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    Airway Airway Document Transcript

    • AIRWAY ASSESSMENT, MANAGEMENT & SUCTION Self Directed Learning Pack Airway Assessment, Management & Suction Practice Development December 2005 LEVEL 1 – LEVEL 3 DEVELOPING PRACTICE EDUCATION Name: Designation: Page 1 of 25 Area of Work: PDD/Reviewed December 2005 Review December 2006
    • AIRWAY ASSESSMENT, MANAGEMENT & SUCTION SKILLS TRAINING MODULE Contents Page Number ♦ Aim 2 ♦ Definition 2 ♦ Standard 2 ♦ Self Directed Learning Method 2 ♦ Competency Levels for Care 3 ♦ Training Summary Sheet 4 • Educational Support/Resources 5 Available ♦ Responsibilities of an Assessor 6 ♦ Learning Outcomes 7 ♦ Theory Assessment 9 ♦ Supervised Practice 21 ♦ Reading List 22 ♦ Additional Reading List 23 ♦ Evaluation 24 The concept of the Self Directed Learning Packs has resulted from funding from the Cornwall and South Devon Education Purchasing Consortium and the subsequent joint project work of the Consortium Project Team, consisting of a representative from Royal Cornwall Hospitals NHS Trust, Plymouth Hospital NHS Trust and South Devon Healthcare NHS Trust. The Core Competency Skills Modules were developed as part of the Critical Care Project at RCHT (2000 – 2001) in response to the Department of Health’s modernisation programme to develop consistent and comprehensive critical care services throughout the NHS (Comprehensive Critical Care, A Review of Adult Critical Care Services, DoH 2000). All rights reserved. Should you need to copy, record, store in a retrieval system or transmit electronically or otherwise, permission must be sought from the Practice Development Department, Royal Cornwall Hospitals Trust, Royal Cornwall Hospital. Page 2 of 25 PDD/Reviewed December 2005 Review December 2006
    • AIRWAY ASSESSMENT, MANAGEMENT & SUCTION AIM To equip healthcare workers with the knowledge and skills to competently assess and manage a patients airway and provide suction appropriate to that airway. The procedure is carried out in accordance with Trust procedures and guidelines ensuring patients receive the highest standard of evidence based care. DEFINITION For the purpose of this self-directed learning pack, airway assessment and management includes the oropharyngeal and nasopharyngeal routes, mainly focusing on initial management without supplementary oxygen therapy. (An oxygen therapy SDLP is available which complements this pack). STANDARD • Care is performed in accordance with RCHT policies, procedures, guidelines and protocols and are available on the intranet document library. • Healthcare workers abide by the relevant policies, procedures, protocols and guidelines which are listed in this pack (see page 5). • There is validated education and training in place to enable staff to attain competency in the skill (see page 5). • There is written evidence of attained competence (see pages 14, 18, 20-21). SELF DIRECTED LEARNING METHOD This training pack is for use by Healthcare Workers for initial training, continual updating and self assessment. • It is designed for you to direct your own learning to achieve the competence level and Trust standard required for this skill. • The flexibility of self directed learning will allow you to utilise your time for study to obtain both theoretical knowledge and practical skills. • You will be able to work at your own pace and decide for yourself when you are ready for assessment. You will then be able to initiate your own updating to maintain your competence of this skill. Page 3 of 25 PDD/Reviewed December 2005 Review December 2006
    • AIRWAY ASSESSMENT, MANAGEMENT & SUCTION COMPETENCY FOR CARE All levels are expected to maintain equipment safety, minimalism patient risk and adhere to local/national policies, procedures (e.g. infection control, blood transfusion). Level 1 Level 2 Level 3 Level 4 Expected of a Expected from Expected of a Health Expected of a Health Care any registered Care Professional Health Care Support Worker, nurse one year who: Professional who: Technician or post registration other support Has acquired the Is experienced in staff who has competence through caring for patients undertaken experience, or has in this care group training in the completed specific and who has skill. education/training. undertaken advanced Can provide educational guidance for programmes. colleagues who are developing Can provide knowledge education and confidence and skills. assessment for colleagues who are developing knowledge, confidence and skills. Page 4 of 25 PDD/Reviewed December 2005 Review December 2006
    • AIRWAY ASSESSMENT, MANAGEMENT & SUCTION TRAINING SUMMARY SHEET Training Entry Criteria • Healthcare Workers, with line manager’s approval. • Holder of current Basic Life Support Certificate. Assessments • Completed self-directed theoretical component of this pack is assessed by the Education Link / Clinical Practice Educator. • The period of supervised practice to be negotiated on an individual basis, until the learner is confident to undertake a practical assessment, where indicated, and ultimately perform the procedure unsupervised. • Self-assessment must be continuous once the individual is competent. • Each Healthcare Worker will take responsibility for their own level of competence and exercise clinical judgement before undertaking this procedure unsupervised. • Each Healthcare Worker is responsible for maintaining and updating his / her knowledge base by analysing the latest research and reflecting on / implementing the recommended changes in practice. Page 5 of 25 PDD/Reviewed December 2005 Review December 2006
    • AIRWAY ASSESSMENT, MANAGEMENT & SUCTION EDUCATIONAL SUPPORT / RESOURCES AVAILABLE There are a variety of educational resources and support available to assist you in gaining the required knowledge and skills to successfully complete the theoretical component and practical assessment for this pack. These include: Web Access All NHS employees have access to the: • University of Plymouth on-site library and Athens database. • Hospital intranet – all additional policies and procedures can be viewed on the hospital document library. Education Resource File This file is available for use within Practice Development and contains: • Reading material as per suggested reading list. Additional Resources • Practice Development Resource Room. • Practice Development Website • Knowledge Spa Library • Document Library • Clinical Practice Educators • Clinical Experts Policies, Procedures and Standards Associated with Airway Assessment, Management and Suction • Trust Risk and Safety Policy. • Trust Infection Control Policy. • Trust Standard for Clinical Skills. • Trust Standard for Record Keeping. • Health Care Professionals' Governing Body's directives on best practice. • Trust procedure for suction for adults via endotracheal tube, tracheostomy, oropharyngeal and nasopharyngeal (G37) (Level 2). • Procedure for insertion and continuing care of nasopharyngeal airway (MISC16) (Level 3). Education Link / Clinical Practice Educator The role of the Education Link / Clinical Practice Educator is to facilitate / support you during your learning, and to assess your competence in the theory assessments and, when available, to supervise / assess practical elements of this pack. Page 6 of 25 PDD/Reviewed December 2005 Review December 2006
    • AIRWAY ASSESSMENT, MANAGEMENT & SUCTION CRITERIA FOR SUPERVISORS AND ASSESSORS • Practice Educator. • Competent Health Care Professional • The supervisor will supervise practice on a one to one basis. • A supervisor is not necessarily required to be an assessor. RESPONSIBILITIES OF AN ASSESSOR • Act always in such a manner as to promote and safeguard the interests and well-being of patients and clients. • Assist professional colleagues in the context of your own knowledge, expertise and sphere of responsibility, to develop their professional competence. • Must honestly acknowledge any limit of personal knowledge and skill and take steps to remedy any relevant deficits. • Recognise and honour the personal accountability borne for all aspects of professional practice. • Enhance trust and confidence within a health care team and promote collaborative work between other health care professionals. • To assist health care professionals in their role as clinical assessors it is expected that all experienced clinically competent health care professionals complete the theoretical self directed learning section of the skills training packages. • By completing the theoretical training the clinically competent health care professional will maintain their knowledge base and ensure that they are equipped to assess other health care workers. • Health care professionals who decline to complete the theoretical section of the training package may not have sufficient expertise or knowledge required to complete the theoretical section and thus would not make suitable assessors. • Health care professionals who do not follow this process may compromise trainees. Page 7 of 25 PDD/Reviewed December 2005 Review December 2006
    • AIRWAY ASSESSMENT, MANAGEMENT & SUCTION LEARNING OUTCOMES Level 1 On completion of this pack and period of supervision you will be able to demonstrate the following knowledge and carry out the following skills to level 1 of the competency descriptor for airway assessment, management and suction: • Demonstrate knowledge of national, local and professional policies, procedures and standards in relation to airway assessment, management and suction. • Demonstrate the correct procedure to patient identification and obtaining valid consent. • Demonstrate knowledge and skills in identifying and recording normal / abnormal respiratory rate and function. • Correctly label a diagram of the normal anatomy of upper respiratory tract. • Prepare and maintain airway management equipment for routine and emergency use. • Explain the rationale for suctioning and demonstrate competency in use of yankeur sucker under supervision. • Demonstrate the ability to assess and identify practical problems associated with using the yankeur sucker and state how to deal with these. • Identify the resources available for up-to-date information and practical advice. • Discuss potential knowledge limitations and when to refer to a suitably skilled member of the healthcare team. Page 8 of 25 PDD/Reviewed December 2005 Review December 2006
    • AIRWAY ASSESSMENT, MANAGEMENT & SUCTION Level 2 Once the Healthcare Worker has completed training in oropharyngeal airway management, he/she will be able to: (Level 2) • Demonstrate a knowledge of safe practice and relevant airway anatomy and physiology. • Identify the need for an oropharyngeal airway. • Select correct size of airway and recognise potential problems. • Prepare all necessary equipment for procedure. • Carry out procedure for correct insertion of airway. • Care for a patient with an oropharyngeal airway in situ. • Select appropriate suction equipment for airway and demonstrate competency in oropharyngeal and nasopharyngeal suction. • evaluate effectiveness of care and demonstrate knowledge of expected and unexpected outcomes. Level 3 Once the Healthcare Worker has completed training in nasopharyngeal airway management he/she will be able to: (Level 3) • Identify the need for a nasopharyngeal airway including patients not suitable for this procedure. • Select correct size of airway and recognise and act upon potential problems. • Prepare necessary equipment for procedure. • Carry out correct procedure for insertion of nasopharyngeal airway. • Demonstrate knowledge of safe practice. • Care for patient with nasopharyngeal airway in situ. • Evaluate the effectiveness of airway and demonstrate knowledge of unexpected and expected outcomes. Page 9 of 25 PDD/Reviewed December 2005 Review December 2006
    • AIRWAY ASSESSMENT, MANAGEMENT & SUCTION THEORY ASSESSMENT LEVEL 1 Infection Control a) What do you understand by the term quot;universal precautionsquot;? b) What is the single most important process in preventing hospital acquired infections? c) What procedure should be followed, as directed by the post exposure prophylaxis protocol, if your mucous membrane or conjunctiva is contaminated by the patient's sputum? d) Where is the Infection Control Policy located in your area? e) Why is it advisable to use suction products which incorporate the use of filters? Page 10 of 25 PDD/Reviewed December 2005 Review December 2006
    • AIRWAY ASSESSMENT, MANAGEMENT & SUCTION Equipment a) How often are disposable liners changed? b) How are reusable jars cleaned? c) How do you clear suction tubing and when should it be changed? d) Which wall suction equipment is used in your area and how is it maintained? Page 11 of 25 PDD/Reviewed December 2005 Review December 2006
    • AIRWAY ASSESSMENT, MANAGEMENT & SUCTION KNOWLEDGE REQUIRED FOR PERFORMING / ASSISTING WITH SUCTIONING (a) Draw a diagrammatic representation of the respiratory system labelling the structures: (b) How do you assess respirations? (c) What is the normal respiratory rate? (d) What would be your immediate action / care for a patient who suddenly develops problems breathing? Page 12 of 25 PDD/Reviewed December 2005 Review December 2006
    • AIRWAY ASSESSMENT, MANAGEMENT & SUCTION (e) What action would you take in the following circumstances: i) Slow respiratory rate ii) Fast respiratory rate iii) Cyanosis iv) Vomiting v) Difficulty breathing Page 13 of 25 PDD/Reviewed December 2005 Review December 2006
    • AIRWAY ASSESSMENT, MANAGEMENT & SUCTION (f) List the type of emergency airway management equipment you may need and where it can be located: (g) Identify three reasons why patients may require suction? i) ii) iii) (h) List three adverse effects of suctioning: i) ii) iii) (i) Describe the procedure for performing suction on a patient using a yankeur sucker: Page 14 of 25 PDD/Reviewed December 2005 Review December 2006
    • AIRWAY ASSESSMENT, MANAGEMENT & SUCTION (j) What are the potential risks of using this piece of equipment? (k) What monitoring / assessment of the patient should take place prior to, during and following suctioning and what is the rationale for this? Completed Satisfactorily: YES NO Signed: (Assessor) Date: Comments: Page 15 of 25 PDD/Reviewed December 2005 Review December 2006
    • AIRWAY ASSESSMENT, MANAGEMENT & SUCTION LEVEL 2 (a) Describe function of alveoli and the route air takes to reach them: (b) List six clinical conditions that may result in retained respiratory secretions: i) ii) iii) iv) v) vi) (c) List three or more routes than can be used for suction therapy? i) ii) iii) Page 16 of 25 PDD/Reviewed December 2005 Review December 2006
    • AIRWAY ASSESSMENT, MANAGEMENT & SUCTION (d) Explain rationale of suction catheter choice and size for patients in your area with specific reference to two or more artificial airway devices: (e) Describe the procedure for carrying out suction on the following (include selection of appropriate device, depth of insertion and appropriate suction pressure): i) oral / nasal without an artificial airway device: ii) oropharyngeal with an airway device: iii) nasopharyngeal with an airway device: (f) When do you apply the suction pressure during the procedure? Page 17 of 25 PDD/Reviewed December 2005 Review December 2006
    • AIRWAY ASSESSMENT, MANAGEMENT & SUCTION (g) List any major differences in technique when carrying out suction via oropharyngeal or nasopharyngeal route: (h) List range of suction pressures acceptable to patients in your area, ie neonates, paediatrics, adult and the elderly: (i) How do you clinically ensure the suction catheter is introduced into the respiratory tract rather than the stomach? Page 18 of 25 PDD/Reviewed December 2005 Review December 2006
    • AIRWAY ASSESSMENT, MANAGEMENT & SUCTION OROPHARYNGEAL AIRWAY (a) What are the reasons for insertion of an oropharyngeal airway? (b) How do you correctly size an oropharyngeal airway? (c) Describe the procedure for insertion of an oropharyngeal airway: (d) What are the possible risks associated with insertion of an oropharyngeal airway: (e) How do you assess the need for removal of an oropharyngeal airway? Completed Satisfactorily: YES NO Signed: (Assessor) Date: Comments: Page 19 of 25 PDD/Reviewed December 2005 Review December 2006
    • AIRWAY ASSESSMENT, MANAGEMENT & SUCTION LEVEL 3 (a) What are the reasons for nasopharyngeal airway insertion? (b) List the contraindications for nasopharyngeal airway insertion: (c) What are the benefits of a nasopharyngeal airway? (d) How do you correctly size a nasopharyngeal airway? (e) Describe the procedure for insertion of a nasopharyngeal airway: Page 20 of 25 PDD/Reviewed December 2005 Review December 2006
    • AIRWAY ASSESSMENT, MANAGEMENT & SUCTION (f) What actions should you take if resistance is met during insertion of a nasopharyngeal airway? (g) How do you check the correct position of a nasopharyngeal airway? (h) What are the complications associated with use of a nasopharyngeal airway? (i) How do you assess the need for removal of a nasopharyngeal airway? Completed Satisfactorily: YES NO Signed: (Assessor) Date: Comments: Page 21 of 25 PDD/Reviewed December 2005 Review December 2006
    • AIRWAY ASSESSMENT, MANAGEMENT & SUCTION SUPERVISED PRACTICE You must successfully complete the theory assessments before attempting any practical learning of this skill. You must successfully complete the theory and supervised practice before undertaking this skill unsupervised. Supervisor: Date supervised practice completed: Signature: Comments: Learners Signature: Comments: Page 22 of 25 PDD/Reviewed December 2005 Review December 2006
    • AIRWAY ASSESSMENT, MANAGEMENT & SUCTION READING LIST Ashurst, S (1992) Suction Therapy in the Critically Ill Patient. British Journal of Nursing, Vol 1, No 10, pp 485-489 Bealt-Harris, R & Bernstein-Hyman, R (1984) Clean vs Sterile Tracheostomy Care and Level of Pulmonary Infection. Nursing Research , Vol 133, No 2, pp 80-85 Boggs, R., Wooldridge-King, M. (1993). The American Association of Critical Care Nurses Procedure Manual for Critical Care Nurses 3rd Edition Chapter 10, pp 303-314. Saunders Clancy & Mcvicar (1995) Physiology and Anatomy – A Homeostatic Approach. Edward Arnold Publishing, London Elliot-Pennels, C J (1997) quot;Legal Issuesquot; Series. Professional Nurse, Vol 13, No 1, pp 49-53 Fiorentini, A (1992) Potential hazards of tracheobronchial suctioning. Intensive and Critical Care Nursing, No 8, pp 217-226 Johnson, G (1998) Latex Allergy: Reducing The Risks. Nursing Times, Vol 94, No 44, Pp 69-71 Macmillan, C (1995) Nasopharyngeal suction study reveals knowledge deficit. Nursing Times, Vol 91, No 50, pp 28-30 Mceleney, M (1998) Endotracheal suction. Professional Nurse, Vol 13, No 6, pp 373- 376 Mallett, J., Dougherty, L. (2000). The Royal Marsden Hospital, Manual of Clinical Nursing Procedures 5th Edition Chapter 44, pp 633-647. Blackwell Science Parker, L J (1999) A Practical Guide To Glove Usage. British Journal Of Nursing, Vol 8, No 7, Pp 420-424 Royal Cornwall Hospitals Trust, Health and Safety Policy Royal Cornwall Hospitals Trust, Control Of Substances Hazardous To Health Royal Cornwall Hospitals Trust, Infection Control Policy Royal Cornwall Hospitals Trust, Disposal Of Waste Policy Royal Cornwall Hospitals Trust, Sharps' Injury Policy Thibodean & Patton (1996) Anatomy and Physiology – 3rd Edition. Mosby Page 23 of 25 PDD/Reviewed December 2005 Review December 2006
    • AIRWAY ASSESSMENT, MANAGEMENT & SUCTION ADDITIONAL READING LIST Adam., S.K., & Osborne. S., Critical Care Nursing: Science and Practice Audit Commission. Critical to Success: The place of efficient and effective critical care services within the acute hospital. Audit Commission Audit Commission. (1999). Critical to Success: The place of efficient and effective critical care services within the acute hospital : briefing. Audit Commission (1999). Chan, ED. (1998). Bedside Critical Care Management. Hanley & Belfus Sheppard. M., Wright, M.W. (2000). Principles and Practice of High Dependency Nursing Shoemaker, W.C., Ayres, S.M., Grenvik, A., Holbrook, P.R., (1999). Textbook of Critical Care (4th Ed). Tinker, J., & Zapol, W.M. (1991) Care of the Critically Ill Patient (2nd Ed) Springer- Verlag UK Department of Health. (2000). Comprehensive Critical Care: A Review of Adult Critical Care Services. UK Department of Health Viney, C. Ed. (1996). Nursing the Critically Ill. Bailliere Tindall Webb., A.Ed. (1999). Oxford Textbook of Critical Care. Oxford Medical Publications. Page 24 of 25 PDD/Reviewed December 2005 Review December 2006
    • AIRWAY ASSESSMENT, MANAGEMENT & SUCTION EVALUATION OF TRAINING PACK Title of training package: Duration of training: Final assessment date: Successful assessment: Yes No Please complete the following evaluations: Very user friendly Very difficult to use 5 4 3 2 1 Information was clearly Information required requested was confusing 5 4 3 2 1 Instructions were clear Instructions were 5 4 3 2 1 unclear Having completed Knowledge base has training knowledge not increased base has increased 5 4 3 2 1 Able to reflect on your Difficult to reflect on training and its benefits your training and its 5 4 3 2 1 benefits. Please detach this page and return to: Practice Development Department, Royal Cornwall Hospital Page 25 of 25 PDD/Reviewed December 2005 Review December 2006