! ! The!New!Zealand!Speech/language!Therapists’!Association! (NZSTA)! ! ! ! Position!Statement:!! Tracheostomy! Management! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! Copyright!©!2015!The!New!Zealand!Speech;language!Therapists’!Association!! !!!!! ! Disclaimer:!To!the!best!of!The!New!Zealand!Speech;language!Therapists’!Association’s!(‘the!Association’)! knowledge,!this!information!is!valid!at!the!time!of!publication.!The!Association!makes!no!warranty!or! representation!in!relation!to!the!content!or!accuracy!of!the!material!in!this!publication.!The!Association! expressly!disclaims!any!and!all!liability!(including!liability!for!negligence)!in!respect!of!use!of!the! information!provided.!The!Association!recommends!you!seek!independent!professional!advice!prior!to! making!any!decision!involving!matters!outlined!in!this!publication.!! ! ! ! Acknowledgements! ! Working!party! Lucy!Greig!(lead)! Molly!Kallesen! Melissa!Keesing! Anna!Miles! Turid!Peters! Samantha!Scott! Katie!Ward! !! Speech!Pathology!Australia!for!sharing!Speech&Pathology&Australia.&(2013).& Tracheostomy&Management&Clinical&Guideline.&Melbourne:&Speech&Pathology& Australia.&with!members!of!the!New!Zealand!Speech;language!Therapists’! Association.! !! Advisors! Karen!Brewer,!Speech;language!Therapist,!Te!Kupenga!Hauora!Maori,!Faculty!of! Medical!&!Health!Sciences,!The!University!of!Auckland.! ! Erena!Wikaire,!Physiotherapist,!Te!Kupenga!Hauora!Maori,!Faculty!of!Medical!&! Health!Sciences,!The!University!of!Auckland.! ! Reviewers! The!New!Zealand!Speech;language!Therapists’!Association!Executive!Committee! The!New!Zealand!Speech;language!Therapists’!Health!Leaders!Forum! ! ! Background+! ! The!New!Zealand!Speech;language!Therapists’!Association!(NZSTA)!identified!the!need! for!a!position!statement!and/or!clinical!guideline!for!speech;language!therapists!(SLTs)! managing!tracheostomy!patients!in!New!Zealand.!A!working!party!was!formed!to! determine!if!an!existing!clinical!guideline!from!one!of!the!Association’s!Mutual! Recognition!Agreement!(MRA)!partners!or!any!other!international!sources!would!be! appropriate!for!use!in!the!New!Zealand!context.!The!working!party!identified!six!such! clinical!guidelines/position!statements.!The!Speech&Pathology&Australia&(2013)& Tracheostomy&Management&Clinical&Guideline.&Melbourne:&Speech&Pathology& Australia&was!deemed!the!most!comprehensive!document!for!NZSTA!both!in!terms!of! rigour!of!development!and!relevance!to!New!Zealand!SLTs.! ! An!in;depth!review!of!this!guideline!was!conducted!to!identify!any!areas!that!needed! modification!in!order!to!assist!SLTs!working!in!New!Zealand!in!applying!the!guideline!to! their!practice.!These!modifications!and!additions!have!been!incorporated!into!this! position!statement.! ! ! 1! Aim! ! This!position!statement!aims!to!be!relevant!to!the!management!of!both!children!and! adults!with!tracheostomies!and!to!support!practice!across!the!breadth!of!services!of! New!Zealand!(i.e.!rural!and!urban,!community!and!hospital;based).!The!position! statement!and!the!supporting!documents!referenced!must!always!be!used!within!the! context!of!local!governance!(i.e.!the!clinician’s/manager’s!own!organisation's!policies! and!procedures).! ! ! The+position+of+the+NZSTA! ! It!is!the!position!of!the!New!Zealand!Speech;language!Therapists’!Association!(NZSTA)! that!working!in!the!field!of!tracheostomy!is!within!the!scope!of!practice!of!speech; language!therapists.!! ! The!NZSTA!endorses!the!use!of!the!Tracheostomy&Management&Clinical&Guideline& (Speech&Pathology&Australia,&2013)&as!the!overarching!guiding!document!for!its! members!working!in!the!field!of!tracheostomy.!! ! This!guideline!should!be!interpreted!with!the!unique!New!Zealand!context!in!mind.!!As! health!professionals!working!in!New!Zealand!and!members!of!the!New!Zealand!Speech; language!Therapists’!Association,!we!are!committed!to!upholding!the!Treaty!of!Waitangi! and!to!reducing!health!inequities.!Clinicians!utilizing!this!guideline!should!ensure!their! practices!are!culturally!appropriate!and!demonstrate!the!importance!of!holistic!views!of! health!and!wellbeing!that!include!physical,!mental,!social!and!spiritual!elements,! especially!with!persons!who!identify!as!Māori.! ! The!amendments!and!additions!listed!below!provide!guidance!and!clarification!for! clinicians!applying!the!Tracheostomy!Management!Clinical!Guideline!(Speech!Pathology! Australia,!2013)!to!clinical!practice!in!New!Zealand.!! ! 2! Modifications/Amendments+to+the+Tracheostomy, Management,Clinical,Guideline,(Speech,Pathology,Australia,, 2013)+for+the+New+Zealand+Context.! ! Terminology! ! ●" speech&pathologist&(SLP)!refers!to/is!interchangeable!with!speech2language& therapist&(SLT)! ! ●" speech&pathology!refers!to/is!interchangeable!with!speech2language&therapy&or& speech&therapy! ! ●" when!Speech&Pathology&Australia!is!used!in!a!sentence,!such!as!“Speech! Pathology!Australia!supports!an!evidence!based!approach!to!assessment!and! management!in!the!area!of!tracheostomy”,!Speech&Pathology&Australia!is! interchangeable!with!The&New&Zealand&Speech2language&Therapists’&Association.! ! ●" state/territory!is!interchangeable!with!national/district! ! ! Documentation+references! ! ●" where!the&Speech&Pathology&Australia&Code&of&Ethics&(2010)!and/!or!Principles&of& Practice&(2001)&are!referred!to,&SLTs!working!in!New!Zealand!should!refer!to!the& NZSTA&Principles&and&Rules&of&Ethics&(2015)&and&NZSTA&Scope&of&Practice&(2012)! ! ●" where!the!Speech&Pathology&Australia&Scope&of&Practice&(2003)&document!is! referred!to,!SLTs!working!in!New!Zealand!should!refer!to!the&NZSTA&Scope&of& Practice&(2012)&document.! ! ! 3! Guideline+amendments+By+section! ! Page! Section! !!Section! Amendment!! no.! 33! 15.4! Credentialing! Please!refer!to!your!own!organisational!policies!&! &! procedures.!These!sit!under!individual!employers! Competency! in!New!Zealand.! ! Please!also!refer!to:! ●" NZSTA!Return!to!Practice!Policy! for!examples!of!appropriate!supervision!logs!and! competencies!documents!for!SLTs!extending!their! scope!of!practice!into!a!new!specialist!area.! 38!! 16.1!! Education/! Please!also!refer!to:! Professional! ●" The!NZSTA!Professional!Development! Development! Policy,!2014!! ! ! Simulation!Training!for!Tracheostomy! Management!is!also!available!in!New!Zealand! through!The!University!of!Auckland!annually.!For! further!information!contact!Anna!Miles! [email protected]! 41! 19.8! Indemnity! This!is!country;specific.!Please!refer!to!NZSTA! cover!&! Indemnity!insurance!advice! insurance! http://www.speechtherapy.org.nz/page/about; slt/indemnity;insurance/! Please!also!check!with!your!employer!that!you! are!covered!for!the!scope!of!practice!that!you!are! undertaking.! 42! 20! Future! Research!into!the!effectiveness!of!Simulation! directions! Training!for!Tracheostomy!Management!is! currently!being!conducted!in!New!Zealand!as!well! as!in!Australia.!!For!further!information!contact! [email protected]! 49! 22! Support! Please!also!refer!to:! Groups! www.tracheykids.co.nz! Patient!and! www.makaton.org.nz! carer!!support! www.nzsl.vuw.ac.nz/signs! groups! www.voicethruyourhands.org.nz! www.passy;muir.com! ! 51! 23! References! Please!also!refer!to:! Andreoli,!Steven!M,!Nguyen,!Shaun!A,!White,! David!R!(2010)!Feeding!status!after!pediatric! laryngotracheal!reconstruction.!Otolaryngology; Head!and!Neck!Surgery!143,!210;213! ! ! ! 4! ! Related+documents+! ! This! guideline! should! be! read! in! conjunction! with! the! New! Zealand! Speech;Language! Therapists’!Association!core!documents!including:!! ! ●" Tracheostomy! training! programme! for! therapists! working! with! adult! patients! (2013)! ●" NZSTA!VFSS!Guideline!(2011)! ●" NZSTA!Principles!&!Rules!of!Ethics!(2015)! ●" NZSTA!Scope!of!Practice!(2012)! ●" NZSTA!Professional!Development!Policy!(2014)! ●" Competency;based!Occupational!Standards!for!Speech!Pathologists!(5)!(2011)! ●" NZSTA!Full!Member!Return!to!Practice!Framework!(2015)! ! ! Review+! ! This!position!statement!is!to!be!reviewed!every!five!years!following!Speech!Pathology! Australia’s!review!of!their!Clinical!Guideline.!The!review,!which!will!be!overseen!by!the! NZSTA!Executive!Council,!must!also!consider!if!the!externally!sourced!clinical!guideline! continues! to! be! suitable! for! NZSTA! members.! ! The! related! NZSTA! documents! listed! above!are!reviewed!every!five!years.!!! 5! Level 2 / 11-19 Bank Place T 61 3 9642 4899 [email protected] Melbourne Victoria 3000 F 61 3 9642 4922 www.speechpathologyaustralia.org.au Clinical Guideline TRACHEOSTOMY MANAGEMENT Copyright ≤ 2013 The Speech Pathology Association of Australia Limited Disclaimer: To the best of The Speech Pathology Association of Australia Limited’s ("the Association") knowledge, this information is valid at the time of publication. The Association makes no warranty or representation in relation to the content or accuracy of the material in this publication. The Association expressly disclaims any and all liability (including liability for negligence) in respect of use of the information provided. The Association recommends you seek independent professional advice prior to making any decision involving matters outlined in this publication. The Speech Pathology Association of Australia Limited ABN 17 008 393 440 Acknowledgements Project Officer: BAKER, Sonia Royal Brisbane and Women’s Hospital, Queensland Speech Pathology Australia BALDAC, Stacey Senior Advisor of Professional Standards & Practice Document Coordinator ATTRILL, Stacie Director, National Professional Standards Coordinator WILSON, Christina