Implementing a Ventilation Protocol in the Long-Term Acute Care Hospital Gary W Mefford RRT, Respiratory Care Manager Regency Hospital of Fort Worth Director VentWorld.com

Ventilation by Protocol Benefits Patient –Shorter time on vent –Shorter ICU stay and total LOS –Decreased chance of HAI Facility –Decreased cost –Improved reputation –Better ability to manage total LOS Staff –More engaged –Less turnover –Easier recruitment –Increased autonomy results in higher satisfaction with work

Begin with the end in mind Set as goal and make it a long term project If you are working where there is still not weaning per protocol, you obviously are up against many challenges.

Challenges Facility Management Staff

Challenges Physician Resistance Control Confidence Ignorance Change phobic

Vision and Perseverance Begin with the end in mind Plan in steps

Use the existing evidence base to build from. The evidence will be in your favor if you use Evidence- Based Guidelines for Weaning and Discontinuing Ventilatory Support. Use ACCP Consensus Conference Statement to build consensus

Physician champion(s)

Administrative support

Involve all disciplines in development

Be there to support and sell as approval process is undertaken.

Be persistent when shot down see it as only a temporary set back

After approval Educate thoroughly Keep good records

On Implementation Monitor and facilitate Celebrate successes Old habits die hard

Adequate staffing required

Ongoing enforcement for adherence

Safety is as required for success as other more obvious benchmarks

If you are still not weaning by protocol you obviously are up against challenges.

Doing whatever it takes Plan Develop Escort through approval process Educate Implement Enforce

Will be worth it for your patients, staff and facility