WHO WILL HEAR ME WHEN I NEED HELP

Calvary Mater Newcastle (CMN) is the second largest hospital in Hunter New England Local Health District (HNELHD) specialising in Cancer Care and Toxicology. It is not uncommon for complex head and neck cancer patients to be admitted for cancer therapies after undergoing a tracheostomy insertion procedure performed at another facility. It is necessary to point out that these patients belong to the Ear, Nose & Throat (ENT) Specialty and in the absence of a specialised ENT Unit at CMN a management and care has provided challenges for this vulnerable and complex group. In 2010 with no medical lead available, a Tracheostomy Multidisciplinary Team (MDT) was formed comprising representatives from Physiotherapy, Speech Pathology and Nursing. The tracheostomy MDT work resulted in overcoming many hurdles without designated medical governance. A MDT policy was developed using the Agency of Clinical Innovation (ACI) ‘Care of Adult Patients in Acute Care Facilities with a Tracheostomy’ Guidelines. Gaps were identified in documentation, education and training which led to a framework for several initiatives. The tracheostomy MDT met each week and sometimes twice weekly. On the ward, independent ward allocation was commenced and staff upskilled in providing tracheotomy care. Lack of appropriate documentation resulted in the development of Admission Flow Chart, Transfer of Care Form, specific and tracheostomy MDT Care Plans. The administrative initiatives resulted in improved communication and recording of care provided. Health professionals providing care were offered one day workshops plus on ward in-service. The Incident Information Management System (IIMS) - investigations of patients with a tracheostomy led to the development of emergency plans and flow charts for individual patients. In 2014 an ICU Specialist and Radiation Oncologist committed to providing the medical governance for the MDT. Evidence Based Practice has supported the changes which have led to reducing the amount of incidents related to patients with tracheostomies