Wells Sarah, Shermont Herminia, Hockman Gail, Hamilton Susan, Abecassis Leah, Blanchette Susan, Munhall Daphne
Boston Children's Hospital, USA.
Boston Children's Hospital, USA.
J Pediatr Nurs. 2018 Nov-Dec;43:120-126. doi: 10.1016/j.pedn.2018.06.004. Epub 2018 Jun 30.
The purpose of this quality improvement project was to create a Tracheostomy Subject Matter Expert (Trach SME) Committee to standardize tracheostomy care, education, and the discharge process across Boston Children's Hospital.
Boston Children's Hospital (BCH) is a free-standing urban tertiary pediatric hospital with 15 inpatient units. The newly formed Trach SME Committee evaluated the discharge process across the enterprise including hospital satellites and intra-hospital practice. Education materials were centralized, and policies were reviewed, revised and standardized to reflect current best practice. The Trach SME provided education to Trach Champions from each area that became resources for their respective units. The Trach SME also developed measurement outcomes to assess the effectiveness of the education process.
In the implementation year of 2104, our 7-day unplanned readmission rate for tracheostomy patients was 18.18%. This rate decreased to 6.67% in 2015 and to 0% in 2016. In 2015, we began to monitor 30-day unplanned readmissions and the rate was 6.67% in 2015 and decreased to 0% in 2016.
Standardization of policies, procedures and caregiver educational materials for the management of patients with a tracheostomy tube improved tracheostomy care across the enterprise and reduced tracheostomy readmission rates.
本质量改进项目的目的是成立一个气管造口术主题专家（气管造口术SME）委员会，以规范波士顿儿童医院的气管造口术护理、教育及出院流程。
波士顿儿童医院（BCH）是一家独立的城市三级儿科医院，拥有15个住院单元。新成立的气管造口术SME委员会评估了整个机构（包括医院卫星机构和院内业务）的出院流程。教育材料进行了集中管理，政策也进行了审查、修订和标准化，以反映当前的最佳实践。气管造口术SME为来自各个区域的气管造口术倡导者提供教育，这些倡导者成为各自科室的资源。气管造口术SME还制定了测量结果，以评估教育过程的有效性。
在2014年实施的这一年，我们气管造口术患者的7天非计划再入院率为18.18%。该比率在2015年降至6.67%，在2016年降至0%。2015年，我们开始监测30天非计划再入院情况，该比率在2015年为6.67%，在2016年降至0%。
气管造口管患者管理的政策、程序和护理人员教育材料的标准化改善了整个机构内的气管造口术护理，并降低了气管造口术再入院率。
