Second Alternative Answer
The current facility at which I am employed uses Elsevier Nursing Skills as its policy for performing nursing skills to include tracheostomy care. However, the tracheostomy care policy states that the nurse should refer to their facilities policy for the frequency of which to perform the trach care. Therefore, a gap exists in our trach care policy or lack thereof. It created confusion among the nursing staff as to how to care for established versus fresh trach sites. There is also no guidance on how to taper down care as the trach site heals.
Joint Commission offers a function on their website called Tracers. Nurses can use it to make individual tracers that target a specific practice at the point of care (Siewert, 2018). For the nursing leadership to determine current practice, a tracer could be established to evaluate the frequency of trach care provided for new versus established tracheostomies, the occurrence of HAIs in relation to trach care frequency, and respiratory distress/desaturation episodes in relation to the frequency of cleaning or changing out the inner cannula. Data for the tracer can be collected via staff interviews, observation of practice, and chart auditing (Siewert, 2018). From this data, it can be determined if harm is coming to the patient from current trach care practices and what are those practices.
Nursing leaders can use clinical reasoning and judgment based on the data, along with a literature review, to formulate a trach care policy to include time intervals based on the age and condition of the tracheostomy. The new policy can be evaluated by implementing a small test of change and creating a corresponding tracer. The Institute for Healthcare Improvement (n.d.) recommends the use of the Plan-Do-Study-Act cycle to implement these small tests of change. Tracers can provide real-time data for the evaluation of small tests of change during the Do and Study steps. According to Bhattarai and Shah (2018), real-time data analysis prevents delays in updates in care practices by months. Based on the data analysis, nursing leaders can determine if the policy needs to be reevaluated or is effective in preventing patient harm.
References
Bhattarai, S., & Shah, R. K. (2018). Leveraging real-time data to drive quality improvement in a pediatric health system. Pediatric investigation, 2(3), 184–187. https://doi.org/10.1002/ped4.12060
Institute for Healthcare Improvement. (n.d.). Science of improvement: Testing changes. Institute for Healthcare Improvement. Retrieved November 30, 2021, from http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementTestingChanges.aspx
Siewert B. (2018). The Joint Commission Ever-Readiness: Understanding Tracer Methodology. Current problems in diagnostic radiology, 47(3), 131–135. https://doi.org/10.1067/j.cpradiol.2017.05.002