1. Trach Management Protocol No Trach Left Behind A Guide to improved patient care Joel Ray RRT Harborview Medical Center Seattle, WA

2. Objectives Comments in the literature that support using a Trach Protocol. Why Harborview benefits from a protocol Order sheet review Overview of Trach Management Protocol (TMP) algorithm. Future goals

3. Heffner July 1999 ……..For most medical centers and hospitals (community or academic), the most important task is to organize a group of interested, multidisciplinary people to come up with a guideline or practice protocol. John E. Heffner, MD Department of Medicine University of South Carolina John E. Heffner, MD Department of Medicine University of South Carolina Respiratory Care: July 1999 VOL 44 No 7

4. John E. Heffner, MD Department of Medicine University of South Carolina..........The exact elements of the protocol are perhaps less important than having a protocol in place that can be monitored and adjusted on the basis of monitored results. Respiratory Care: July 1999 VOL 44 No 7

5. April 2005

6. Kent Christopher MD RRT Department of Medicine University of Colorado The tracheostomy tube decannulation process is well suited for therapist-implemented protocols.

8. Objectives Comments in the literature that support using a Trach Protocol. Why Harborview benefits from a protocol Order sheet review Overview of Trach Management Protocol (TMP) algorithm. Future goals

9. How Many Trachs a Year? October 2006 thru October 2007 324 trach patients

10. Who does the trachs at HMC? Surgery ( 3 teams ) Surgical, percutaneous Otolaryngology (OTO) surgical Oral Maxillofacial Surgery (OMFS) surgical Neuro Critical Care (NCCS) Primarily percutaneous

11. Challenges of variability Services performing trachs have differing management styles. Care plans arent consistent. Therapist skill level varies

12. Common problems Sutures in too long Inexperienced residents performing first trach change Variable physician knowledge or follow through

14. Current trach practices Trach Team: 1) Meets every Tuesday for one hour 2) Consists of RT, Speech Path, Clinical RN Educator 3) the month of January averaged over 20 trachs a meeting

15. Common denominator of HMC trach patients?

16. Respiratory Therapy

19. Getting Started

20. Whats next?

21. Home stretch