NHS England: Improving tracheostomy care during the COVID-19 pandemic (26 September 2023)

Summary

In anticipation of an increase in patients requiring a temporary tracheostomy due to the huge surge in patients placed on ICU ventilation at the peak of the COVID-19 pandemic, the NHS England National Patient Safety Team launched a National Patient Safety Improvement programme to rapidly support the NHS to provide safe tracheostomy care.

Content

Tracheostomy is a procedure to provide an artificial airway to assist breathing. A small surgical opening is made through the front of the neck into the windpipe and a curved plastic tube, known as a tracheostomy tube, is placed through the hole allowing air to flow in and out of the windpipe. There are various reasons why someone might need a tracheostomy. The commonest reasons are due to a blockage of the normal air passages (nose and mouth or at the back of the throat) or because a patient needs help from a ventilator for more than a few weeks.

Previous research showed up to 30% (nearly one in three) patients receiving tracheostomy care have been found to suffer from avoidable harms related to lack of equipment, staff training, and/or limited infrastructure. During the pandemic this risk increased as patients with temporary tracheostomies were managed in makeshift ICUs or ward areas, and by staff who may not be familiar with the key principles to keep these complex and vulnerable patients safe.

To support staff to keep tracheostomy patients safe at this challenging time, the National Patient Safety Improvement Programme expanded the work of the Improving Tracheostomy Care (ITC) project, that had been working with 20 NHS sites between 2016 and 2019; and commissioned the Academic Health Science Network’s (AHSN) 15 Patient Safety Collaboratives to rapidly deliver safety interventions across 180 NHS hospital sites in England.

Central to this was the roll out of the three safety specific strategies (interventions) from the ITC programme:

• Standardised tracheostomy care bundles – evidence-based practices that are grouped together to encourage the consistent delivery of safe care.
• Bedhead signs – providing specific key information about the patient’s tracheostomy, along with details of what staff should do in an emergency and who to call for help.
• Standardised bedside and ward tracheostomy equipment – ensuring emergency equipment needed to manage a blocked or displaced tube was immediately available at all times, and accompanied the patient wherever they went during their hospital stay

A ‘Safer Tracheostomy Care – a toolkit for healthcare staff’ was also developed by a multi-disciplinary team to further support healthcare staff.