2002 OPEN FORUM Abstracts
TIME REQUIRED TO PERFORM A SIMPLE VENTILATOR CHECK
William French, MA, RRT, Lakeland Community College, Kirtland, OH
In recent years, the practice of performing routine ventilator checks (VC) has been questioned. Nevertheless, the practice persists in most acute care hospitals, usually every two to four hours, and when ventilator changes are made. Generally, a ventilator check consists of recording data such as ventilator settings, patient/ventilator interface data (e.g. actual respiratory rate, return volume, peak inspiratory pressure, etc.), and basic assessment data (e.g. heart rate, breath sounds, SpO2, etc.). Although there is little documentation of need, respiratory therapy departments probably require routine checks for the following reasons: 1) basic documentation of satisfactory ventilator function, and 2) ensure that a therapist visits the bedside on a timely basis. However, it is unlikely that administrators are aware of how much time is actually spent in performing a routine VC. Thus, the purpose of this study was to see how long it takes to perform a simple VC.
Ventilator flowsheets were obtained from several local acute care hospitals. An intubated manniquin was placed on a 7200 ventilator at the following settings: rate 12, Vt 400, O2 40%, PEEP +5, mode CMV, peak flow 50 Lpm, square wave. The simulation also had a cardiac monitor displaying a regular rhythm and rate, and audible breath sounds. Five respiratory therapy students near graduation and previously familiar with the particular flowsheets and the process of performing VC were recruited. The students were informed as to the nature of the project and were instructed to perform the VC as though it were a real situation. For each flowsheet, three students performed a VC, each independent of the other and without observing each other. Each VC was timed with a digital stopwatch without the student being aware of the time. The students were sequenced so that no student performed more than one VC on the same flowsheet. In addition, for the second two sets of checks, the ventilator settings were slightly altered.
The first flowsheet required a total of 26 separate items that had to be observed and recorded. The mean time required to accomplish this was 4.1 minutes. The second flowsheet also required the recording of 26 separate items. The mean time required to accomplish this was 3.3 minutes. The third flowsheet required the recording of 21 items of information. The mean time per VC was 3.9 minutes. When the three means were averaged together, the time was 3.8 minutes.
Obviously, this study was very limited since it was done under simulated conditions in a quiet laboratory. However, because of the stable nature of the simlated environment and the fact that the patient/ventilator interface was ideal, the mean time recorded probably represents the absolute minimum time required to perform a VC. From the perspective of time management, if we assume that the average VC requires a minimum of about 4 minutes to perform, then a therapist assigned five ventilators in a typical ICU would spend at least 20 minutes every round of checks just observing and recording data.