The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts


John Rendle, Lori Alturo, Steve Williams, Dawn Selhorst, Rustin Bladen-Daugherty, Kelly Walsh, James Hertzog; Respiratory Care, Nemours, A. I. dupont Hospital for Children, Wilmington, DE

Background: The two most important goals of Non-Invasive Positive Pressure Ventilation (NIPPV) for a pediatric patient are to ensure patient comfort and to effectively deliver prescribed therapy. Our hospital's Respiratory Care Department is continuously looking for areas in which to improve quality outcomes and elevate our patient satisfaction. A "BiPAP Workshop" was a hands-on, mandatory education, developed for all RTs and Sleep Technicians in the hospital. The goal of the workshop was to create consistency in prevention of skin breakdown, choosing the appropriate mask,correctly assessing the presence and proper placement of the exhalation port in the circuit and in providing nebulizer treatment in-line with NIPPV. Method: RTs signed up in groups of five for effective hands-on instruction, which took place in a virtual lab. Each RT took a pre-workshop evaluation. Education was presented three ways: didactically, demonstration and return demonstration. Topics covered were: skin prep, skin barrier options, proper measuring for nasal vs. full face mask, need for only one location for exhalation port and in-line nebulizer placement. Then, each group was asked to prepare the mannequin with the appropriate skin barrier device, choose appropriate mask, decide whether or not to add a disposable exhalation device (DEP), place the patient on 12/6 with a back-up rate of 10 and assess the patient. Results: The most common discussion among groups involved the skin barrier, the fact that a DEP in not always indicated and placement of a nebulizer in-line. The results of the post workshop assessment demonstrated 150%-350% improvement in understanding. Of additional benefit was the initiation of several process improvements, suggested by workshop participants. There have been no cases of skin breakdown secondary to BiPAP application since the workshop (6+ months). Conclusions: The benefits of a hands-on workshop are immeasurable. Improved consistency in all categories of education has positively impacted the quality of care provided to an NIPPV pediatric patient.
Sponsored Research - None
Evaluation Questions:
1. Describe what types of patients would benefit from BiPAP via the Focus
2. Describe what types of patients would benefit from BiPAP via the V60.
3. Understand the need for one exhalation port.
4. Determine which skin barrier to use for any given patient.
5. Perform a skin assessment at the required frequency and size/cut the appropriate skin
6. Choose the appropriate BiPAP interface dependent on patient.
7. Correctly size and secure a BiPAP mask.
8. Identify when a patient needs to be transitioned from a nasal mask to a full face mask.
9. Troubleshoot effectiveness of BiPAP settings and device.