2003 OPEN FORUM Abstracts
TIMING OF ROUTINE VENTILATOR CHECKS IN A MEDICAL INTENSIVE CARE UNIT
William French, MA, RRT, Lakeland Community College, Kirtland, OH
Introduction Routine ventilator checks (RVC) are a standard duty performed in most intensive care units. A RVC consists of two primary phases: observing and recording. Examples of typical observations include patient data, ventilator function, ventilator settings, and patient/ventilator interface. Observations are typically recorded on some kind of flowsheet which becomes part of the patient's medical record. Occasionaly, a third phase, interacting/adjusting, may also be performed; however, this is not a true component of the RVC. A recent study determined that it took an average of nearly four minutes to perform a RVC in a controlled laboratory setting using a variety of flowsheets. This, then, set a probable minimum time to perform a RVC. The present study was designed to measure the time to perform a RVC in a busy ICU on real patients.
Methods A respiratory care supervisor was recruited and trained to time RTs as they performed RVCs during the course of their shifts. The timing was done in a medical intensive care unit of a large academic medical center. The time was measured on a watch with a second hand and rounded up to the nearest minute, then recorded on a form designed for the study. The therapists were not aware of the study or that they were being timed. The flowsheet contained 21 separate items to be recorded. The RVCs were done on either the P-B 7200 or 840 ventilator. All the patients were adults. Potential distractors (e.g. interaction with other caregivers, patient situations, drawing blood, etc.) were also noted and timed as they occurred.
Results A total of 22 RVCs were timed. These were performed by 7 different therapists on 13 different patients. One or more distractions occurred during 9 of the checks. The time consumed by the distraction was subtracted from the total time. When all the data were compiled, the mean time required to perform a RVC was 5.1 minutes. The data ranged from a high of 10 minutes (for a patient who had just undergone a bronchoscopy) to 3 minutes. The total amount of time consumed by the distractions was 27 minutes. The times per RVC seemed to be pretty evenly distributed among patients and therapists.
Discussion Clearly, this study is limited in that it looked only at one group of RTs in one intensive care unit. However, the data does seem to follow from the previously calculated mean of 4 minutes in a simulated environment. From a management perspective, one can use the time to assess and measure workload (e.g. a RT would require at least 50 minutes to check 5 ventilators twice during an eight hour shift - not counting any other interaction with any particular ventilator patient). In the future, this study should be enlarged to include RTs performing RVCs in a variety of settings with a variety of ventilators.