overcoming barriers speaking valve use: 8/8/13 …passy-muir.com/ceu2/handouts/success_team.pdf ·...

OvercomingBarrierstoSpeakingValveUse:SuccessThroughTeamwork

8/8/13

NicoleRiley,MSCCCSLPDirectorofClinicalEducationPassyMuirInc. 1

Welcome to Passy-Muirs Event Webinar:

OVERCOMING BARRIERS TO SPEAKING VALVE USESuccess Through Teamwork

If you have not registered for this event, go to the Education Portal to complete your registration. ep.passy-muir.com

This is an Audio Broadcast meeting, which means that the audio signal will be sent out through your computer. A toll telephone number will also be g y p pavailable. Use the Audio section of the file menu for audio options.

Call-in toll number (US)+1-415-655-0001 Access code: 666 956 524

The audio for this meeting is one-way, so the presenter will not be able to hear the attendees, nor will the attendees be able to hear each other.

If you have a question for the presenter, please use the Q and A (not the chat box), to the lower right of meeting window.

After the webinar ends, you will have an opportunity to fill in your evaluation on the Passy-Muir Education Portal

If you have a technical issue, please call Passy-Muir at 949-833-8255, or email Daniel at [email protected]

SUCCESS THROUGH TEAMWORKOVERCOMING BARRIERS TO SPEAKING VALVE USE

Disclosure Statement Passy-Muir, Inc. has developed and patented

a licensed technology trademarked as the Passy-Muir Tracheostomy and Ventilator Swallowing and Speaking Valve. This

t ti ill f i il th bi dpresentation will focus primarily on the biased-closed position Passy-Muir Valve and will include little to no information on other speaking valves.

Presenter

Nicole Riley, MS CCC-SLPDirector of Clinical EducationPassy-Muir Inc.

[email protected](949) 783-3755

Disclosure: Financial Employee of Passy-Muir Inc.Nonfinancial No relevant nonfinancial relationship exists.

Course Outline

1. Evidence for Passy-Muir Protocols

2. Common barriers and practical strategies to overcome barriers to

Passy-Muir Valve UsePassy Muir Valve Use

3. How to implement a Passy-Muir protocol

4. Forming a tracheostomy team

5. Outcomes and Case Studies

My Story at Barlow


8/8/13


Why make the Passy-Muir Valve a standard of care?

Benefits of the valve: Voice/Speech

Production Improved swallowing Secretion management Secretion management Restores positive airway

pressure Restores PEEP Weaning Decannulation Quality of Life

Goal

Common Barriers to this Goal Myths, misconceptions and excuses Sociological Issues

Barrier 1: We cant deflate the cuff because the patient will aspirate

Amathieu, R., et al. British journal of anaesthesia109.4 (2012): 578-583.Davis, Daniel G., et al. Journal of Intensive Care Medicine 17.3 (2002): 132-135.

Cuff deflation REDUCES aspiration Laryngeal elevation is

improved Aspiration rate is lower Reduced cases of silent

i tiaspiration

Ding, R. & Logeman, JA, Head and Neck. 2005 Sep;27(9):809-13.


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Deflating the tracheal cuff in tracheostomized patients shortens weaning, reduces respiratory infections, and probably improves swallowing

Hernandez, Gonzalo, et al. Intensive care medicine (2013): 1-8.

One Way Valve Reduces Aspiration Further

Improved scores on penetration-aspiration scale1

Restores expiratory airflow2

Improves laryngeal l 2clearance2

Improved secretion rating scale3

Maintains lung volumes4

Restores subglottic air pressure5

1. Suiter, D. Head and Neck. 2005. Sep;27(9):809-132. Prigent, Helene. Intensive Care Med. 2012 June38(1):85-90.3. Blumenfeld, L. Oral Abstract Presented at Dysphagia Research Society Annual Meeting 20124. Gross, R., et al. (2006). The Laryngoscope, 116:753-7615. Eibling, D., & Gross, R. (1996). Annals of Otology, Rhinology, & Laryngology, 105(4):253-8.

Barrier 2: The patient has too many secretions Before Passy-Muir Valve

After Passy-Muir Valve Barrier 3: We need to wait until the patient is on a trach collar


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Disuse Atrophy Mechanical ventilation

can cause atrophy, and injury of diaphragmatic muscle fibers

Patients in intensive Patients in intensive care lose about 2% of muscle mass a day during their illness.1

Muscle weakness predicts pharyngeal dysfunction2

1. Jaber, S.et al, 2011; Griffiths, BMJ, 19992. Mirzakhani, H. et al Anesthesiology. 2013

Use of the Passy-Muir can facilitate weaning Barrier 4: The patients are too sick

Patients should be medically stable Barrier 5: The Ventilator will continuously alarm

500cc

0cmH20

PEEP

.30FiO2

PIP10cmH2O

VT500cc0cc


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Set your pressure alarms appropriately Barrier 6: Tracheostomy tube is too large

Tracheostomy Tube is Too Large

Hernandez, Gonzalo, et al. Intensive care medicine (2013): 1-8.Fisher, Daniel F., et al. Respiratory care 58.2 (2013): 257-263.

Barrier 7: Absence of a Team

Tracheostomy Teams

Affordable Care Act Joint Commission

Tracheostomy Teams Increased speaking valve use Improved decannulation time Reduce Length of Stay (LOS) Reduced costs

Speed, Lauren, and Katherine E. Harding. Journal of Critical Care (2012).


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Tracheostomy Team

Role of Speech-Language Pathologist Help assess airway

patency Assess swallow ability

and diet recommendations

Assess vocal ability Speech/swallow

exercises Monitor tolerance Recommend wear time Educate caregivers

Role of Respiratory Therapist Help assess airway

patency Adjust and monitor

ventilatorT h i l Technical troubleshooting

Monitoring of pt status Cough/breathing

techniques

Barrier 8: Lack of Knowledge/Inconsistency Educate Be a leader Physician support is KEY! Pulmonologists, RTs, SLPs,

nursing Use Passy-Muir

webinars/inservices


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Performance Improvement Protocol to assess all

tracheostomy patients for Passy-Muir Valve within 72 hours of admission

Criteria: Tolerate cuff deflation Patent upper airway 48-72 hrs post trach Medically stable

FiO2


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Barlow Flow Chart for Decannulation Success! Earlier decannulation times Reduced restraint use as patients were less anxious Individual success stories

Case 56 y/o female Dx: Pulmonary Fibrosis 2 month vent-

dependent

After PMV Placement:

Started a diet Weaned and

Portex #8 Typical weaning

methods failed

decannulated in less than 3 weeks

Summary Be a leader Provide research to

support your information Educate the clinicians

and MDsand MDs-Use Passy-Muir webinars-Consider live webinars or

inservices Implement a protocol Competencies Build your team!

Q and A Presenter

Nicole Riley, MS CCC-SLPDirector of Clinical EducationPassy-Muir Inc.

[email protected](949) 783-3755

Disclosure: Financial Employee of Passy-Muir Inc.Nonfinancial No relevant nonfinancial relationship exists.


8/8/13


Receiving CEUs for this Course You will have 5 days from the time this courses

ends to complete the evaluation, which is required to receive credit. Look in your email for a reminder link, or type this into your

I t t b dd bInternet browsers address bar:

ep.passy-muir.com If you are a late registrant, the meeting code is:

passy752 If you are already registered, you do not need to use this

code

Overcoming Barriers to Speaking Valve Use: Success Through Teamwork

Here are some links and references to get you to overcome your barriers at your facility!

Evidenced-based research on the Passy-Muir Valve:

http://www.passy-muir.com/research

Centers of Excellence (COE):

http://www.passy-muir.com/centers_of_excellence

Policies and Procedures of our COE:

http://www.passy-muir.com/policiesandprocedures

Barlows Passy-Muir Valve Protocol-

http://www.passy-muir.com/sites/default/files/pdf/barlow_p_and_p.pdf

FEES study, by Lisa Blumenfeld

http://www.passy-muir.com/what_is

http://www.passy-muir.com/researchhttp://www.passy-muir.com/centers_of_excellencehttp://www.passy-muir.com/policiesandprocedureshttp://www.passy-muir.com/sites/default/files/pdf/barlow_p_and_p.pdfhttp://www.passy-muir.com/what_is

Passy-Muir Valve Decannulation Diagram

References:

Cuff Deflation Benefits:

Amathieu, R. et al. (2012). Influence of the cuff pressure on the swallowing reflex in tracheostomized intensive care unit patients. British Journal of Anaesthesia. Oct;109(4):578-83

Davis, et al. (2002) Swallowing with a Tracheotomy Tube in Place: Does Cuff Inflation Matter? Journal of Intensive Care Medicine.17(3): 132-135.

Ding, R. & Logeman, J. (2005). Swallow Physiology in Patients with Trach Cuff Inflated or Deflated: A Retrospective Study. Head & Neck. Sep;27(9):809-13 Hernandez, G. et al. (2013). The effects of increasing effective airway diameter on weaning from mechanical ventilation tracheostomized patients: a randomized controlled trial. Intensive Care Medicine. Jun;39(6):1063-70

Improved Swallowing with Passy-Muir Valve:

Elpern, E., et al. (1994). Pulmonary Aspiration in Mechanically Ventilated Patients with Tracheostomies. Chest, 105:583-586. .

Eibling, D., & Gross, R. (1996). Subglottic Air Pressure: A Key Component of Swallowing Efficiency. Annals of Otology, Rhinology, & Laryngology, 105(4):253-8.

Prigent, H. et al. (2012). Effect of a tracheostomy speaking valve on breathing-swallowing interaction. Intensive Care Medicine. Jan;38(1):85-90.

Suiter, D. et. al. (2003). Effects of Cuff Deflation and One Way Speaking Valve Placement on Swallow Physiology. Dysphagia, 18: 284-292.

Blumenfeld, L. (2012). The effect of tracheostomy speaking valve use on disordered swallowing {abstract}. Oral Abstract Presented at Dysphagia Research Society Annual Meeting.

Trach tube downsizing benefits:

Hernandez, G. et al. (2013). The effects of increasing effective airway diameter on weaning from mechanical ventilation tracheostomized patients: a randomized controlled trial. Intensive Care Medicine. Jun;39(6):1063-70 Fisher, D. et al. (2013). Tracheostomy Tube Change Before Day 7 is Associated With Earlier Use of Speaking Valve and Earlier Oral Intake. Respiratory Care. 2013 Feb;58(2):257-63. Tracheostomy team benefits:

Cameron, T. S., et al. (2009). Outcomes of patients with spinal cord injury before and after introduction of an interdisciplinary tracheostomy team. Critical Care Resuscitation, 11(1), 1419.

Speed, L. & Harding, K. (2012). Tracheostomy teams reduce total tracheostomy time and increase speaking valve use: A systematic review and meta-analysis. Journal of Critical Care, 28(2):216.e1-10.

De Mestral, C., et al. (2011). Impact of a specialized multidisciplinary tracheostomy team on tracheostomy care in critically ill patients. Canadian Medical Association, 54(3), 167-72.

LeBlanc, J., et al. (2010). Outcome in tracheostomized patients with severe traumatic brain injury following implementation of a specialized multidisciplinary tracheostomy team. The Journal of Head Trauma Rehabilitation, 25(5), 362.

Contact us if you would like more information:

800-634-5397 Toll Free 949-833-8255 [email protected]

Overcoming Barriers5-eOvercoming Barriers to Speaking Valve Use Handout

overcoming barriers speaking valve use: 8/8/13 …passy-muir.com/ceu2/handouts/success_team.pdf ·...

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