A co-ordinated multi-disciplinary team approach to tracheostomy weaning
To achieve a better co-ordinated, structure and documented Multi-Disciplinary Team (MDT) approach to tracheostomy weaning with Neuro-rehabilitation.
1. Establish a weekly MDT tracheostomy ward round.
2. Devise and implement documentation to record and support the weaning process.
3. Develop advanced tracheostomy weaning competencies.
Quantitative data: 7 tracheostomy patients previously on Ashby Ward. Weaning agreed by MDT (29%), Formal MDT weaning plan (29%), Formal initial physiotherapy tracheostomy assessment (14%), MDT tracheostomy ward round (0%). All MDT members involved in weaning plan (0%).
Qualitative data: Members of Ashby MDT.
“The plan is normally adhoc and very consultant dependant, and sometimes difficult to find”.
“With regards to MDT working, decisions may be made without certain MDT members contributing, with vague rationale for decisions”.
What have I done:
• Co-ordinated several tracheostomy-specific MDT meetings
• Liaised with specialist Neuro-rehabilitation units in London
• Devised draft documentation for weaning charts, MDT tracheostomy ward round and physiotherapy assessment proformas
• Set up a weekly MDT tracheostomy ward round
• Currently developing advance competencies for tracheostomy weaning
Thinking differently model
Key performance indicators
Started 2 month pilot, includes:
• MDT ward round every week (PT, SLT, Nurse, and Consultant present) including documentation
• Initial physiotherapy tracheostomy assessment within 24 hours of admission
• All stages of weaning documented on charts with “The Ashby Trac” pack
• Closer MDT collaborative working
Developing advanced tracheostomy weaning competencies with CCOT for select staff.
• Complete 2 month pilot of MDT ward round and documentation charts
• Approval of paperwork through clinical records committee
• Complete development of advanced tracheostomy weaning competencies and training for select staff
• Delivery of training session by CCOT
• Repeat data collection in 12 months
For further information Daniel Thompson, Team Lead Neuro-Rehab Physiotherapist