The development of an integrated care pathway for managing oral saliva difficulties in patients with tracheostomy and brain injury on a hyperacute neurorehabilitation unit: a service evaluation

Complications in tracheostomy weaning, linked to an inability to manage oropharyngeal saliva because of dysphagia, can lead to pneumonia and delayed removal of the tracheal tube. This study focuses on the development and service evaluation of an oral saliva management integrated care pathway on a neurorehabilitation unit designed to improve saliva management and tracheostomy outcomes. The aim of this study was to explore health professionals' perspectives on the acceptability of the integrated care pathway in managing oral saliva difficulties and to refine the integrated care pathway accordingly. Phase one involved the constitution of a core advisory group, and liaison and discussion with experts to develop an integrated care pathway for saliva management. Phase two involved a mixed-methods design methodology (survey and focus groups) to ascertain the acceptability of the integrated care pathway among those who used it. Survey data were analysed descriptively; thematic analysis was used for focus group data. The integrated care pathway was refined based on participants' comments. Initially, a flowchart style integrated care pathway was developed to help with timely saliva management decision making. Following phase two, the integrated care pathway was refined into a collaborative staged approach to saliva management decision making as there was perceived value in the integrated care pathway in promoting multiprofessional discussion and signposting saliva management decisions. The integrated care pathway users found the integrated care pathway aided saliva management decision making and supported multidisciplinary team discussion. Integrated care pathways may provide a novel approach to saliva management decision making. By exploring expert professionals' perspectives, it can help to develop and refine the integrated care pathway design and evaluation process.