NCEPOD recommends that all nurses involved in the care of patients with an altered airway should be competent in the management of the tracheostomy or laryngectomy, including the actions to take in an emergency (Wilkinson et al. [286]). All procedures should be undertaken in accordance with local policies and protocols, and only after approved training, supervised practice and competency assessment. The core skills related to caring for a patient with an artificial airway are detailed in Box 12.4.

In addition, NCEPOD recommends that nurses are trained in the recognition and management of common airway complications including tracheostomy tube dislodgement, and airway obstruction in tracheostomy and laryngectomy. Written algorithms to support the emergency management of a laryngectomy airway and a blocked or dislodged tracheostomy tube (Figure 12.35) should be available at the patient's bedside, along with signage detailing the patient's current airway status (Figure 12.36). Emergency equipment should also be readily available at the bedside (NTSP [206]); this is discussed further below. The algorithms should not only include the practical steps required to manage the airway emergency but also details of who to call to assist. This may include teams or individuals specialized in anaesthetics and airway management; critical care and resuscitation; and ENT or head and neck surgery.

Tracheostomy tube information should be readily available detailing the type, size and date of tube insertion, in addition to any other information that may be required in an emergency (Wilkinson et al. [286]). This is often referred to as either the ‘tracheostomy passport’ or ‘altered airway passport’. Similar information should be available regarding laryngectomy stoma patency and method of communication. Signage for the bedside is useful to provide instant recognition of the presence of an altered airway and its type and duration (Figure 12.36).

Each altered airway or head and neck ward should have at least one altered airway trained nurse (band 5+) on duty who has passed a trust‐approved altered airway competency standard. At the beginning of each shift, each patient with an altered airway should be assessed to determine: