Competencies for staff caring for patients with tracheostomies or laryngectomies

Tracheostomy care: competency assessment criteria

COMPETENCY STATEMENTDemonstrates 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 systemDiscuss the position of these structures in relation to their functionDiscuss the mechanics of respirationDiscuss the process of oxygen delivery
2. Describes indications for tracheostomy	Identify reasons for the insertion of a tracheostomy tubeDiscuss the benefits to the patientDiscuss the different techniques used for tracheostomy insertionDescribe 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 tubeDiscuss 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 requiredDiscuss issue of consentAssemble the correct equipment and perform safety checks prior to procedureEnsure 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 decannulationAssemble the correct equipment for decannulationIdentifies personnel required to assist/support during the procedureDemonstrates the procedure safely and correctlyDiscuss possible complications following this procedure, for example, ineffective cough, aspiration, exhaustion
6. Demonstrates the ability to perform tracheal suctioning	Identify the need for suctionAssemble the correct equipment – including correct size cathetersDemonstrate and understand the need for aseptic technique throughoutExplain the procedure to the patientDiscuss complications and interventions to reduce riskDemonstrate good suction techniqueEvaluate effectiveness of suctioningDemonstrate correct documentation and reporting as necessary
7. Demonstrates and discusses the nursing care for a patient with a tracheostomy tube	Discuss the importance of humidificationDemonstrate the ability to care for tracheostomy tube, including cleaning of inner tubeDiscuss the care of the stoma, including appropriate selection of dressings and tapesPatient positioning and comfortDiscuss issues with communicationDiscuss 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 assessmentDiscuss how these observations alter in respiratory failureDiscuss normal blood gas values and how they alter in respiratory failureAssess the effectiveness of respiratory supportDemonstrates and understands the measurement of cuff pressuresDemonstrates 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 useDiscuss where the emergency equipment and fibreoptic scope are locatedDiscuss their role in an emergency situationDemonstrates understanding of the use of all equipment
11. Demonstrate the emergency algorithm for tracheostomy patients	Able to discuss the algorithmUnderstands the importance of each stepDemonstrates the need to get help immediatelyDemonstrate the algorithm in a scenario
12. Demonstrate the emergency algorithm for laryngectomy patients	Able to discuss the algorithmUnderstands the importance of each stepDemonstrates the need to get help immediatelyDemonstrate the algorithm in a scenario
13. Demonstrates correct documentation and reporting as necessary	Refer to local policy or guidelinesUse of observation chartsUse of nursing documentationUse of bedhead signsClear, 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.