Post-Acute Care Ventilator Weaning Takes a Team

Author: 
Bill Barnes, Jr., RN, RRT
Due to the matrix of caregivers involved in successful liberation from the ventilator and continued ventilatory rehabilitation, it is necessary to identify and agree on clinical pathways to maximize respiratory rehabilitation and keep interdisciplinary communication simple, yet meaningful and comprehensive.
 
Respiratory clinical pathways give the clinical team, the patient and his/her family, an outcome-based, time-defined program to follow and to benchmark a patient’s progress. The respiratory clinical pathway begins in post-acute care at the pre-admission screening. The care team and nurse liaisons work closely to assure candidate criteria for admission to the ventilator weaning program.  Each candidate must meet level of care criteria and be medically stable to begin the journey on the respiratory pathway. At this juncture, the team discusses potential obstacles to weaning and strategizes what start point within the pathway will provide the patient with the most potential for success.
 
The collaboration continues each day after admission, with daily team conferences and open communication between various disciplines and case managers keeping the team outcome-oriented and patient-focused.  In the direct clinical area, well-established ventilator weaning protocols provide the respiratory department with guidelines to wean each patient and continue pulmonary rehabilitation. It is important to quickly identify and treat barriers to weaning, which include, but are not limited to mobility, progress in speech therapy, participation in physical therapy, nutrition, pain control and anxiety management.
 
Complete respiratory clinical pathway documentation allows for a historical timeline regarding patient progress and cues clinicians for interventions to meet the dynamic needs of some patients.  Not all patients have complete and/or successful liberation from the ventilator or ventilatory support devices, but regardless of the outcome, the team provides feedback and transitional planning to both the patient and the family.
 
The Good Shepherd Specialty Hospital Ventilator Weaning Program offers comprehensive services designed to liberate patients from mechanical ventilation and achieve the highest possible level of functional independence. Historically, more than 90 percent of patients, on average, have been liberated from mechanical ventilation by the team at Good Shepherd Specialty Hospital.
 
Bill Barnes, Jr., RN, RRT is the Respiratory Care Manager for Good Shepherd Rehabilitation Network. He is a licensed respiratory care practitioner and a certified respiratory therapist and technician. Bill specializes in ventilator weaning and tracheotomy decannulizations, as well as long-term venitlation.