D., Lunney, M., Keenan, G., & Moorhead, S. (2010). Standardized nursing languages: essential for the nursing workforce. Annual Review Of Nursing Research, 28253-294. doi:10.1891/0739-6686.28.253
Levin, R. F, Lewis-Holman, S. (2011). Developing guidelines for clinical protocol development. Retrieved from http://web.ebscohost.com.ezproxy.langara.bc.ca:2048/ehost/detail?vid=5&hid=107&sid=675bb109-8761-486d-8707-b28849138d24%40sessionmgr115&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=c8h&AN=2011398260 Michelle Fernihough, BsN, RN. Professional Practice and Integration Project Lead for Mosby’s at FHA. Located at the Clinical Policy Office, Surrey. Telephone interview July 3, 2012 @ 1400.
Paul, F. (2010). Tracheostomy care and management in general wards and community settings: literature review. Nursing In Critical Care, 15(2), 76-85. doi:10.1111/j.1478-5153.2010.00386.x
Russel,C. (2005). Providing the nurse with a guide to tracheostomy care and management. British Journal of Nursing. Retrieved from http://web.ebscohost.com.ezproxy.langara.bc.ca:2048/ehost/pdfviewer/pdfviewer?sid=37db7b61-99f0-4845-aa13-2f29cbd4ebf3%40sessionmgr104&vid=9&hid=107
Vardaman, J. M , Cornell, P, Gondo, M.B, Amis, J. M , Townsend-Gervis, M & Thetford, C. (2011). Beyond communication: The role of standardized protocols in a changing health care environment. Retrived from http://web.ebscohost.com.ezproxy.langara.bc.ca:2048/ehost/detail?vid=12&hid=107&sid=675bb109-8761-486d-8707-b28849138d24%40sessionmgr115&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=c8h&AN=2011417725
Zhu, H., Das, P., Brereton, J., Roberson, D., & Shah, R. (2012). Surveillance and management practices in tracheotomy patients. Laryngoscope, 122(1), 46-50. doi:10.1002/lary.22375 (Ireton, 2007)
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