ACI Tracheostomy Point of Care Audit tool

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Point of care Audit tool – ward areas

Instructions:

1. Where multiple elements exist the answer must be yes to all items unless specified

2. Can be used to evaluate multiple patients across a ward or hospital setting or care of individual patients across their stay

Possible answers 1 2 3 4 5 6 7 8 9 10

1 Communication – patient has communication strategy in place AND call bell within reach (yes for part 2 if patient is unconscious Yes/No

2 Patient has documented Tracheostomy plan in place which has been reviewed within last 24hrs Yes/No

3Patient assessment (see below) for past 24 hrs

clinical observations have been documented and actioned in accordance with clinical status documentation of evaluation of need for and outcomes of suctioning

Yes/No

4 Nurse caring for patient is an enrolled nurse or registered nurse AND has or is supervised by a registered nurse who has completed a tracheostomy training program within past 2yrs Yes/No

5 All safety equipment (see below) is available, functional and has been checked within past 24 hours Yes/No

6

The tracheostomy tube is secure

Yes/No1. Tapes changed within last 24 hrs (NA if < 24 hrs since insertion)

2. TT does not move more than 1cm in any direction3. Able to insert small finger between tapes

4. If Tube is an Adjustable flangea. Flange position marked & documented in notesb. Inspected & documented within past shift

8 Cuff pressure 1. Has been checked & documented within last 4 hours AND2. between 20-30cmH2O

Yes/No/NA

9 Humidification Heat moisture exchanger (HME) – clean & checked within last 2hrs OR Active – Temp > 37 C, H2O level > 1/3

Yes/No

10 Inner Cannulae1. is patent2. cannulae has been cleaned within last 4hrs AND3. spare clean & dry inner cannulae within bed area

Yes/No/NA

11 Stoma Dressing attended within past 24 hours AND Dressing clean & dry OR No dressing - Stoma clean & dry with no secretions

Yes/No

Patient Assessment – must be undertaken in accordance with Between the Flags Program Safety equipment – wards should clearly identify what equipment should be available in specific areas

Airway patency (includes evaluation of tracheostomy tube patency, effectiveness of stabilization method and cuff pressure)

Breathing (includes chest auscultation)

Level of consciousness and orientation

Routine post operative observations and Tracheostomy observation chart Stable post op period and patients discharged m

ICU: Observations a minimum of 4 hourly for first 48

Thereafter as clinically indicated, however, this interval is not to be greater than eight hours

Within bed area

1. Oxygen2. Suction equipment3. Spare inner cannula (where applicable)4. Sterile water5. Humidification devices as appropriate6. Emergency response plan

Immediately adjacent to bed area

7. Cuff manometer & 10ml syringe8. PPE9. Waste receptacles10. Spare tracheotomy tubes

+/- tracheostomy transport box

Within ward

11. Resuscitation trolley (includes intubation equipment and tracheal dilators)

12. Patient monitor

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