Practice Innovation Abstracts: Changing the Climate to Prevention Practices for Post Tracheostomy Wound Care

Zoe Carter Bishop, RN, BSN, CWOCN, Inpatient wound care, Mercy Hospital Medical Center, Des Moines, IA
The project’s purpose was to improve the outcomes of post tracheostomy (trach) care of inpatients. The problem identified was the increasing Hospital Acquired Pressure Ulcer (HAPU) injuries related to the post care of this tracheostomy population.

The objectives included:

  • Change the mindset from reactive intervention to team prevention based on six evidence-based references (available upon request) and best practice data.  Key elements included identification of key members and providers of the multidisciplinary team and secure their engagement and commitment to the project. 
  • Reduce variation in practice with standardized post insertion management with minimal complications, and improvement of outcomes with predictable and measurable positive results.  Development of a round table work group facilitated discussion of evidence-based data to minimize and eliminate exposed anecdotal variations in practice.  
  • Improve commitment of bedside staff, patients, and families by reducing fragmentation of care,  elimination of anecdotal practices, and implementation of cost-effective balanced outcomes with improved delivery of care.  

In summary, a change to a prevention focus improved standardization of care with predictable outcomes and reduced pressure injuries related to post trach care. 

Data from a baseline 24 month period identified 252 tracheostomies (ICD-9 codes 31.1 and 31.29) performed. Sixteen percent (n=14) of device related pressure ulcers were related to tracheostomies. Those reported injuries were stage II, III, suspected deep tissue injury (DTI), and unstageable pressure injuries. Since implementation of these strategies, one device related pressure ulcer (N=207 total trach procedures) occurred in the twenty months following implementation of prevention strategies since January 2015. Nursing care protocols and value-added dressing products were updated.  Provider standard orders were developed to include an evidence-based standard of care available through the electronic medical record.