1. TRACHEOSTOMY MANAGEMENT IN THE HOSPICE SETTING DR JESS BRIGGS SPR PALLIATIVE CARE Kelly Keane, Ward Sister; Suzie Doe, practice development; Dr Jo Rogers, Consultant Anaesthesia / ICU

2. THE PROBLEM Increasing incidence Increasing incidence Greater patient survival Greater patient survival New equipment New equipment Increased medical specialisation Increased medical specialisation National guidance - NTSP National guidance - NTSP NAP4 NAP4 Highlight education Highlight education

3. IDEAL TRACHEOSTOMY MANAGEMENT: Equipment Equipment Personnel Personnel Training Training Resources Resources Appropriate management for patient? Appropriate management for patient?

4. THE REALITY

5. SETTING OUT A PLAN Aim: improve patient safety & practitioner knowledge & confidence Aim: improve patient safety & practitioner knowledge & confidence Ideal vs reality Ideal vs reality Short term goals Short term goals Team approach Team approach Gaining support Gaining support Focus on education Focus on education Visualise outcomes

6. IDENTIFYING RISKS Referra l WrongTracheostomytubeActivetherapyoptionsIdentifying High risk factors Staff fear & perceivedlimitations EducationSupport Focus on basic skills Admissions Booklet & training training Referral & admission Equipment availability & emergencymanagement Basic safety equipment, algorithm, algorithm,training

7. INDIVIDUALISED PATIENT PLANS Right patient - right place Right patient - right place Referral checklist Referral checklist Admission details Admission details Risk stratification Risk stratification Proactive planning Proactive planning Decision making Decision making Senior involvement Senior involvement

8. WHAT IS ACHIEVABLE

9. EMERGENCY SKILLS Focus on basics Focus on basics Transferable skills Transferable skills Repetition Repetition Expert sessions Expert sessions Mandatory Training Mandatory Training Drop in sessions & maintenance Drop in sessions & maintenance

10. EQUIPMENT

11. TRAINING DAYS 150 (>90%) staff 150 (>90%) staff Separate days for regional trainees Separate days for regional trainees Small groups (12 max) Small groups (12 max) Morning: basic knowledge, individual used plans, decision making, emergencies Morning: basic knowledge, individual used plans, decision making, emergencies Afternoon: workshops Afternoon: workshops Feedback: Feedback: 94% excellent 6% good "Brilliant. Makes you more aware of your actions in an emergency situation and less overwhelmed on tackling a tracheostomy emergency." "Before this study day I was fearful of tracheostomies. This study day has made a big difference and made me feel confident"

12. THE FUTURE Re-audit Re-audit Roll out locally Roll out locally Expand? Expand?

13. WHAT WOULD I CHANGE? Have end goal in mind Have end goal in mind Planning Planning Collecting evidence Collecting evidence Funding Funding Broad team Broad team

14. ANY QUESTIONS? THANK YOU