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CLINICAL PATHWAY
ADULT TRACHEOSTOMY CARE
Inclusion criteria: All Adult patients admitted to hospital with
Tracheostomy
All Adult patients who acquire a tracheostomy
during their hospitalization
Date/Time Pathway Initiated: ____/____/____ ___________ hrs
Date Tracheostomy inserted: _________ Pathway Initiated by Dr. ____________
Clinical Pathways are not considered a substitute for professional judgement.
Phase: Entry Phase Intermediate Phase Maintenance Phase
Date:
Patient Maintain patient airway Clinical Indicator #2: Patient/family able to perform
Outcomes Free from obvious signs of Decannulation occurs? (ENT) care?
LY
Infection Yes No Yes No
Assessment from Trach Team If yes, able to demonstrate the
complete as follows: If Yes following care interventions:
ENT _____ date and time: ____/____/______hrs
Pathway completed: _____ Suctioning
PT _____
If No, lowest maintenance Dressing changes
RT _____ accomplished (ENT) __________ Inner cannula change/cleaning
N
RD if tube feeding _____ Emergency equip
SLP for communication _____ Assessment completed by: Suction machine
SLP for oral intake __________ Suction tubing
Accessories in place _____ Catheters
O
RD for oral intake ___________
Saline
Hydrogen peroxide
Clinical Indicator #1:
CE
Method of communication
identified? (RN/SLP)
Yes No
All outcomes achieved?
If YES, method? _________________
Yes No
N
_________________________________ Signature: ______________________
Patient/family teaching related Communication systems in Communication systems in
Teaching to type of Trach and care place _____ place _____
RE
required _____ Reinforce patient/family teaching Demonstrates ability to manage
Communication systems in of trach care: Trach care:
place ______ Inner cannula cleaning/changing Inner cannula cleaning _____
_____ Suctioning _____
Suctioning _____ Dressing change _____
FE
Dressing change _____ Maintaining
Maintaining humidification: ____ humidification: _____
Discharge Progress towards cuffless Trach Progress towards cuffless Trach Arrangements made for
Planning or decannulation ______ or decannulation _____ maintainence care: _____
RE
Criteria Referral to SW as Referral to SW if placement
appropriate _______ required _____ Referrals to:
Referral to CCAC as SW: _____
appropriate _____ CCAC: _____
If decannulation does not occur
progress to maintenance
phase _____
60500 D HR (July/2008) Page 1 of 2
Pathway Reviewed with
Patient/Family (Initial): _______ Yes _______ No _______ Yes _______ No _______ Yes _______ No
Signatures: Initials Initials Initials
_________________ ________ _________________ ________ _________________ ________
_________________ ________ _________________ ________ _________________ ________
_________________ ________ _________________ ________ _________________ ________
_________________ ________ _________________ ________ _________________ ________
_________________ ________ _________________ ________ _________________ ________
_________________ ________ _________________ ________ _________________ ________
CLINICAL PATHWAY
ADULT TRACHEOSTOMY CARE
CLINICAL PATHWAY
ADULT TRACHEOSTOMY CARE
Clinical Pathways are not considered a substitute for professional judgement.
Phase: Entry Phase Intermediate Phase Maintenance Phase
Date:
Assessments ABC's Trach dependency determined Comm. modalities as appropriate
Type of trach, size and accessories Assessment by ENT prior to corking Refer to Manull III
Stage of trach Swallowing function assessed P&P Tracheostomy care
Establish when trach last changed following tolerance of cuff Oral Hygiene assessment
Consciousness / Co-morbidities deflation Quality and quantity of
P/F understanding & participation Assess for speaking valve secretions
in care (SLP+RT)
LY
Care requirements NOTE: DO NOT
Needs assessment
perform swallow assessment if
Bowel/Bladder status
Fome cuff
Comm. modalities as appropriate
Comm. modalities as appropriate
Consults Trach Team via Order Entry SLP Skin care team as required
N
ENT, PT, RT, RD, RT RT
CCAC, SLP ENT SLP
Pharmacy Skin care team as required ENT as required
O
Skin care team as required
Tests Tracheostomy site culture Repeat culture if site appears Consider repeat cultures if change
Sputum culture for patient infected in colour, odour, secretions
CE
transferred in Repeat cultures every 3 months
Treatments Tubes changed Need for tube change Need for tube change
ENT/Surgeon/RRT/Intensivist Attempt corking O2 protocol
O2 protocol O2 protocol Humidification device
Humidification device Humidification device Suction prn
N
Suction prn Suction prn Tracheostomy care
Cleaning & cuff pressures Cleaning and cuff pressures as per Manula III P&P
as per Manual III P&P as per Manula III P&P Oral hygiene
Trach ties changed as Trach ties changed as needed Cuff Pressures twice a week &
RE
needed by RT by RT prn (RT)
Trach ties changed as needed by RT
Medications Consider medications if Consider medications if Consider medications if
increase secretions present increase secretions present increase secretions present
FE
Consider antibiotics Consider antibiotics Consider antibiotics
Nutrition Past history Past history Past history
Nutrition as assessed by MD, RD Nutrition as assessed by MD,RD, SLP Nutrition as assessed by MD, RD, SLP
Activity/Safety Based on patient status Based on patient status
RE
Based on patient status
Placed in room nearest nurse's Placed in room nearest nurse's
Placed in room nearest nurse's
station, if possible (better station, if possible (better
station if possible
observation) observation)
(better observation)
Emergency call bell system Emergency call bell system
Emergency call bell system
available to patient at all available to patient at all
available to patient at all times
times times
AAT
AAT AAT
Manual resuscitator with adapter
Manual resuscitator with
60500 D HR (July/2008) Page 2 of 2)
in room & O2 Flow meter Manual resuscitator with
adapter in room adapter in room
Spare Trach in room &
during transport Spare Trach in room & Spare Trach in room &
during transport during transport
Humidification O2 setup in room O2 setup in room
Suction setup in room Humidified air Humidified air
Controlled shower with assistance Suction setup in room Suction setup in room
Controlled shower with assistance Controlled shower with assistance
Elimination Establish Bowel/Bladder routine Maintain Bowel/Bladder routine Maintain Bowel/Bladder routine
Pain Management Assess pain at site Assess pain at site Assess pain at site
Analgesia as per orders Analgesia as per orders Analgesia as per orders
CLINICAL PATHWAY
ADULT TRACHEOSTOMY CARE
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