Accidental Decannulation Following Placement of a Tracheostomy Tube

BACKGROUND: Accidental decannulation is a cause of substantial morbidity and mortality in patients in long-term acute care hospitals who require a tracheostomy tube. OBJECTIVE: To analyze features of accidental decannulation (AD) following placement of a tracheostomy tube, and to implement strategies to reduce the problem. METHODS: An analysis of data collected prospec-tively for quality management in a long-term acute care hospital was performed. RESULTS: AD occurred at a rate of 4.2 0.9/1,000 tracheostomy days over a 7 month period. Factors associated with AD included mental status changes, increased secretions, and change of shift. Following the implementation of a series of interventions (staff education on risk factors for AD and best tra-cheostomy care practice; increased availability of telemetry and oximetry; and signage to identify patients at high risk of AD), the incidence of AD over a subsequent 7 month period was significantly reduced, to 2.7 1.9/1,000 tracheostomy days. In addition the numbers of multiple, unmonitored, unreported, and night shift ADs were all significantly reduced. CONCLUSIONS: Targeted inter-ventions can significantly reduce both the incidence of AD following tracheostomy and associated morbidity. Best practice guidelines to help minimize AD in patients with tracheostomy tubes are proposed. Key words: accidental decannulation; morbidity; mortality; long-term care; tracheostomy; tracheotomy; interventions; quality. [Respir Care 2012;57(12):2019–2025. © 2012 Daedalus Enterprises