CH232-Comprehensive Tracheostomy Care and Support Policy

Registration Number: {{org_field_registration_no}}

Comprehensive Tracheostomy Care and Support Policy

1. Purpose

The purpose of this policy is to establish a clear and comprehensive approach to the safe management and support of individuals with a tracheostomy at {{org_field_name}}. This policy ensures that tracheostomy care is delivered in accordance with the latest Care Quality Commission (CQC) regulations, the Health and Social Care Act 2008, and the guidance outlined by the National Institute for Health and Care Excellence (NICE). It prioritises the safety, dignity, and well-being of service users while maintaining a high standard of care and promoting staff competence.

2. Scope

This policy applies to all staff members involved in the care and support of service users with a tracheostomy, including registered nurses, care assistants, and allied health professionals. It encompasses routine care, emergency management, training requirements, and collaboration with healthcare providers. This policy applies whether the tracheostomy is temporary or permanent, ensuring continuity of care across all stages.

3. Policy Statement

{{org_field_name}} is committed to providing safe, person-centred, and evidence-based tracheostomy care. All service users with a tracheostomy will receive individualised care plans, regular assessments, and appropriate interventions to maintain airway patency, prevent complications, and promote comfort and quality of life. This policy ensures that staff are adequately trained and competent in delivering tracheostomy care, including emergency procedures.

4. Best Practice Procedures

4.1 Initial Assessment and Care Planning Upon admission of a service user with a tracheostomy, a comprehensive assessment will be conducted by a registered nurse. This assessment includes the reason for the tracheostomy, type and size of the tracheostomy tube, presence of a cuff, frequency of suctioning, and any associated risks or complications.

A personalised tracheostomy care plan will be developed in collaboration with the service user, their family or advocate, and healthcare professionals. The care plan will outline daily care routines, equipment requirements, medication needs, and emergency protocols. It will be reviewed regularly and updated based on the service user’s condition and healthcare recommendations.

4.2 Daily Tracheostomy Care Daily tracheostomy care will be provided by trained staff, ensuring cleanliness, comfort, and safety. This includes:

Tube Cleaning and Maintenance: The tracheostomy site will be cleaned daily, and the tube will be inspected for signs of infection, blockage, or displacement. Inner cannulas, if present, will be changed or cleaned according to clinical guidelines.
Suctioning: Suctioning will be performed as needed to maintain airway patency, following infection prevention and control practices. Suction pressure will be adjusted appropriately, and staff will monitor for signs of respiratory distress.
Humidification: Appropriate humidification will be provided to prevent airway dryness and irritation, either through humidified oxygen, a heat and moisture exchanger (HME), or a nebuliser if prescribed.
Cuff Management: If the tracheostomy tube has a cuff, it will be inflated and deflated according to clinical need, ensuring the pressure remains within safe limits.

4.3 Monitoring and Observation Service users with a tracheostomy will be closely monitored for signs of complications, including infection, tube blockage, displacement, bleeding, or respiratory distress. Observations will include respiratory rate, oxygen saturation levels, and overall well-being. Any abnormal findings will be reported to the nurse in charge and documented in the care plan.

Regular multidisciplinary reviews will be conducted, involving the GP, respiratory specialist, speech and language therapist (if applicable), and the service user’s family. These reviews will ensure that care remains appropriate and responsive to changing needs.

4.4 Emergency Management All staff must be trained in recognising and responding to tracheostomy-related emergencies, including tube blockage, displacement, and respiratory arrest. Emergency equipment, including spare tracheostomy tubes (same size and one size smaller), suction devices, oxygen, and airway adjuncts, will be readily available in designated locations.

In case of a tracheostomy emergency:

Staff will follow the emergency protocol outlined in the service user’s care plan.
The nurse in charge will be alerted immediately, and emergency services will be contacted if needed.
Basic life support will be provided if necessary, ensuring the airway is clear and oxygenation is maintained.

4.5 Infection Prevention and Control Strict infection prevention measures will be followed to minimise the risk of infection. This includes hand hygiene, wearing appropriate personal protective equipment (PPE), and using sterile or single-use equipment for suctioning and tracheostomy care. The tracheostomy site will be inspected daily for redness, swelling, discharge, or other signs of infection.

4.6 Staff Training and Competency All staff involved in tracheostomy care will undergo specialised training to develop the necessary skills and knowledge. This training includes:

Anatomy and physiology of the airway.
Tracheostomy tube types and functions.
Routine and emergency tracheostomy care.
Infection prevention and control.
Communication strategies for service users with a tracheostomy.

Competency assessments will be conducted regularly to ensure staff maintain their skills. Only staff deemed competent will perform tracheostomy care without direct supervision.

4.7 Communication and Emotional Support Service users with a tracheostomy may face communication challenges and emotional distress. Staff will use alternative communication methods, such as communication boards, writing pads, or speech valves, to facilitate effective interaction.

Emotional support will be provided through regular check-ins, reassurance, and involving the service user in decision-making about their care. Family members and advocates will be kept informed about the service user’s condition and involved in care planning when appropriate.

4.8 Equipment Management and Maintenance All tracheostomy-related equipment will be maintained in good working order, with regular checks for functionality and cleanliness. This includes suction machines, humidifiers, oxygen supplies, and spare tracheostomy tubes. Expired or damaged equipment will be replaced promptly.

4.9 Documentation and Record-Keeping Accurate and detailed documentation is essential for ensuring continuity of care. Staff will record all aspects of tracheostomy care, including daily care routines, suctioning frequency, observations, changes in condition, and any interventions provided. Care plans will be updated promptly to reflect any changes in the service user’s needs.

5. Communication

Effective communication is essential for service users with a tracheostomy, as the presence of a tracheostomy tube can significantly affect verbal communication. Staff will adopt alternative communication methods tailored to each service user’s needs. This may include the use of communication boards, writing pads, electronic devices, or non-verbal cues such as gestures and facial expressions.

Where appropriate, speech and language therapists (SLTs) will be consulted to assess the service user’s communication abilities and recommend suitable interventions, such as the use of speaking valves. Staff will be trained to use speaking valves safely, ensuring that the cuff is deflated before application and that the service user is monitored closely for signs of discomfort or respiratory distress.

All staff members will receive training on communication strategies to ensure that service users can express their needs, preferences, and concerns. Emotional support will also be provided, recognising the frustration and anxiety that communication barriers can sometimes cause.

6. Eating and Drinking

Eating and drinking require special consideration for service users with a tracheostomy, as there is an increased risk of aspiration. A multidisciplinary approach will be taken, involving speech and language therapists (SLTs), dietitians, and healthcare professionals to assess swallowing ability and recommend safe practices.

Service users will undergo a swallowing assessment before oral intake is introduced. If the service user is deemed safe to eat and drink orally, appropriate modifications will be made, such as adjusting food texture and fluid consistency to reduce the risk of aspiration.

For those unable to take food and fluids orally, alternative nutrition methods, such as enteral feeding, will be provided based on clinical recommendations. Staff will monitor for signs of aspiration, choking, or respiratory distress during and after meals, documenting all observations in the care plan.

Regular reviews of the service user’s nutritional status and swallowing ability will be conducted, ensuring that any changes in condition are promptly addressed and care plans updated accordingly.

7. Educating People Living with a Tracheostomy

Education is an essential part of empowering service users to manage their tracheostomy confidently and safely. At {{org_field_name}}, we ensure that individuals living with a tracheostomy, as well as their families and caregivers, are provided with comprehensive education tailored to their specific needs and abilities.

7.1 Individualised Education Plans: Each service user will receive a personalised education plan developed in collaboration with healthcare professionals, including respiratory specialists and speech and language therapists. This plan will cover:

Understanding the purpose and function of the tracheostomy.
Routine tracheostomy care, including cleaning, suctioning, and tube changes (where applicable and where it is safe for the service user to self-care).
Recognising signs of infection, blockage, or other complications.
Safe practices for eating, drinking, and communication.
Emergency procedures in case of tube displacement or respiratory distress.

7.2 Practical Demonstrations and Resources: Hands-on training sessions will be provided to service users and their caregivers to build confidence in managing the tracheostomy. Educational materials, such as leaflets, videos, and step-by-step guides, will be made available to reinforce learning.

7.3 Ongoing Support and Review: Education will be an ongoing process, with regular reviews conducted to address any concerns, refresh knowledge, and adapt teaching as the service user’s condition or needs change. Staff will remain available to answer questions and provide additional training as required.

By equipping service users with the knowledge and skills they need, {{org_field_name}} ensures that individuals living with a tracheostomy can lead safe, comfortable, and empowered lives.

8. Related Policies

CH07: Person-Centred Care Policy
CH11: Safe Care and Treatment Policy
CH13: Safeguarding Adults from Abuse and Improper Treatment Policy
CH17: Infection Prevention and Control Policy
CH27: Staff Supervision, Training, and Development Policy

9. Policy Review

This policy will be reviewed annually or sooner if there are changes in legislation, clinical guidelines, or operational requirements. Any updates will be communicated to all staff, and training will be provided to ensure ongoing compliance and best practice.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
Copyright © {{current_year}} – {{org_field_name}}. All rights reserved.