Total Community Care - Specialists in spinal & neurological care

Providing bespoke care nationwide for clients with spinal injuries and neurological conditions

01 Jul

Reflection on Tracheostomy Care Course

The two day Tracheostomy Care course was excellent! Maureen, Theresa, Paula and I have definitely learnt something new.   Leading on from Maureen’s introduction on what the course was about; it was very interesting and we had the opportunity to take part in scenario workshops and simulation and of course the wonderful lectures.   It was very fascinating to hear about other medical professionals and the challenges that they face. One thing I have come away with is that we are all having the same issues and that the UK needs to come together and have one guideline instead of this post code lottery health care.

Another interesting point was to learn that the gold standard of discharge from an ITU Unit to the community is for the client to be discharged with 2 ventilators and 2 suctions machines. But as Maureen and Theresa stated during the question time; there have been times when clients are sent home and told that they are only allowed 1 of each and it’s been a struggle to get a second one.

We also learnt about the 3 phases of discharge planning from critical care for clients requiring long term invasive mechanical ventilation.

  • Phase 1 – Identify client who cannot be weaned
  • Phase 2- Assessment and planning with multidisciplinary group
  • Phase 3- Discharge date agreed, all risks planned managed and minimized. 2 weeks supply of all consumables ready to go with client. Discharge letter completed, home hospital Passport written, date of next tracheostomy tube changed by who and where , both ventilators locked external batteries and carry case, fisher & Paykal MR85 humidification unit and wires (2 sets of wires) and most importantly NO DISCHARGE ON A FRIDAY.

Then we had 4 wonderful workshops. Workshop 1 was about tracheostomy tubes and management. Workshop 2 was about secretion management, tracheal suction humidification and medication and other adjuncts. Workshop 3 was about ventilators, alarms and circuit set ups and trouble shooting and checks. Workshop 4 was about emergency scenarios and what to do. Practice makes perfect. Wow that was a full first day.

Folks if you think the first day sounded interesting well have I got news for you; the second day was even better! It started out with a wonderful story of a patient’s journey from being healthy then having a hypoglycaemic episode that was so severe that she ended up in a coma on a vent. She was unresponsive and the health professionals had basically written her off, but her family were very vigilant and after years of fighting for her and never giving up on her, she then finally woke up and with a lot of hard work she was finally weaned from the ventilator. It took her 5 years, but she is now home and is looking for work. She is not like she was before as her memory is not the greatest but has made incredible progress. So as a point never, ever take away anyone’s hopes because you never know how what the end story will be.

The next talk was from a family of a young man called Jonathan Gently. He has written two books about his life; the first one is titled Hospital Tales and we had the privilege of getting a copy of his second book Home Tales. I have included a picture of his book; it is a look at his life while at home and things he did and how he dealt with things. This too was very moving.

Then we had a powerful story from a current patient who presented her journey of despair and hope, it was so interesting hearing her journey and the struggles that she is undergoing.   She is still in the process of fighting to be decannulated but so far that is not possible. However she has been weaned from the vent and she is able to talk for herself. She said it was the hardest thing not being able to communicate and move when she was diagnosed with Gillian Barnes syndrome.   We then heard a presentation from the speech therapist about the power of communication where she stressed the power of communication and how important it is to get the Specialist SLT in the community (side note the speech specialist is not just for swallowing but most importantly for speech).

So we then closed down the day with two scenarios. They combined scenario 1 and 2 together so it was first Scenario our discharge client Mark a 38 year old from ITU on TIV to a care home – what must we make sure is set up for him before he goes home. Scenario 2 was how to enable a life of quality for Mark and others: tools made available and taking risks. With this one it was important that where ever he is going that they are able to handle tracheostomy and vents, that the staff are trained, consider how far is it from his family who will follow up with his Trachy changed.

Then we had two simulation activities; In one the person is in respiratory distress at home at 0300. I have included a picture of me suctioning the individual during that simulation. We had to go through checking equipment, suction, changing the tube, to eventually carrying out CPR until 999 arrived. That was very interesting

Simulation 2 was a dislodged tracheostomy tube whilst in the car going on an outing. For this one we had to replace the tube, pull over make sure we were safe, then made sure the tube was back in properly and that it is secure. We then discussed what happened and what should we make sure we have when we are going out.

Wow, well folks I hoped you enjoyed this article because I can say without a doubt that this was a very good two day study course and I would definitely recommend it to Nurses and Trainers!

Thank you

Sophia Wilson, Clinical Nurse