VENTILATOR CARE
Ventilator Care
Ventilator Care
Plaza Healthcare is committed to give patients the best achievable quality of life. Whether it is to decrease or eliminate the need for mechanical ventilation, or offer the patient and their loved ones the education and support for sustained ventilator dependent care, Plaza Healthcare has assembled a team of dedicated professionals to assist with any need a patient and/or family may present.
Plaza Healthcare has developed its ventilator program so both time and resources are available for in-depth evaluation, comprehensive treatment and close monitoring. Through an interdisciplinary approach, patents are regularly reviewed regarding rehabilitation goals and progress, weaning capabilities, nutrition and medication management, and family education. In addition to the clinical aspects, Plaza Healthcare’s Activities and Social Services Departments work closely with the ventilator population to ensure the spiritual, recreational and psychosocial needs of each patient is met.
Dr. Alpa Shah, a Board Certified Physician specializing in Pulmonology with subspecialties in General Pulmonary Medicine, Critical Care Medicine, Interventional Pulmonology and Pleural Disease, is Plaza’s Medical Director of Pulmonology. Dr. Shah and her partners round at least three times per week with our Respiratory team and work collaboratively with the patient’s attending physician, other specialists and the Plaza team to ensure an optimal and personalized plan of care is carried out for each patient’s recovery.
Plaza Healthcare’s expertise extends to patients who have the following;
• Mechanical ventilator dependence
• Chronic lung disease including COPD, Emphysema, Cystic Fibrosis, interstitial Lung Disease, or Asthma
• Neuromuscular Disorders
• Guillain-Barre Syndrome
• Acute Respiratory Involvement, including pneumonia, stroke, traumatic brain injury, post-surgical complications, spinal cord injury, pulmonary fibrosis and/or metabolic encephalopathy
Plaza Healthcare provides the following pulmonary specialty services;
• Ventilator Management
• Ventilator Weaning
• Non-invasive Positive Pressure Ventilation (NPPV)
• Continuous Positive Airway Pressure (CPAP)
• Bilevel Positive Airway Pressure (BiPAP)
• High-Flow Oxygen (up to 60 liters per minute)
• Tracheostomy Management
• Trach Decannulation
• Chest Percussion Therapy (vest/manual)
• Chest tube Management
Ventilator Management/Weaning
Prior to arrival to Plaza Healthcare, each ventilator dependent patient is reviewed by the Director or Assistant Director of Respiratory Therapy; to become familiar with the person’s history, their current condition, and to ensure the appropriate equipment is set up in the patient’s room.
Immediately upon arrival, the Respiratory Therapist (RT) along with a licensed nurse will perform their initial evaluation and assessments. Based upon this initial evaluation, information from the hospital, the RT’s expertise and consultation with the Pulmonologist and attending physician, each patient’s likelihood of weaning is determined.
While this determination is continually evaluated throughout a person’s stay, the initial determination is used as the starting point for the patient’s plan of care. Over the next several days, this plan of care is further personalized based on goals discussed with the patient and/or family members, the Pulmonologist and attending physician seeing the patient, and secondary conditions and/or co-morbidities that exist.
The Speech Therapist will also do an initial evaluation and work in cooperation with the other disciplines to develop a strategy and plan for each patient’s communication needs. Speech Therapy plays an integral role in ventilator weaning. Speech Therapists often work with a ventilator patient to retrain and strengthen the muscles necessary in swallowing and speech. Bedside swallow exams allow a Speech Therapist to evaluate a patient’s current abilities, and working with Plaza’s Registered Dietician, can modify their diet accordingly. Speech Therapists can also help patients find the best way to communicate and goals may include training to use a speaking valve, strengthening throat muscles to make speech and voice easier, or learning to communicate through non-vocal means.
Often, ventilator patients have multiple medical issues that need to be addressed. Some ventilator patients require dialysis, or extensive Physical and Occupational Therapy before weaning can be considered. While other programs may try to wean prematurely, Plaza Healthcare focuses on our patient’s strength and endurance to ensure success.
Plaza reviews its ventilator program monthly as part of the facility Quality Assurance and Performance Improvement Program. Plaza Healthcare can attribute its success, which includes an extremely high weaning rate, to this constant evaluation, multidisciplinary approach, and skill level of the care team.
Staffing
Licensed Respiratory Therapists are available around the clock, seven days a week to monitor and treat patients. Licensed Nurses who work on the ventilator unit are specially trained in the care and unique requirements ventilator dependent patients can present. In addition, Certified Nursing Assistants must achieve Sub-Acute CNA status prior to being assigned ventilator patients. This status is achieved by way of extended orientation including additional hours of training and skills checks. Their status is maintained through frequent competency tests and annual evaluations.
Plaza Healthcare partners with Synertx for its rehabilitation services. Part of that partnership’s understanding is facility specific staffing which affords the ventilator patients to maintain consistency in their therapy by having the same therapist for the entire stay. The Rehabilitation staff is also specially trained on ventilator care if they have not worked in a similar setting prior to coming to Plaza.
All other departments, at least annually, are in-serviced on the special needs of ventilator dependent care. This includes but not limited to; Activities, Social Services, Environmental Services and Administration.
Facilities/Equipment
Plaza Healthcare uses the most current state of the art ventilators. Each ventilator is capable of both full ventilator support and weaning modes and houses multiple alarm settings and function capability. With a scheduled preventative maintenance program and battery backup, ventilators are constantly in excellent working condition, and able to maintain operable status even in an extended period of power failure.
Plaza Healthcare has the largest bulk oxygen storage of any skilled nursing facility and multiple redundancies in its suction capabilities so the building’s piped in oxygen and suctioning system will maintain functionality at all times.
In addition to the ventilators themselves, Plaza Healthcare has a computerized vent alarm monitoring system that alerts staff when an alarm has been sounded. Through a network of room lights, corridor lights, and station computers, staff is able to immediately recognize what alarm is sounding and respond quickly and appropriately to any patient.
Plaza Healthcare has customized the service rooms to specifically address the needs of ventilator dependent patients. The shower rooms have been remodeled with specially designed half walls and counter overhangs so ventilator patients can have showers without the fear of damage to the ventilator. One shower is designed for gurneys so those patients unable to sit in a chair, are still able to enjoy a shower. Plaza’s investment in specialized lifting devices and HoverMatt air transfer systems allow for an easy and safe transition from bed to shower gurney for both the patient and staff.
The lounges are designed with piped in oxygen and suctioning for those patients wanting to spend time outside their room to either engage in group activities and/or visit with loved ones. Plaza Healthcare’s abundant stock of portable oxygen tanks allows for freedom of movement throughout the building and any of the three courtyards available to patients and their loved ones.
Activities
Remaining as active as possible contributes to a patient’s rehabilitation and recovery. The activity staff have developed programs specific for the ventilator population. In addition to multiple in-room activities and at least daily visits from activity staff, the respiratory department is involved in the patient’s engagement in group activities. Whether it is to attend a special function, participate in an art class, or go on an outing to feed ducks, or see Christmas lights, a Respiratory Therapist attends as well to ensure the ventilator patient can participate safely and confidently.
Plaza Healthcare is dedicated to quality of life, encouraging patients to get out of bed, and live as independently as possible.
Transition of Care
Patients who are weaned from a vent usually maintain a tracheostomy and focus shifts to decannulation. See Tracheostomy Care for a detailed description of Plaza Healthcare’s tracheostomy program.
Throughout the entire care program, Plaza Healthcare’s Case Management team is in constant contact with the insurance company regarding the patient progress. In addition, multiple meetings throughout a person’s stay are conducted with the patient and/or responsible party to update those involved of the plan of care, address existing goals, develop strategies for continued coverage for those patients taking longer to recover, and prepare for what hopefully will be a discharge home or to a lower level of care such as an assisted living or board and care.
Plaza Healthcare understands patients move at their own pace through the weaning and decannulation process and patients may experience setbacks and frustration if the recovery process is not progressing as well as first expected. Especially during these times, it is critical that communication and an understanding of what is taking place is addressed. Plaza staff is always available to address any concerns or questions.
In addition to the Social Services Department, Plaza Healthcare has Psychiatry and Psychological resources available to assist in the psychosocial aspects of ventilator dependency or the anxiety of a transition whether it is to home or to an extended period of ventilator dependence.