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LINDE RSSPuritan Bennett- LP10

Weight 35 Lbs (16 kg)

Patient Size >22 LBS

Internal battery life 1 hours

Hot Swap Battery None

PM Schedule 6k or 1 yrs

Touch Screen No

Proprietary Circuits No

Circuit Type Single limb

Flow Capabilities 20-100 LPM

Oxygen Connection Low flow

Ongoing Cost Low

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LINDE RSSNew Technology

Less than 13 lbs

Long battery life

Multiple Modes

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LINDE RSSNow a 1 pound device

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LINDE RSSTypes of Interfaces

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Other Equipment Needs

� Cough Assist devices (MAC)

— A REQUIREMENT for NIV in PMV patients

� Suction Equipment

� High Frequency Percussive Ventilation

� Airway clearance devices

� High flow humidified gases Airvo

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LINDE RSSTelemedicine

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LINDE RSSPatient expectations

Quality of life

Mobility

Prompt service

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Meet Matt Johnston.

Matt is a 35 year old ventilator

user who's lifelong

dream was to go scuba diving.

He asked us 2 questions, 1) Is it

possible and 2) will you help me.

We of course said yes to both!

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My brother Scott is a diver so he took

the role of Matt and we began the

process of experimenting with

different vents and settings for a

shallow dive.

The results were somewhat out of the

box but doable. We fed the

information to Matt via internet and

cross checked it with clinicians from

across the country.

Although ventilated from the surface

Matt could still get below and

experience the underwater world.

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He had goals set to extend his time under water

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His final goal was to be able to spend an hour

under water. Once he achieved this it was time

for the next step.

Arrangements were made for a dive boat and

team to go along.

Flights were paid for by the vent

manufacturer.

And finally, the Today show was contacted

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November 14, 2006

Matt made diving history!

He became the first in his

condition to complete two

open water dives in the warm waters

off the Florida Keys!

Cumulative dive time for the day was

25 minutes at a depth of 5 feet.

The Today Show went along……..

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LINDE RSSProvider expectations

No readmissions..

Training…

Responsibility of partners…

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TRAINING, TRAINING, TRAINING

Training is key to success in Home ventilation, there are 2 important aspects of training

� Internal staff training

— Policies & Procedures

— Equipment

— Clinical training

— On call services – Heavy time commitment on front end

— Laws and regulations

� Patient/Family training

— Must be comprehensive

— Must include your staff and hospital staff

— Must be check off and hands on

— Caregivers must be trained to the worst case scenario

— Repetition, Repetition, Repetition

— Don’t be afraid to say NO!

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LINDE RSSNew care sites & models

� Green house skilled nursing facilities

� Group homes – cross between institution and home

� Independent living – younger patients &

older parents

� Self directed care

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LINDE RSSThe number one challenge

Staying on the edge

&

Keeping up with change

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LINDE RSSLess invasive less cost

Arterial Blood Gases Invasive, risk of injury, requires special handling, time

consuming, costly

Aerosalized Meds Time consuming, requires disposables etc.., of

infection, great for acute exacerbations and patients

unable to cooperate

Suction Invasive, great for rt main stem clearance,

uncomfotable, traumatic, risk of infection, requires

equipment and ongoing supplies

Compressors Loud, space consuming, cool particulate matter, risk

of infection,

etCO2 and Pulse OximetryNoninvasive, no risk, no special handling, less costly

over time

MDILess time, effective if properly administered, Less

cost, good for long term maintenance,

Cough AssistNoninvasive, total lung clearance, more comfortable,

no trauma, no infection risk, less costly over time, can

be self administered

AirvoQuiet, high flow, vapor, less infection risk

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Practice StandardsAARC CPGs

http://www.rcjournal.com/cpgs/index.cfm

•Application of Continuous Positive Airway Pressure to Neonates Via Nasal Prongs, or Nasopharyngeal Tube, or Nasal Mask 2004 Revision & UpdateHTMLPDF

•Assessing Response to Bronchodilator Therapy at Point of CareHTML

•Bland Aerosol Administration 2003 Revision & UpdateHTMLPDF

•Blood Gas Analysis and Hemoximetry 2001 Revision & UpdateHTML

•Body Plethysmography 2001 Revision & UpdateHTMLPDF

•Bronchoscopy Assisting PDF

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LINDE RSSAARC QRCR Standards

AARC - LTC QUALITY RESPIRATORY CARE RECOGNITION

I attest that this organization adheres to the following respiratory care standards:

• All respiratory therapists who are employed or contracted by the long term care facility to deliver bedside respiratory

care services are either legally recognized by the state as competent to provide respiratory care services or hold the CRT

or RRT credential in non-licensed states.

• All respiratory therapy employees must have completed background checks.

• For routine care and patient assessment, respiratory therapists are available 24 hours a day.

• Respiratory therapists provide patient assessments and make clinical recommendations regarding the service needs and

plan of care for the respiratory-impaired residents to respective physicians.

• A policy and procedure manual that is reviewed annually and addresses the provision of respiratory care and services is

available at the facility.

•

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•A competency-based training program shall be in place for personnel administering respiratory

related care.

• A doctor of medicine (preferably a pulmonologist) or osteopathy is designated as a medical

director of respiratory care services.

• A preventive maintenance program must be in place for all RT equipment.

• An established respiratory QA/PI program must be in place.

• The medical director reviews plan of care at least weekly in facilities providing ventilator care and

at least monthly in

facilities providing only routine respiratory care.

• In facilities that provide ventilator management, respiratory therapists are available 24 hours per

day within the facility.

• All ventilator systems shall have a remote external alarm system and an emergency back-up

power source.

I will notify the AARC in writing when any of these standards cannot be upheld.

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Ventilator and High Acuity RC Standards

American Association for Respiratory Care

Position Statement

Delivery of Respiratory Therapy Services in Skilled Nursing Facilities

Providing Ventilator and/or High Acuity Respiratory Care

Skilled nursing facilities are increasingly becoming the venue for the management of patients

who require the full array of respiratory therapy services, from oxygen therapy and inhalation

medication management to pulmonary rehabilitation and ventilator management. Skilled

nursing facilities should recognize the clinical value to the patient of utilizing a respiratory

therapist to provide the complete spectrum of services that respiratory therapists are both

educated and competency tested to provide.

The American Association for Respiratory Care recommends that the basic standard of care for

skilled nursing facilities be to employ Respiratory Therapists to render care to patients.

Additionally, the following basic standards are recommended to ensure the safe and efficient

delivery of respiratory therapy services in skilled nursing facilities delivering ventilator and/or

high acuity respiratory care:

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• A Certified, or Registered, Respiratory Therapist—licensed by the state in which he/she is practicing if applicable—will be on site at all times to provide ventilator care, monitor life support systems, administer medical gases and aerosol medications, and perform diagnostic testing.

• A Pulmonologist, or licensed physician experienced in the management of patients requiring respiratory care services (specifically ventilator care), will direct the plan of care for patients requiring respiratory therapy services.

• The facility will establish admission criteria to ensure the medical stability of patients prior to transfer from an acute care setting.

• Facilities will be equipped with technology that enables it to meet the respiratory therapy, mobility and comfort needs of its patients.

• Clinical assessment of oxygenation and ventilation—arterial blood gases or other methods of monitoring carbon dioxide and oxygenation—will be available on site for the management of patients receiving respiratory therapy services at the facility.

• Emergency and life support equipment, including mechanical ventilators, will be connected to electrical outlets with backup generator power in the event of power failure.

• Ventilators will be equipped with internal batteries to provide a short term back-up system in case of a total loss of power.

• An audible, redundant ventilator alarm system will be located outside the room of a patient requiring mechanical ventilation to alert caregivers of a ventilator malfunction/failure or a patient disconnect.

• A backup ventilator will be available at all times that mechanical ventilation is being provided to a patient.

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Iron lung rides

$5 to enter $500 to get back out

Iron lung rides$5 $500 !!

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[email protected]

931-239-0123

Trends in Alternate Site Respiraroy Care - Gant

Education

Transcript of Trends in Alternate Site Respiraroy Care - Gant