2004 OPEN FORUM Abstracts
RESIDENT PHYSICIAN COMPETENCY IN OPERATION OF MECHANICAL VENTILATORS IN THE SETTING OF NO SPECIALIZED RESPIRATORY CARE PRACTITIONERS
Yoshihiro Uzawa RRT/RPT1,
Norihiro Kaneko MD2, Junmei Fudoji MD3.
Rehabilitation Medicine1; Pulmonary Medicine2;
Emergency Department3; Kameda Medical Center, Kamogawa,
Chiba, Japan
Introduction: Knowledge
of the operation of mechanical ventilators (MV) and application of
these principles to clinical practice are important and require
formal education. There have been reported ventilator-related deaths
and injuries associated with improper operation of MV. In many
countries, specifically trained respiratory care practitioners (RCPs)
provide MV management. However, in some countries there are no
specialized health care practitioners for respiratory care. In this
situation, staff or resident physicians have taken the responsibility
to order and operate the MV, even though he/she is not specialized in
respiratory care. In this study, we surveyed residents about their
comfort level with their MV knowledge, how they were educated about
MV before graduation, and what types of education they would like to
have in the clinical setting.
Subjects and Methods: Thirty
residents employed by an 800 bed general hospital were given written
questionnaires. The residents were asked to describe their subjective
feelings of confusion both when first operating MV and about their
present situation, using a 100 mm visual analog scale (VAS) as well
as in a comment section. They were asked of their educational
experience with MV before graduation, and their perceived need for
education regarding MV after graduation. We also administered a
20-item written examination based on established RCP MV competencies.
Results: Twenty-three subjects (76.6%) responded. All
responders had operated MV except for one first year resident. VAS
values were 86.0±15.5 at the first, 42.2±22.3 at the
present. Their knowledge of initial settings, changes of parameters
and skill of MV operation was limited. Ten of 23 had studied MV
before graduation; however, training was insufficient to allow them
to apply their knowledge to the clinical setting. Most residents
hoped to receive additional education regarding MV within the first
year of residency. The topics most desired are initial settings,
alarm settings, trouble-shooting, mechanical operation of MV and
weaning patients. The mean test score was 55.6% correct.
Conclusion: Resident knowledge and confidence about the use of MV was
limited
even though half of them had received some education regarding MV.
Although an educational system for teaching MV at the clinical site
has not been established yet in our country, the absence of RCPs
requires physicians to pursue formal clinical education to maintain
good job performance. To provide an increased level of patient
safety, it is also important to train health care practitioners as
specialized non-physician RCPs.