Trachea Care: protocol versus real life

[coffeebean88]

Hello! I am writing a paper contrasting the hospital's protocol for trachea care (suctioning, changing cannula, etc) with what actually happens in the patient's room. Does anybody deviate from what their protocol states, and why is that?

I asked the RN's on my clinical floor, but they all said they had no issues with the protocol.

Any help would be appreciated :) Thank you!

[Double-Helix, BSN, RN]

*Just a caution to you, this may be a very difficult paper for you to write. Your instructor likely wants reliable, peer-reviewed studies used in your paper. It will be very difficult to find studies on this topic, as a lot relies on the nurse's honesty and you can't really conduct any research in this area. Not too many RN's are likely going to admit to breaking hospital policy, especially when you're planning on writing a paper about it.*

To answer your question, no. I don't deviate from my hospital policy of sterile technique when cleaning, changing and suctioning a trach. I work in PICU and our kiddos are often very susceptible to infection. I wouldn't want anyone putting anything possibly contaminated into my trachea, and neither do my patients.

[coffeebean88]

Thanks for responding!

I figured I wouldn't have too many responses.. the main portion of my paper is comparing an evidence-based practice protocol to my current hospital's. The section of where nurses have difficulty or deviate from the protocol is also required in the paper.

I guess the better question is, why would a person have difficulty in following trachea care protocol?

[Esme12, ASN, BSN, RN]

Poor nursing....this is going to be difficult as it is our jobs to follow protocol. I do know that in home care it is a "clean technique" and not Sterile.....as they are "used to the bugs" at home.

[sapphire18]

The only time I have ever deviated from hospital P&P or best practice regarding trach care was when I had a pt on the verge of coding. I figured he would've liked to be kept breathing and with a beating heart than have perfectly sterile trach care.

[coffeebean88]

Thank you! This helps :)

[hodgieRN]

They only time I would deviate is during life-threatening situations or if a doctor wanted something specifically different. Maybe (for arguements sake), the ENT/ or Pulm doctor wanted the cannula washed in a solution that's not normally used. You will see that sometimes. Some old school docs will stick with what they are used to doing instead of following the newer protocols. Other than that, I would think the only way for you to see if nurses break protocol is to see any researched projects or even witness it yourself. No one is going to admit they cut corners.

Now that I think about it, you might be able to find some answers from Quality Control. They have a way of finding out how many nurses aren't washing their hands or not doing routine oral care. The respiratory managers could also help out with finding information on quality control for trach care. Maybe there's some info from JACHO or something? There's gotta be info somewhere that monitors nurses habits for quality control. Hope this helps...