The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

Use of a Respiratory Therapist–Driven Weaning Protocol by a Respiratory Care Student at a Long-Term Adult Care Facility

By Marcia Haymans, B.S., R.R.T., DiAnn Larson, R.R.T., David Snyder, M.D., Marty Arnson R.N., and Larry Arnson, Ph.D., R.R.T. Gwinnett Technical College, Lawrenceville GA

At Decatur Hospital, a long-term ventilator dependent care facility, a large percentage of our patients go directly home from the hospital. Decatur Hospital’s comprehensive approach to patient care assures that patients receive treatment that is tailor-made to their needs. To further improve patient care and to increase the number of patients that go directly home without mechanical ventilator assistance, the Respiratory Care Department implemented a ventilator weaning protocol. As a student in a respiratory care program, I worked with participants of the heath care weaning team which consisted of nine full-time respiratory therapists, 11 part-time respiratory care practitioners, 5 employees of the Rehab Group, one nurse practitioner, 6 nurses, one nutritionist, 2 physician assistants and one pulmonologist. The patients at this Long-Term Acute Care Ventilator Dependent Hospital are sent to us from the intensive care units of area hospitals. These are difficult patients to wean because of physical and mental dependency of the ventilator and the need for endurance training. Weaning success comprised of moving through each of the stages of the protocol from full ventilator dependency to 24 hour spontaneous unassisted breathing and then discharge. The patient was not counted as successful if they expired after being weaned from the ventilator. To be counted as a successful wean, patients had to be discharged home without ventilator support. During the time of my clinical rotation, as a member of the weaning team, I utilized the Ventilator Weaning Protocol. This is an easy straight forward approach to weaning the difficult patient. The Ventilator Weaning Protocol was developed by DiAnn Larson RRT, Dan Pike RRT, and David Snyder M.D., FCCP. The patient was not counted as successful if they expired after being weaned from the ventilator. To be counted as a successful wean, patients had to be discharged home without ventilator support. Patients that were ventilator dependent because of neurological disorders/diseases were excluded from the weaning protocols. During the first quarter of 2004, the mean age of the weaned patients was 62.1 years of age with a range of 47 to 83 years. Of those 29 ventilated patients, 53% were Caucasian, 32% were African-American. The majority of the patients (75%) were ventilated due to respiratory failure with a mean age of 60.7. These patients were primarily African-American (71%) and 77% were female. Fifty-four percent of the patients had been weaned successfully with an average length of time on the ventilator of 17 days. The purpose of the protocol was to establish department wide policies with strict provisions for the care and safety of patients who have artificial airways and are being mechanically ventilated. The following policies describe specific practices the department will abide by in caring for the ventilator patient. The entire protocol would be presented at the open forum.

  • A licensed Respiratory Therapist assesses and documents on ventilator patients every 4 hours.
  • Ventilator patient coverage will be 24 hours a day by a licensed Respiratory Therapist. The process for instituting and weaning patients from mechanical ventilation will be implemented when the standing orders are signed by the Physician. The weaning process will be a collaborative effort between the patient care team. All disciplines will be fully informed of patient progress and current status. Coordination of patient treatment times with RT/PT/OT.
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