Competencies for staff caring for patients with tracheostomies or laryngectomies

Tracheostomy care: competency assessment criteria

COMPETENCY STATEMENT Demonstrates safe practice for patients requiring a tracheostomy and dealing with tracheostomy emergencies
Key skills	Assessment criteria
1. Demonstrates an understanding of the anatomy and physiology of the respiratory system	Identify the main structures of the respiratory system Discuss the position of these structures in relation to their function Discuss the mechanics of respiration Discuss the process of oxygen delivery
2. Describes indications for tracheostomy	Identify reasons for the insertion of a tracheostomy tube Discuss the benefits to the patient Discuss the different techniques used for tracheostomy insertion Describe the investigations that are required prior to insertion
3. Demonstrates and discusses choice of tube	Identify the different tubes available and the reason for the choice of tube Discuss the principles of cuff safety
4. Demonstrates the ability to assist with insertion and can discuss potential complications	Preparation and explanation to the patient as required Discuss issue of consent Assemble the correct equipment and perform safety checks prior to procedure Ensure chest radiograph is ordered and reviewed post insertion (if required) Discuss possible complications following this procedure, for example, pneumothorax, bleeding, tube inserted incorrectly
5. Demonstrates the ability to assist with decannulation and can discuss potential complications	Can state the standards for decannulation Assemble the correct equipment for decannulation Identifies personnel required to assist/support during the procedure Demonstrates the procedure safely and correctly Discuss possible complications following this procedure, for example, ineffective cough, aspiration, exhaustion
6. Demonstrates the ability to perform tracheal suctioning	Identify the need for suction Assemble the correct equipment – including correct size catheters Demonstrate and understand the need for aseptic technique throughout Explain the procedure to the patient Discuss complications and interventions to reduce risk Demonstrate good suction technique Evaluate effectiveness of suctioning Demonstrate correct documentation and reporting as necessary
7. Demonstrates and discusses the nursing care for a patient with a tracheostomy tube	Discuss the importance of humidification Demonstrate the ability to care for tracheostomy tube, including cleaning of inner tube Discuss the care of the stoma, including appropriate selection of dressings and tapes Patient positioning and comfort Discuss issues with communication Discuss the role of speech therapy in assessing the swallow reflex
8. Demonstrates the ability to perform an accurate respiratory assessment with reference to specific tracheostomy checks	Describe the routine respiratory observations and their significance in patient assessment Discuss how these observations alter in respiratory failure Discuss normal blood gas values and how they alter in respiratory failure Assess the effectiveness of respiratory support Demonstrates and understands the measurement of cuff pressures Demonstrates and understands the use of end-tidal CO₂ monitoring
9. Discuss the ‘red flag’ indicators that represent tracheostomy problems	Discuss red flag indicators that represent tracheostomy problems, for example, inability to pass suction catheter, vocalising with cuff up, added sounds, increasing respiratory distress
10. Discuss and demonstrate the use of the emergency equipment needed for a tracheostomy emergency	Assemble the equipment required at the bed side and describe the use Discuss where the emergency equipment and fibreoptic scope are located Discuss their role in an emergency situation Demonstrates understanding of the use of all equipment
11. Demonstrate the emergency algorithm for tracheostomy patients	Able to discuss the algorithm Understands the importance of each step Demonstrates the need to get help immediately Demonstrate the algorithm in a scenario
12. Demonstrate the emergency algorithm for laryngectomy patients	Able to discuss the algorithm Understands the importance of each step Demonstrates the need to get help immediately Demonstrate the algorithm in a scenario
13. Demonstrates correct documentation and reporting as necessary	Refer to local policy or guidelines Use of observation charts Use of nursing documentation Use of bedhead signs Clear, legible, timely documentation

This list has been adapted from the Central Manchester NHS FT guidelines and is available as a PDF from www.tracheostomy.org.uk.

Implementation

The NTSP asked two colleagues who work in large NHS trusts in the North West of England to describe how they have implemented these resources in their trusts. Their accounts describe some of the barriers to implementation and how these were overcome (Figures 11.1 and 11.2).

Figure 11.1 Implementation at LTHTR.