Policy Manual sample

MDT Home Health Care Agency, Inc. MANAGEMENT OF HOME VENTILATORS POLICY Purpose: Provide guidelines for home health nurses and other caregivers who care for ventilator dependent clients. Promote safety in management of high tech care in the home setting. Promote self care in the home. Applies To: Registered Nurses, Licensed Practical Nurses, Respiratory Therapists Guidelines • Caregivers who are willing and able to help with client care needs are necessary for discharge to the home setting. • Individual manufacturers of home ventilator equipment have handbooks for recommendations on safe use in the home. • Prior to discharge the home care team including the home vendor and respiratory therapist from the vendor to participate in establishing the plan. • All family and care giving staff must be familiar with ventilator alarms and how to appropriately respond. • The client/caregivers are instructed in how to use the manual resuscitation bag. • A backup electrical or battery source should be available and local utility companies notified of the client home needs. Equipment/Supplies • Ventilator and associated circuits, filters, and tubing. • Heated humidifier or cascade. • External 12 volt battery and cord. • Ambu bag. • Disinfectant (as defined in infection control guidelines and policy). • Air compressor and tubing for aerosol treatments (see separate procedure). • Tracheostomy equipment and supplies. • Communication aids. • Equipment as needed for bowel, bladder and personal care such as hospital bed, wheelchair, commode and/or bedpan. PROCEDURE Assessments to be performed at start of care and at regular intervals during client care: 1. Clinical assessment including observation of respiratory effort, color, secretions (color and odor if present) vital signs, client concerns, anxiety level, sleep patterns, skin condition, nutrition and fluid status, neuro status, and signs and symptoms of infection or mechanical concerns. 2. Assess oximeter readings, blood gases and electrolytes as indicated. 3. Assess ventilator settings and effectiveness of plan of care. 4. Perform a safety check on the equipment: a. Tubing - drain water from tubing, check connections, and check tubing for leaks or cracks. Change as needed. b. Evaluate whether cleaning and changing procedures are followed per plan. c. Assess mode of delivery: Control Mode: (CM) Preset volume at a fixed rate. Client does not initiate breaths or changes in rate. Assist Control: (AC) Allows client to initiate breaths and rate varies as client is able to initiate. Each breath is delivered at the same tidal volume (preset). Intermittent Mandatory Ventilation: (IMV) Preset number of breaths per minute by ventilator, but client can also breathe with no assistance from machine at his own tidal volume. Synchronized Intermittent Mandatory Ventilation: (SIMV) Ventilator senses client breath and synchronizes mechanical breath at same time. d. Assess Alarm Settings: Home Health Agency Nursing Care & Procedures K-201