A Ghori

A Gunawardena Daamayanthi

A Pendilhe

A Young

C Soares

H Raubenheimer

I Naldrett

L Allibone

L Carey

M Dusmet

M Griffiths

M White

N Maistry

S Jordan

T Pemberton

V Lutchmee

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POSTER PRESENTATION Open Access
The impact of the introduction of a multi-
professional altered airway ward round on
improving patient safety
A Young1*, I Naldrett2, L Carey3, V Lutchmee4, C Soares5, T Pemberton3, N Maistry1, H Raubenheimer6,
A Gunawardena Daamayanthi2, A Pendilhe2, L Allibone7, M Dusmet6, A Ghori8, S Jordan6, M Griffiths2, M White2
From ESICM LIVES 2015
Berlin, Germany. 3-7 October 2015
Introduction
Multidisciplinary tracheostomy teams have been imple-
mented in acute hospital settings for over ten years. There
is evidence that this initiative contributes to a reduction in
total tracheostomy time and an increase in speaking valve
use for patients leading to improved quality of life [1]. The
recent NCEPOD safe trache report recommended a num-
ber of safety factors to maintain patient wellbeing in this
cohort [2]. We investigated whether the introduction of a
multidisciplinary tracheostomy team had an impact on the
reduction of adverse incidents.
Objectives
To determine the tracheostomy rounds impact the inci-
dence of adverse incidents in tracheostomised patients.
Methods
Data was prospectively collected over a 3-month period on
64 patients on the ICU, HDU, and general ward (January
2015 to March 2015). Data collected included the access
to availability of a difficult airway trolley and fiberoptic
bronchoscopy, presence of emergency equipment at the
bedside, identifiable tracheostomy information, the
presence of emergency airway management in the event of
tracheostomy emergency, the presence of a weaning and
nutrition plan.
Results
A total of 64 patient contact episodes were recorded. 16
incidences of latent patient safety issues were identified
(16/64; 25%). January (n = 8; 12.5%), February (n = 6;
9.4%) and March (n = 2; 3.1%). Emergency airway plan
related (n = 11; 17.1%), missing equipment (n = 8; 12.5%).
The number incidence of blocked or dislodged tracheost-
omy in this period was 0. All patients reviewed had an
appropriate weaning and nutrition plan.
Conclusions
The introduction of a multi-disciplinary tracheostomy
outreach team has led to a reduction in the latent critical
incidents associated with tracheostomised patients. This
audit highlights that the presence of a MDT tracheostomy
ward round has a positive impact on patient safety.
Authors’ details
1Royal Brompton and Harefield NHS Foundation Trust, Speech and
Language Department, London, United Kingdom. 2Royal Brompton and
Harefield NHS Foundation Trust, Adult Intensive Care Medicine, London,
United Kingdom. 3Royal Brompton and Harefield NHS Foundation Trust,
Physiotherapy, London, United Kingdom. 4Royal Brompton and Harefield
NHS Foundation Trust, Respiratory Medicine, London, United Kingdom.
5Royal Brompton and Harefield NHS Foundation Trust, High Dependancy
Unit, London, United Kingdom. 6Royal Brompton and Harefield NHS
Foundation Trust, Thoracic Surgery, London, United Kingdom. 7Royal
Brompton and Harefield NHS Foundation Trust, Nursing Development,
London, United Kingdom. 8Royal Brompton and Harefield NHS Foundation
Trust, Anaesthesia, London, United Kingdom.
Published: 1 October 2015
References
1. Garrubba M, Turner T, Grieveson C: Multidisciplinary care for
tracheostomy patients: a systemic Review. Crit Care 2009, 13(6):R177.
2. [http://www.ncepod.org.uk/2014report1/downloads/On%20the%20Right%
20Trach_FullReport.pdf].
doi:10.1186/2197-425X-3-S1-A279
Cite this article as: Young et al.: The impact of the introduction of a
multi-professional altered airway ward round on improving patient
safety. Intensive Care Medicine Experimental 2015 3(Suppl 1):A279.
1Royal Brompton and Harefield NHS Foundation Trust, Speech and
Language Department, London, United Kingdom
Full list of author information is available at the end of the article
Young et al. Intensive Care Medicine Experimental 2015, 3(Suppl 1):A279
http://www.icm-experimental.com/content/3/S1/A279
© 2015 Young et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://
creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.


THE IMPACT OF THE INTRODUCTION OF A MULTI-PROFESSIONAL ALTERED AIRWAY WARD ROUND ON IMPROVING PATIENT SAFETY

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THE IMPACT OF THE INTRODUCTION OF A MULTI-PROFESSIONAL ALTERED AIRWAY WARD ROUND ON IMPROVING PATIENT SAFETY

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