TRACHEOSTOMY CARE
Tracheostomy Care
Tracheostomy Care
Plaza Healthcare is committed to give patients the best achievable quality of life. Whether it is to eliminate the need for a trach or offer the patient and their loved ones the education and support for sustained tracheostomy dependent care, Plaza Healthcare has assembled a team of dedicated professionals to assist with any need a patient and/or family may present.
Plaza Healthcare has developed its tracheostomy program alongside its ventilator program so both time and resources are available for in-depth evaluation, comprehensive treatment and close monitoring. Through an interdisciplinary approach, patents are regularly reviewed regarding rehabilitation goals and progress, decannulation capabilities, nutrition and medication management, and family education. In addition to the clinical aspects, Plaza Healthcare’s Activities and Social Services Departments work closely with the trach population to ensure the spiritual, recreational and psychosocial needs of each patient is met.
Dr. Alpa Shah, a Board Certified Physician specializing in Pulmonology with subspecialties in General Pulmonary Medicine, Critical Care Medicine, Interventional Pulmonology and Pleural Disease, is Plaza’s Medical Director of Pulmonology. Dr. Shah and her partners round at least three times per week with our Respiratory team and works collaboratively with the patient’s attending physician, other specialists and the Plaza team to ensure an optimal and personalized plan of care is carried out for each patient’s recovery.
Plaza Healthcare’s expertise extends to patients who have a tracheostomy for the following;
• Mechanical ventilator dependence
• Medical conditions that block or narrow an airway such as
o vocal cord paralysis
o tumors such as Cystic Hygroma
o infections, such as Epiglottitis
o congenital abnormalities of the airway
o Subglottic Stenosis
o Tracheobronchomalacia
• Laryngeal injury or spasms
• Severe neck or mouth injuries
• Obstructive Sleep Apnea
• Chronic Pulmonary Disease
• Neuromuscular diseases paralyzing or weakening chest muscles and diaphragm
• Aspiration related to muscle or sensory problems in the throat
• Disorders of respiratory control such a s congenital central hypoventilation or central apnea
• Long-term unconsciousness or coma
Plaza Healthcare provides the following pulmonary specialty services;
• Ventilator Management
• Ventilator Weaning
• Non-invasive Positive Pressure Ventilation (NPPV)
• Continuous Positive Airway Pressure (CPAP)
• Bilevel Positive Airway Pressure (BiPAP)
• High-Flow Oxygen (up to 60 liters per minute)
• Tracheostomy Management
o Newly trached patients
o Established tracheostomy patients
• Trach Decannulation
• Chest Percussion Therapy (vest/manual)
• Chest tube management
Tracheostomy (Trach) Management
Prior to arrival to Plaza Healthcare, each tracheostomy patient is reviewed by the Director or Assistant Director of Respiratory Therapy; to become familiar with the person’s history, their current condition, and to ensure the appropriate equipment is set up in the patient’s room.
Immediately upon arrival, the Respiratory Therapist (RT) along with a licensed nurse will perform their initial evaluation and assessments. Based upon this initial evaluation, information from the hospital, the RT’s expertise and consultation with the Pulmonologist and attending physician, each patient’s likelihood of decannulation is determined.
While this determination is continually evaluated throughout a person’s stay, the initial determination is used as the starting point for the patient’s plan of care. Over the next several days, this plan of care is further personalized based on goals discussed with the patient and/or family members, the Pulmonologist and attending physician seeing the patient, and secondary conditions and/or co-morbidities that exist.
Licensed Respiratory Therapists will continually monitor, treat and suction trach patients throughout their stay. The frequency of suctioning is patient specific and may be done multiple times a day or even within an hour depending on the amount of secretions being produced.
The Licensed Respiratory Therapists are trained on all types of trachs, trach sizes, humidification, and supportive equipment and are able to change trachs at the bedside and/or begin the decannulation process once determined by the team to be safe to do so.
Trach Decannulation
While some patients require a permanent trach, most can be decannulated. Decannulation is simply the process whereby a tracheostomy tube is removed once the patient no longer needs it. However, steps leading up to this “simple process” involves multiple disciplines performing several evaluations, consultations, testing, and the expertise of the pulmonology team to ensure a safe and successful decannulation.
Often, trach patients have multiple medical issues that need to be addressed. Some trach patients require dialysis, or extensive Physical and Occupational therapy before decannulation can be considered. While other programs may try to decannulate prematurely, Plaza Healthcare focuses on our patient’s strength and endurance to ensure success.
Plaza reviews its trach program monthly as part of the facility Quality Assurance and Performance Improvement Program. Plaza Healthcare can attribute its success which includes an extremely high decannulation rate to this constant evaluation, multidisciplinary approach, and skill level of the care team.
Eating
Having a tracheostomy can affect a patient’s eating or swallowing patterns. For some, it will require a comprehensive evaluation to determine if eating or drinking is achievable.
Speech Therapy plays an integral role in trach and swallowing management. Speech Therapists will work with a trach patient to retrain and strengthen the muscles necessary in swallowing. Plaza Healthcare’s Speech Therapists are trained in fiberoptic endoscopy evaluation of swallowing (FEES) and use this procedure to assess the safety of a patients swallow. A FEES test can help assess aspiration and choking risk. Based on the FEES result, the Speech Therapist will work with Plaza’s Registered Dietician and the pulmonology team to develop a diet with the safest consistency and nutritional value to maximize a person’s recovery while maintaining a healthy airway.
Speaking
As with eating, the Speech Therapist will perform an initial evaluation and work in cooperation with the other disciplines to develop a strategy and plan for each patient’s communication needs. Speech Therapy will work with the patient to retrain and strengthen the muscles necessary in speech and voice. The Speech Therapists will work with the patient to find the best way to communicate. Goals may include training to use a speaking valve, strengthening throat muscles to make voice and speech easier, or learning to communicate through non-vocal means.
Respiratory Therapy may indicate for a speaking valve and upon evaluation and pulmonary consultation, the patient will be fitted for the valve and trained on its use. A Passy-Muir speaking valve is commonly used to help patients speak. As some patients may immediately adjust to breathing with the valve in place, others may need to gradually increase the time the valve is worn. Patients may need to build up the strength and ability to use the valve which is part of the on-gong evaluation, observation, and treatment the Respiratory Therapists plan for each individual patient.
Staffing
Licensed Respiratory Therapists are available around the clock, seven days a week to monitor and treat patients. Licensed Nurses who work on the tracheostomy unit are specially trained in the care and unique requirements trach patients can present. In addition, Certified Nursing Assistants must achieve Sub-Acute CNA status prior to being assigned trach patients. This status is achieved by way of extended orientation including additional hours of training and skills checks. Their status is maintained through frequent competency tests and annual evaluations.
Plaza Healthcare partners with Synertx for its rehabilitation services. Part of that partnership’s understanding is facility specific staffing which affords the trach patients to maintain consistency in their therapy by having the same therapist for the entire stay. The Rehabilitation staff is also specially trained on trach care if they have not worked in a similar setting prior to coming to Plaza.
All other departments, at least annually, are in-serviced on the special needs of trach patients. This includes but not limited to; Activities, Social Services, Environmental Services and Administration.
Facilities/Equipment
Plaza Healthcare carries a well-stocked supply of different types of trachs in all sizes, and maintains a supply of like types and sizes by each patient’s bedside for any urgent needs.
Plaza Healthcare has the largest bulk oxygen storage of any skilled nursing facility and multiple redundancies in its suction capabilities so the building’s piped in oxygen and suctioning system will maintain functionality at all times.
The lounges are designed with piped in oxygen and suctioning for those patients wanting to spend time outside their room to either engage in group activities and/or visit with loved ones. Plaza Healthcare’s abundant stock of portable oxygen tanks allows for freedom of movement throughout the building and any of the three courtyards available to patients and their loved ones.
Activities
Remaining as active as possible contributes to a patient’s rehabilitation and recovery. The activity staff encourages participation in all group activities and have the necessary training to identify patient’s requiring suctioning. The Respiratory Department is involved in the patient’s engagement in group activities by utilizing portable suctioning machines for functions and/or outings. Whether it is to attend a special function, or go on an outing to feed ducks or see Christmas lights, a respiratory therapist attends as well to ensure the trach patient can participate safely and confidently.
Plaza Healthcare is dedicated to quality of life, encouraging patients to get out of bed, and live as independently as possible.
Transition of Care
Throughout the entire care program, Plaza Healthcare’s Case Management team is in constant contact with the insurance company regarding the patient progress. In addition, multiple meetings throughout a person’s stay are conducted with the patient and/or responsible party to update those involved of the plan of care, address existing goals, develop strategies for continued coverage for those patients taking longer to recover, and prepare for what hopefully will be a discharge home or to a lower level of care such as an assisted living or board and care.
Plaza Healthcare understands patients move at their own pace through the decannulation process and patients may experience setbacks and frustration if the recovery process is not progressing as well as first expected. Especially during these times it is critical that communication and an understanding of what is taking place is addressed. Plaza staff is always available to address any concerns or questions.
In addition to the Social Services Department, Plaza Healthcare has Psychiatry and Psychological resources available to assist in the psychosocial aspects of trach dependency or the anxiety of a transition home or to an extended period of tracheostomy dependence.