Quality Improvement on the Long-term Care Ventilator Unit: Interventions to Increase Patient Safety and Prevent Patient Harm

BACKGROUND: Tracheostomy patients are susceptible to life-threatening emergencies when their airways are compromised. Epidemiologic data suggests that 3.2% to 30% of tracheostomy patents have a complication. The long-term care ventilator unit (LTCVU) is a 25-bed unit in a nursing home. It has noted that 40% of patients have a complication. A group of hospitals demonstrated a 90% reduction in complications through five interventions. METHODS: The Johns Hopkins Nursing Evidence-Based Practice model was utilized to take the Global Tracheostomy Collaborative interventions and apply them to the LTCVU with the aim of reducing the number of airway complications on the unit by 50%. INTERVENTIONS: Five interventions were implemented for this quality improvement project: Bedside multidisciplinary team rounds, nursing in-services, continued protocolization of care, tracking complication rates and active prevention measures. Pre- and post-education surveys were distributed to nurses. Pre-education surveys averaged a 49% score, while the post-education average was 98%. RESULTS: Complications per patient per day were tracked pre- and post-intervention and a control chart compared pre- and post-intervention rates. Pre-implementation there were 0.00655 complications per patient per day over 22-weeks. Post-implementation there were 0.01012 complications per patient per day over 6-weeks. CONCLUSIONS: While complication rates seem to have increased following implementation, there are many reasons that an increase may have been noted. During implementation, census increased while staffing did not. Additionally, the project was implemented during the winter season, when dry air often causes increased mucous plugging. Finally, the post-implementation period has only covered six weeks. Perhaps with extended monitoring, rates would decrease