Method
Background/Purpose
•
•
•
•
Do
• Identified the residents who are fit for
weaning
• Co-ordinated with MDT team, speech
therapist and doctors and identified the
residents fit for weaning
• Residents were given speaking valve trial
for 24 hours and tracheostomy capping
PLAN
To identify the residents
who are fit for weaning
To co-ordinate with
multidisciplinary team,
speech therapist and
doctors and identify the
residents for weaning
To refer to ENT if the are
able to tolerate speaking
valve for 24 hours
To identify the residents
who are fit for
tracheostomy capping
with the help of speech
therapist and ENT
doctors
ACT
To continuously monitor the residents fit for
weaning and to increase the rate of
decannulation to 20% by end of Dec 2017
Goals / Objectives
Result
Number of Patient
1
0
RESULT
Enaya –M4 was opened on OCT-2014,as
per our data from Dec-2014 till Jan2017 we have 11 residents
decannulated from Tracheotomy, still
other residents are given trial for
weaning ,some of the residents did not
tolerated the weaning
Team Members
Number of Patient decanulated
PROBLEMS
Residents were not weaned off
from tracheostomy due to
secretion.
Resident were not given follow up
again for weaning
Delay in giving weaning trial for
residents
CRITERIA FOR WEANING RESIDENT
FROM TRACHEOSTOMY
Oxygen requirement less than 40
%
Resident hemodynamic ally stable
Residents able to cough and clear
secretions
Resident is able to maintain
upright Sitting position in bed or
chair
the resident is awake and alert at
least 15 Minutes
The resident requires occasional
suctioning
1.To
discharge
or
repatriate the resident
home
without
tracheostomy tube and
in stable condition.
2.To give weaning trial
to at least 15% of the
residents by Dec 2017.
3.Continue to conduct
periodic observation
monthly to ensure
consistent
implementation
among staff.
4.Reinforce the desired
change by rewarding
the staff at unit level.
5.Organize education
program me for new
staff and reinforce
other staff, to be
appreciated for their
hard work.
1
0
Feb-17
0
Jan-17
1
0
Dec-16
0
Nov-16
0
Oct-16
0
Sep-16
0
Aug-16
0
Jul-16
1
Jun-16
1
May-16
0
Apr-16
0
Dec-15
0
Oct-15
0
Sep-15
0
18 18 18 18 18 18 18 18 18 18 18 18 18 18
Mar-16
2
Aug-15
0
May-15
0
Apr-15
Mar-15
0
1
16
17
Feb-16
17
Jan-16
18
15 15
2
0
17 17
Jul-15
16 16
Feb-15
1
18 18
Jun-15
17
Jan-15
20
18
16
14
12
10
8
6
4
2
0
Percentage of Decannulation 2014-2017
Dec-14
Our goal is to increase the rate
of decannulation from 9% to
15% by the end of December
2017, and to discharge or
repatriate home early with safe
airway, reduce the length of
stay of residents, and to reduce
the rate of infection, through
continuous
process
improvement utilizing PDSA
NEXT STEPS:
STUDY
Through our study it was identified that 9% of
residents were decanulated,5% of the residents
did not tolerate weaning
Nov-15
Around 87.5% of residents at Enaya
specialized care centre in unit M4
is on tracheostomy tube. All of
these residents are received as
transfer in from other facility with
tracheostomy tube. Around 9% of
the residents were decannulated
and weaned off from tracheostomy
tube.Decannulation is a planned
intervention
for
permanent
removal of tracheostomy tube,
once the underlying indication for
tracheostomy tube has been
resolved or corrected. However
these
residents
are
on
tracheostomy tubes our aim is to
wean at least 20% of the residents
from tracheostomy tube and to
improve their lifestyle so they can
have their normal activity of daily
living.
CONCLUSIONS:
To increase the rate of decannulation
from 9% to 15% at the end of December
2017,Implementation of bundles of care,
guidelines, daily goals and MDT rounds
has helped in early decannulation of
patients and to reduce the length of stay
of patients through continuous process
improvement utilizing PDSA.
Ms Elizabeth Ann Thiebe/ACEO/RH
Dr Abdul Aziz Darwish A/Medical
Director RH
Mr. Steven Beaumont /Executive
Director of Nursing
Dr. Hanadi Khamis Mubarak
Dr Amal Shaaban/QPS
Ms.Lynne Mendonsa, DON
Ms. Magda Attia, HN
Ms Simmy John, CN
Ms Solomi Jasmine CN
MR Raneesh Neelangandan,SN
Ms Mini Skariah,SN
References
1.Residential services policy
on Tracheostomy Care
Protocol CL10063
2.National Database of
Nursing Quality Indicators
guidelines-NDNQI (American
Nurses Association)