Improving Patient Outcome Through Functional Communication

The Americans with Disabilities Act (ADA) mandates practitioners to provide patients with an effective means of communication. However, the presence of a tracheostomy tube and decreased physical abilities from neurological diagnoses can make communication arduous and nearly impossible. Inability to verbally communicate or consume food by mouth can cause distress symptoms in patients with tracheostomy, which can delay their progress time in treating their medical conditions. The team at this hospital has endeavored to return and honor the patient’s right to communicate by establishing evidence-based interventions within a multidisciplinary team. They collaboratively created a facility policy to ensure that the patient was at the center of our care with safety kept paramount, contributing to overall satisfaction and progress towards goals.

This hospital identified appropriate patients in the medical-surgical unit to evaluate the effect of using one-way speaking valve on their communication ability. The valve improved their communication and improved their quality of life atop of improved functional outcomes as physiological benefits such as improved lung recruitment and trunk control. In 2018, this facility published a policy outlining duty during assessment and treatment for communication and swallowed safety. This set a precedence that nursing can provide progressive involvement beyond general trach care.

After implementation, continued education was pursued, including vendor mentorship and advanced training courses for optimization. This hospital updated the policy in 2019 for patient safety and in 2020 according to widen criteria for candidacy. In 2021, this hospital was recognized a center of excellence (COE).

This poster will focus on several patient cases that significantly changed trajectory and autonomy after multidisciplinary intervention using a one-way speaking valve. Nursing identified appropriate candidates upon initial assessment and obtained an order for speech-language pathology evaluation. After evaluation, intervention, and education, nursing supported the endeavor by donning and doffing the one-way speaking valve during daytime hours, as directed. This responsibility increased nursing efforts with tracheostomy care far beyond traditional bedside needs and rooted them as an imperative member of the trach team. Additionally, this facilitated improved communication, medication management, pain management, and patient satisfaction. Patients with extended wear hours progressed towards trach downsize/modification, initiation of food and drink, improved autonomy, and enhanced disposition.

Evidence-based references
1. Agency for Healthcare Research and Quality (AHRQ) Guide to Patient and Family Engagement in Hospital Quality and Safety. [Internet]. [Last reviewed February 2017; accessed January 19,2022.] Available from: https://www.ahrq.gov/patient-safety/patients-families/engagingfamilies/index.html.
2. Bartlett G, Blais R, Tamblyn R, Clermont RJ, and Macgibbon B. Impact of patient communication problems on the risk of preventable adverse events in acute care settings. Canadian Medical Association Journal 2008 178(12), 15551562.
3. Bovento B, Wallace S, Lynch J, Coe B, & McGrath BA. Role of the multidisciplinary team in the care of the tracheostomy patient. Journal of Multidisciplinary Health 2017 10, 391-398.
4. Freeman-Sanderson A, Togher L, Elkins M, and Phipps P. Quality of life improves with return of voice in tracheostomy patients in intensive care: An observational study. Journal of Critical Care 2016 33, 186-191.
5. U.S. Department of Justice, Civil Rights Division, Disability Rights Section: Effective Communication [Internet]. [Last reviewed 2014; accessed January 19, 2022.] Available from: http://www.ada.gov/hospcombr.htm.