Summary
This article in the journal Patient Safety describes a state-wide, population-based study into tracheostomy- and laryngectomy-related airway safety events. The Pennsylvania-based study aimed to assess the relationship of these events with associated factors, interventions and outcomes, to identify potential areas for improvement.
The authors queried the Pennsylvania Patient Safety Reporting System (PA-PSRS) to find tracheostomy- and laryngectomy-related airway safety event reports involving adults age 18 years and older that occurred between 1 January 2018, and 31 December 2020.
Content
The authors found that the four most frequent tracheostomy-related complications were:
- unplanned decannulations, 71.4%
- uncontrolled bleeding/hemorrhage, 9.2%
- partial/total occlusion, 6.9%
- mucus plug/thick secretions, 6.9%.
They concluded that in order to manage patient airways safely, staff need to be knowledgeable, confident and equipped with appropriate skills and equipment to respond promptly when there are complications. They discuss potential safety strategies to reduce the risk of complications and issues related to equipment, knowledge and communication.
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