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The Trach Safe Initiative

A screenshot of The Trach Safe Initiative report.

Being a nurse is an honor that comes with the intersection of many emotions over the span of your career. This happened to me about 15 years ago—when there were too many preventable deaths at home within our trach/vent population.


During the years prior, any preventable death at home was always a tragedy, but not extraordinary. These are sick children, but that year was different—so different and sad that I connected with a colleague and we both felt the need to do something to stop the tragedies. 

We weren’t sure what we’d do, but we ended up collecting ten of our best ideas on how to make home-based trach and vent dependence as safe as possible. That led to a series of targeted meetings over the course of three days with several wonderful colleagues, other nurses, RT’s, parents, and doctors.  A short time later, The Trach Safe Initiative was written and the Seattle Children’s Trach Safe Program was launched, which targeted three interventions to make care safer at home:


  1. Trach Safe Emergency Airway Diagram:

    1. An airway diagram developed for every tracheostomy patient prior to the first discharge home, then repeated over the years when the doctors felt they needed more information on the airway or the emergency/ reconstruction plan.

    2. This diagram lists the medical diagnoses, but also the explanation of the diagnoses without using medical jargon.

    3. We discovered in our workgroup that parents and home nurses did not reliably know why their child had a trach tube and we wanted to try and fix this. You have to know this in order to save their lives.

    4. Most important, every child went home with a personalized emergency airway plan showing how that child would be resuscitated in the event the trach was either in or out of the stoma.

    5. EVERY trach patient prior to going home for the first time had the diagram sent to the paramedics at the fire station near the home and the home nursing agency.  Everyone could know the patient-specific emergency airway management plan.

  2. Trach Safe Emergency Airway Management Class:

    1. Since 2014, over 250 nurses have attended this class that focuses on how to respond to an airway emergency at home.

    2. It was very well received by the home care and school nursing community and a great place to practice through simulation without the fear of causing patient harm.

  3. Trach Safe Near Miss Data Collection:

    1. Each vent clinic visit includes a questionnaire to the family on the events at home requiring the use of emergency airway care, such as airway plugging, equipment failures, which also then provides an avenue for review and congratulations for a job well done.   


Trach Safe has made a positive impact on the homecare community and patient/family safety at home. It significantly dropped the number of preventable deaths at home and I can’t say enough about how parents shaped this program for success. Anything we do to promote home safety must include the voices of those doing the care at home. ‘Nothing about us without us’ is a powerful statement that should guide all homecare safety improvement ideas.

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