Patient and Caregiver Education
Patient education on care of the tracheostomy tube and stoma is of utmost importance in preventing many complications. The Joint Commission32 has identified the safety implications of patient education. Patients and caregivers should be taught how to perform basic care of the tracheostomy, including the importance of changing the tracheotomy tube as scheduled, cleaning or replacing the inner cannula, cleansing the stoma, and replacing the tracheostomy holder or ties.
The clinical consensus statements on tracheostomy care2 recommend that when possible patient and family education should begin before the tracheostomy is done. Before discharge, patients and their caregivers should receive a checklist of supplies that should be taken with the patient at all times. Patients and caregivers should be evaluated before discharge to assess their competency in caring for the tracheostomy. They should know what to do in an emergency. They should be informed of the type, size, and length of the tracheostomy tube; how and when to use suctioning; how to clean the stoma and the tube itself; how to change the ties; indications of respiratory distress; how to use all home equipment; and signs and symptoms of infection and skin breakdown. Finally, a home care instruction manual should be given to patients and caregivers before the patient is discharged.2 Most manufacturers of tracheostomy tubes provide a home care manual for their products. Otherwise, Northwest Memorial Hospital in Chicago has published an instruction manual33 that can be downloaded from the Internet. Emergencies at home are an essential part of the discharge discussion. Possible home emergencies should be discussed before discharge, ideally allowing patients and their family members to discuss and demonstrate key skills such as suctioning, use of the manual resuscitation bag, and reinsertion of the tracheostomy tube.
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