Physiotherapy EPA3 Tracheostomy Management

Able to demonstrate knowledge of general infection control prevention and control including hand hygiene, aprons, masks and aseptic non-touch technique

Has completed Basic Life Support Training as per local trust policy

Describes how they would summon help in an emergency and locate crash bells

Describes how to call a medical emergency call via switch

Describes own role and expected contribution in medical emergency eg. Basic Life Support, providing assistance to MDT as able

Demonstrates positive patient identification and awareness of allergies

Demonstrates how to monitor vital signs (Temp, HR, SpO2, RR, blood pressure, MAP)

Interprets observations in an ICU setting, considering trends and normal ranges for all (Temp, HR, SpO2, RR, blood pressure)

Able to troubleshoot difficulties with taking vital signs eg. poor trace on pulse oximeter, missing ECG leads, positional sensitivity of arterial line

Awareness of who to escalate concerns to in relation to patient safety with recognition of different levels of urgency and reporting to different staff members dependent on situation

Can describe the bed numbering, storage location of safety equipment, location of offices and other key areas within the critical care unit

Can describe the shift patterns and handover process of other MDT members

Able to identify key MDT members by their role, including critical care nurses, nurse in charge, consultant on call

Demonstrates how to locate the local protocols and guidelines relevant to own role

Has an awareness of key ICU meetings relevant to role e.g. MDT meetings, handovers, safety briefings, teaching sessions.

Can identify standard ICU bedspace equipment and location of equipment necessary for role

Describe barriers to communication in ICU including those associated with PPE, illness and ICU interventions.

Awareness of communication aids with patients to overcome communication barriers i.e. PPE + oral intubation

Describe the support services available to help liaise with family including family support nurses, PALS, psychology services as appropriate.

Describe barriers to communication with family and methods to improve this

Knows importance of confidentiality and consent to share information with friends and family

Awareness of peer support and psychological support

Demonstrates how to access and document in patient records using local IT systems

Demonstrates how to view results and imaging on local IT systems

Awareness of Falls prevention and who to escalate to if concerned regarding falls risks

Compliant with Manual Handling training as per local trust policy.

Demonstrate working in an MDT by building and maintaining relationships with other professions

Aware of the roles and responsibilities of other members of the MDT

Clarifies, accepts and executes tasks delegated by the team leader

Explains the importance of highlighting safety issues / concerns to a member of your team in a prompt manner

Uses appropriate level of assertiveness for the clinical situation

Demonstrates a logical and systematic handover using local format

Outline how to escalate and to whom if there are patient / safety concerns

Identify and respond to patient / staff safety issues appropriately

Demonstrate ways to open up airway using simple manoeuvres (inc. repositioning, head tilt chin lift, jaw thrust)

Demonstrates how to deliver manual ventilation using two person bag-valve-mask (BVM) technique

Recognise and escalate airway compromise in a tracheostomised patient

Demonstrates how to perform and document oral hygiene

Knows the types of oxygen delivery system and their limitations (including reservoir mask, simple face mask, venturi system and nasal cannulae)

Demonstrates how to deliver oxygen urgently (including reservoir mask, simple face mask, venturi system and nasal cannulae)

Describe how to escalate or de-escalate oxygen therapy in a step wise manner eg. nasal cannulae to face mask.

Recognise different lines and their location relevant to local population (eg arterial lines, central line, vas-cath)

Identify enteral feeding tube in situ, whether it is connected to feed and whether the feed pump is running

Knows to discuss plans with nursing staff prior to moving or reposition a patient with NG feed running

Aware of events which can displace feeding tubes and to escalate accordingly

Describes how to check enteral feeding length and escalates if tube length has changed

Describe how to recognise dysphagia and an escalation plan including referral to SLT

Demonstrates how to assist patients with eating and drinking

Have an awareness of modified diets or thickened fluids in line with SLT recommendations

Demonstrate how to categorise neurological status using the AVPU scoring

Describe factors that may cause or contribute to delirium

Describes how to recognise delirium

Demonstrates how to complete a CAM-ICU score

Demonstrates an understanding of non-pharmacological management of delirium

Demonstrates knowledge of the Mental Capacity Act, when capacity assessment is indicated, how to assess capacity and when specialist communication support is required eg. referral to SLT

Demonstrates how to use pain faces or a similar visual analog scale

Demonstrates an understanding on the impact of pain on patient presentation eg. agitation

Demonstrates an understanding of the impact of pain medication on patient presentation eg. sedative effect

Demonstrates an understanding of RASS (or alternative sedation) scoring system

Able to access and read using ICU drug charts

Demonstrates an awareness of common ICU sedative medications

Demonstrates a basic knowledge of common ICU medications and their role e.g. sedatives, vasopressors, inotropes

Explains physiotherapy role to patients and family

Acquires consent for assessment and treatment or understands when to “treat in best interest”

Ascertains the presenting condition and relevant medical and social history to inform assessment and goal setting

Ascertains limitations of treatment (e.g. resuscitation status, End of life pathway)

Identifies type of airway, airway adjuncts and patency

• Own
• Naso Pharyngeal (NP)
• Endo tracheal tube (ETT)
• Tracheostomy

Awareness of grades of Intubation and measures taken to secure ETT

Identifies the oxygen delivery device, flow rate and FiO2

Ability to interpret vital signs from bedside monitoring equipment including respiratory rate, and saturations

Auscultates patient and describes breath sounds and added sounds

Observes and describes breathing pattern and chest wall movement

Assesses cough and describes effectiveness

Interprets a CXRAY, completing a systematic assessment identifying volume loss, consolidation, pneumothorax, pleural effusions and pulmonary oedema.

Interprets blood gases demonstrating knowledge of parameters appropriate for the patient

Able to identify mucolytics, bronchodilators and antibiotics within a prescription chart

Mechanically Ventilated Patients:

Identifies the mode of ventilation and can interpret set parameters including PEEP, inspiratory support, I to E ratio and fio2

Awareness of spontaneous modes, controlled modes and mixed modes of ventilation.

Able to identify tidal volumes, peak airway pressures and aware of safe limits

Interprets vital signs from bedside monitoring including heart rate and rhythm.

Identifies systolic and diastolic pressure and recognise a poor arterial trace

Interprets cardiac monitoring demonstrating knowledge of parameters appropriate for the patient.

Able to identify commonly used cardiac drugs within a prescription chart

Able to complete an accurate assessment of level of consciousness using AVPU or GCS

Able to understand the RASS scoring system in the sedated patient

Recognises Delirium scoring system and can describe methods to reduce delirium

Able to identify commonly used medications to reduce agitation and ones that may affect level of consciousness

Identifies and explain the indication for Chest drains and comment on their status (swinging/bubbling/on suction)

Identifies and explain the indication for a PCA (Patient controlled analgesic)

Identifies the urinary catheter or filter for Renal replacement therapy

Identifies and explain rationale for NG tube and completes the 4 checks for safety

Identifies abnormal blood results and describes their potential impact on physiotherapy treatment.

HB, Platelets, INR, APTT, K+, CRP, WCC, NA, Urea, Creatinine and Albumin

Forms a problem list informed by the holistic patient assessment with and understanding of which problems are amenable to physiotherapy intervention

Identifies the manual handling risks to the MDT associated with providing care to this patient

Identifies positions that can reduce the work of breathing

Explains ventilation and perfusion in the spontaneously breathing and ventilated patient and identifies positions to optimise gas exchange

Identifies postural drainage positions to optimise secretion clearance

Explains how to instruct the patient in ACBT

Explains the benefits of a supported cough and how to instruct the patient to complete one.

Explains how to set up IPPB and can recommend treatment pressures

Aware of local guidelines for its use and can safely assemble equipment required

Can discuss the risks and benefits associated with use and how to monitor effectiveness

Explains how to set up cough augmentation device and can recommend treatment pressures

Aware of local guidelines for its use and can safely assemble equipment required

Can discuss the risks and benefits associated with use and how to monitor effectiveness

Explains how to size for and insert a nasal airway.

Aware of local guidelines for insertion and frequency of change

Can discuss the risks and benefits associated with its use and how to monitor effectiveness

Explains manual techniques (including percussion and vibrations) and their role in sputum clearance.

Can discuss the risks and benefits associated with its use and how to monitor effectiveness

Explains aseptic technique and the importance of this

Aware of local guidelines and safe suction pressures

Can discuss the risks and benefits associated with its use and how to monitor effectiveness

Explains the indications for Manual assisted cough (MAC) and it use in cough augmentation

Can discuss the risks and benefits associated with its use and how to monitor effectiveness

Explains manual hyperinflation and its role in secretion clearance and volume loss

Aware of local guidelines for its use and can safely assemble equipment required (including pressure manometer)

Can discuss the risks and benefits associated with use and how to monitor effectiveness

Can discuss the use of MHI vs VHI

Explains Ventilator hyperinflation and its role in secretion clearance and volume loss.

Aware of local guidelines for its use.

Describes mandatory modes of ventilation and suggests alterations to optimise sputum clearance and volume loss

Can discuss the risks and benefits associated with its use and how to monitor effectiveness

Able to demonstrate a basic understanding of the anatomy and physiology of the respiratory system

Identifies type of tracheostomy (single or double lumen/cuffed or uncuffed, fenestrated or unfenestrated

Identifies surgical or percutaneous

Identifies presence of stitches

Identifies which oxygen delivery system is in use and how humidification is being delivered

Can establish cuff status (up or down)

Can state appropriate safe cuff pressure with cuff pressure manometer

Can describe when we would consider deflating the cuff and what physiological parameters to use to assess tolerance of this

Can describe the rationale for use of a one way valve.

Can explain the role of SALT in tracheostomy weaning and when to refer.

Can perform open suction using a sterile technique

Can change an inner cannuale and store this safety

Awareness of emergency tracheostomy algorithm

Awareness of contents of emergency tracheostomy box

Can state local requirements for decannulation including any objective measures and requirements

Can discuss the indications for initiation of high flow oxygen therapy and is aware of the precautions

Can explain how to adjust and modify the therapy (flow rate and oxygen) to optimise the patient’s condition

Can recommend next steps if set parameters are not being achieved

Can discuss the indications for initiation of CPAP and is aware of the precautions

Can explain how to adjust and modify the therapy (PEEP and oxygen) to optimise the patient’s condition

Can recommend next steps if set parameters are not being achieved

Can discuss the indications for initiation of NIV and is aware of the precautions

Can explain how to adjust and modify the therapy (PEEP, oxygen and Inspiratory Pressure) to optimise the patient’s condition

Can recommend next steps If set parameters are not being achieved