TRACHAEOSTOMY CARE

Tracheostomy care for adults with complex needs

While undergoing a tracheostomy can be a traumatic process, living a fulfilling and independent lifestyle afterwards is easily achievable with the right support from expert clinicians.

And getting the right specialist support can ensure a person lives a fulfilling life, both physically and psychologically. Exemplar Health Care currently has over 30 adults across its homes who have a tracheostomy or other respiratory requirements, and is a specialist in providing the care and support they need. With 20 years’ experience of caring for some of the most complex and acute individuals, Exemplar Health Care supports people who may otherwise be in a hospital setting if not living in their homes. Across its growing portfolio of homes, its teams are highly trained, and its homes adequately equipped, to safely care for people with tracheostomies and other complex respiratory requirements. Here, Sharon Jolley, clinical specialist nurse - respiratory support at Exemplar Health Care, discusses its capability in tracheostomy care and how it supports people through the process and towards recovery.

Delivering specialist care from the point of referral

At Exemplar Health Care, we support adults who require long or short-term tracheostomies, and work with them to achieve their individual goals. Our expert clinicians, who have experience and expertise in delivering tracheostomy care, focus on assisting individuals to live a fulfilling and happy life, despite the challenges their tracheostomy brings. We support people with different types and

"We support adults who require long or short-term tracheostomies, and work with them to achieve their individual goals."

makes of tracheostomies, including cuffed and un-cuffed, fenestrated, non-fenestrated, and subglottic tubes to help to support with the management of excess secretions whilst maintaining a safe airway We also have the expertise to support people who require mechanical and manual cough assist, adhering to their personalised regime, and also those that require continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BIPAP). From the first point referral, we take a personcentred approach to tracheostomy and respiratory care. Our clinical assessors work with individuals and professionals to understand their care needs prior to admission, and develop a personalised care plan to ensure their safety. When someone moves into one of our care homes, we take the time to get to know them, and carry out an in-depth assessment to understand their holistic care needs, including their communication needs. We work with each individual to identify which communication strategy is right for them and identify their aims and goals for their future life. We also work closely with other members of the multi-disciplinary team such as speech and language therapists, respiratory physiotherapists and assisted technology specialists, to enable people to have the best opportunity to fulfil their communication needs.

Specialist staff giving bespoke support

Our homes are led by an experienced nurse-led management team, and supported by a trained in-house team of registered nurses and health care assistants. Each of our homes has a high ratio of registered nurses and health care assistants, which enables us to provide attentive care and minimise the risk of, and respond to, complications which may arise from people’s complex respiratory needs. Our health care assistants and nurses are trained to complete daily tracheostomy care such as cleaning the stoma site, changing tapes and dressing, changing inner tubes as per individual protocols, tracheal suction techniques and ensuring that the correct Heat and Moisture Exchange (HME) is used, including mechanical HME. They regularly monitor basic vital signs, including temperature, heart rate and oxygen saturations, and are able to detect early warning signs of infection and respond appropriately. Colleagues are trained in emergency care and follow the National Tracheostomy Safety Project emergency protocol, alongside individual emergency protocols issued by the Respiratory Teams that manage service user care as outpatients. Our teams are also experienced in the use of Passy Muir Valves (PMV) for those that use them, and Invasive Ventilation (IV) for those who require invasive respiratory support from a ventilator, both short and long term. We have an in-house competency process to train and validate our nurses to complete full tracheostomy change, either routine or in an emergency. This ensures that our care is proactive and dynamic, which reduces the need for hospital admission.

"Our life skills teams support people to adapt to life with a tracheostomy and respiratory needs, so they can continue to live a full and fulfilling life in the way they choose."

In-house teams of skilled professionals

Many of our homes have in-house physiotherapists who can carry out respiratory assessments, and advise on suction techniques, patient positioning and optimal respiratory therapy. Our life skills teams support people to adapt to life with a tracheostomy and respiratory needs, so they can continue to live a full and fulfilling life in the way they choose. We’ve also facilitated training for family and friends to enable those with a tracheostomy or complex respiratory needs to maintain their connections and activities outside of the home. Our in-house clinical experts deliver bespoke training to ensure that colleagues are confident and competent to understand people’s needs, and deliver safe tracheostomy and respiratory care, including with those who display behaviours of concern. We tailor training to the needs of our service users, and colleagues are empowered to develop personalised plans for addressing behaviours of concern. We review training and competencies regularly to ensure that colleagues are up-to-date with their knowledge and skills.