Assessment on basic post-operative tracheostomy care in intensive care unit

Introduction - Tracheostomy care is essential in management of patients after tracheostomy procedure, especially during initial postoperative period to ensure optimum benefits for patients. Such care can be complex requiring good communication and coordination amongst nursing team. We evaluated the standard of tracheostomy care for patients in intensive care unit (ICU) at Kepala Batas Hospital (KBH), according to the international guidelines, as local national guideline is yet to be available. Methods - This was a mixed retrospective and prospective audit involving 29 patients, whom tracheostomy were performed for prolonged ventilation, in ICU. Patients’ charts of whom admitted between January and December 2012 were hand-searched for retrospective evaluation. A checklist for standard tracheostomy care was developed for a prospective audit from January till October 2013. The nurses’ knowledge on tracheostomy care was surveyed. Results - Up to 35% had limited information on tracheostomy dressing documented in 2012 as compared to 100% in 2013. Checking of cuff pressure was not documented in 2012 while it achieved 94% in 2013. About 70% developed bleeding after suction between day 3 and 6 post-operatively in 2012, and it was reduced to 19% in 2013. Survey responses revealed half of the nurses were unaware of suitable pressures for tracheostomy cuff and suction, and depth of sterile catheter insertion during care process. Conclusion- Tracheostomy nursing care remained inconsistent in local setting, partly due to lack of standardized guideline.  A checklist of tracheostomy care has been developed to guide and ensure standard care for ICU patients. We recommend organizing educational and practical workshops on tracheostomy care for nursing staffs.