Paper
Wednesday, July 13, 2005
This presentation is part of : Evidence-Based Nursing for Acute Care
Evidence-Based Innovation Converts Tracheostomy Dread into Confidence
Jan Yates, PhD, RN, Nursing Department, National Institutes of Health, Bethesda, MD, USA, Beth Solomon, MS, Rehab Medicine, National Institutes of Health, Bethesda, MD, USA, and Paul Hoernes, DA, Department of Networks and Applications, National Institutes of Health, Bethesda, MD, USA.
Learning Objective #1: Discuss innovative strategies to implement evidence-based tracheostomy care
Learning Objective #2: Cite two mnemonics that assist the practitioner to remember a trach care principle, i.e., "down-sound"

According to AllNurses.com, “tracheostomy care is the second most dreaded procedure for nurses”. Tracheostomies are episodic, problem prone, and frightening. Despite having a Tracheotomy Consult Service (TCS), our facility experienced an abrupt increase in adverse reports for patients with tracheostomies. A multidisciplinary group was convened to identify the deficits and offer an action plan to the staff. The project group creatively used evidence based practice to structure the problem solving process.

“Come for tea” has been a historical method to critically think and gently resolve frustrations. Thus, our first innovative effort was to invite medicine, nursing, and respiratory therapy to a “T” party to discuss key issues. Twelve concerns were identified in 4 categories: advertising, evidence based guides, education and evaluation. Provider staff was unaware of TCS and its valuable resources. Following successful marketing principles, an easy to remember email was created, trach@nih.gov. This allowed staff access to TCS for questions and living laboratory appointments. Business cards with a unique logo were distributed to all staff. Additionally, TCS was advertised through variety high profile mediums.

The principal creative effort was focused on education. Prior traditional efforts were ineffective; in a word the instruction did not ‘stick' with the caregiver. Twelve educational minutes were emailed to staff managing trach patients. Each minute features a scientist in an animated Flash™ program who captures the audience with subtle humor and assistive mnemonics. The one minute format helped the project team distill information to its shortest, most potent level. Each minute is devoted to one of the 12 issues identified at the “T” party. Brochures, designed with graphics and photos, are attached to the emails for more complicated topics. An evidence based guide is accessible thru multiple institutional web sites.

The project effectiveness is currently being evaluated with four validated instruments.