To determine whether all elements of the tracheostomy checklist are implemented and documented whenever percutaneous tracheostomy is performed.4
Performance of tracheostomy at the bedside
Preoperative phase:
- Use of appropriate local safety standards for invasive procedures which follow Intensive Care Society/ Faculty of Intensive Care Medicine guidance, including documentation of indication for procedure, staff present and roles, clotting status, airway management plan, anaesthetic record, equipment checklist.4,5
- Appropriate consent has been obtained and documented.
Perioperative phase:
- Time outperformed according to the World Health Organization surgical safety checklist.6
- Use of bronchoscopic/ultrasound guidance when appropriate.7
- CO2 monitoring to confirm placement.7
- Complications and subsequent management.
- Whether a chest x-ray is required and the findings if one is performed.
Postoperative phase:8
- Type of equipment and tracheostomy tube used.
- Postoperative management plan recorded.
- Appropriate equipment to manage an emergency tracheostomy issue is available on the unit.
Is the tracheostomy care package being implemented?
- Analysis of documentation to determine whether the following are regularly implemented:
- Tracheostomy tube is being properly secured and supported; regular wound care of stoma; regular suctioning; humidification device used; cuff pressure monitored and recorded eight-hourly; regular inner- tube cleaning recorded.
- Display of appropriate signage at bedside.
- Tracheostomy weaning and decannulation plan recorded.
- Type and size of tracheostomy tube is clearly recorded.
Departmental and organisational issues
To determine workload and incidence of issues:
- Total number of tracheotomised patients passing through the CCU.
- Percentage of procedures performed in the unit.
- Percentage of procedures performed in theatre.
- Tracheostomy-associated complications recorded.
- Monitoring staff training in tracheostomy related issues (eg leak, blockage, replacement).
- Training for staff.
- Destination of patients on discharge from the CCU with tracheostomy in place.
- Quality of handover to ward concerning further tracheostomy management.
