1. 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

2. 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

3. 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.

4. Challenges Facility Management Staff

5. Challenges Physician Resistance Control Confidence Ignorance Change phobic

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

7. 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

8. Physician champion(s)

9. Administrative support

10. Involve all disciplines in development

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

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

13. After approval Educate thoroughly Keep good records

14. On Implementation Monitor and facilitate Celebrate successes Old habits die hard

15. Adequate staffing required

16. Ongoing enforcement for adherence

17. Safety is as required for success as other more obvious benchmarks

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

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

20. Will be worth it for your patients, staff and facility