Implementing a Ventilation Protocol in the Long-Term Acute Care Hospital

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Implementing a Ventilation Protocol in the
Long-Term Acute Care Hospital

• Gary W Mefford RRT,
• Respiratory Care Manager
• Regency Hospital of Fort Worth
• Director
• VentWorld.com

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Ventilation by Protocol Benefits

• Patient
• Shorter time on vent
• Shorter ICU stay and total LOS
• Decreased chance of HAI
• Facility
• Decreased cost
• Improved reputation
• Better ability to manage total LOS
• Staff
• More engaged
• Less turnover
• Easier recruitment
• Increased autonomy results in higher satisfaction
  with work

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Begin with the end in mind

• Set as goal and make it a long term project
• If you are working where there is still not
  weaning per protocol, you obviously are up
  against many challenges.

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Challenges

• Facility
• Management
• Staff

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Challenges

• Physician
• Resistance
• Control
• Confidence
• Ignorance
• Change phobic

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Vision and Perseverance

• Begin with the end in mind
• Plan in steps

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Use the existing evidence base to build from.
The evidence will be in your favor if you use
Evidence-Based Guidelines for Weaning and
Discontinuing Ventilatory Support. Use ACCP
Consensus Conference Statement to build consensus
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Physician champion(s)
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Administrative support
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Involve all disciplines in development
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Be there to support and sell as approval process
is undertaken.
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Be persistent when shot down see it as only a
temporary set back
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After approval

• Educate thoroughly
• Keep good records

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On Implementation

• Monitor and facilitate
• Celebrate successes
• Old habits die hard

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Adequate staffing required
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Ongoing enforcement for adherence
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Safety is as required for success as other more
obvious benchmarks
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If you are still not weaning by protocol you
obviously are up against challenges.
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Doing whatever it takes

• Plan
• Develop
• Escort through approval process
• Educate
• Implement
• Enforce

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Will be worth it for your patients, staff and
facility