Trends in Alternate Site Respiraroy Care - Gant


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Trends in Alternate Site Respiraroy Care - Gant

  1. 1. Trends in Alternate Site LINDE RSSRespiratory Care Delivery 5/10/2012 1Trends in equipment LINDE RSS More technology More modalities Portability Cost vs reimbursment 5/10/2012 2 1
  2. 2. 1940s – 50s LINDE RSS5/10/2012 3 LINDE RSS5/10/2012 4 2
  3. 3. Puritan Bennett- LP10 LINDE RSS 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 Low5/10/2012 5New Technology LINDE RSS Less than 13 lbs Long battery life Multiple Modes5/10/2012 6 3
  4. 4. Now a 1 pound device LINDE RSS5/10/2012 7Types of Interfaces LINDE RSS5/10/2012 8 4
  5. 5. Other Equipment Needs LINDE RSS 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 5/10/2012 9Telemedicine LINDE RSS 5/10/2012 10 5
  6. 6. Patient expectations LINDE RSS Quality of life Mobility Prompt service5/10/2012 11 LINDE RSS Meet Matt Johnston. Matt is a 35 year old ventilator user whos 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!5/10/2012 12 6
  7. 7. LINDE RSS 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.5/10/2012 13 LINDE RSSHe had goals set to extend his time under water5/10/2012 14 7
  8. 8. LINDE RSS 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 contacted5/10/2012 15 LINDE RSS 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……..5/10/2012 16 8
  9. 9. Provider expectations LINDE RSS No readmissions.. Training… Responsibility of partners…5/10/2012 17 LINDE RSSTRAINING, TRAINING, TRAININGTraining 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!5/10/2012 18 9
  10. 10. New care sites & models LINDE RSS Green house skilled nursing facilities Group homes – cross between institution and home Independent living – younger patients & older parents Self directed care5/10/2012 19The number one challenge LINDE RSS Staying on the edge & Keeping up with change5/10/2012 20 10
  11. 11. Less invasive less cost LINDE RSSArterial Blood Gases etCO2 and Pulse OximetryInvasive, risk of injury, requires special handling, time Noninvasive, no risk, no special handling, less costlyconsuming, costly over timeAerosalized Meds MDITime consuming, requires disposables etc.., of Less time, effective if properly administered, Lessinfection, great for acute exacerbations and patients cost, good for long term maintenance,unable to cooperateSuction Cough AssistInvasive, great for rt main stem clearance, Noninvasive, total lung clearance, more comfortable,uncomfotable, traumatic, risk of infection, requires no trauma, no infection risk, less costly over time, canequipment and ongoing supplies be self administeredCompressors AirvoLoud, space consuming, cool particulate matter, risk Quiet, high flow, vapor, less infection riskof infection,5/10/2012 21Practice StandardsAARC CPGs LINDE RSS•Application of Continuous Positive Airway Pressure to Neonates Via Nasal Prongs, orNasopharyngeal 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 PDF5/10/2012 22 11
  12. 12. AARC QRCR Standards LINDE RSSAARC - LTC QUALITY RESPIRATORY CARE RECOGNITIONI 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 deliverbedside respiratorycare services are either legally recognized by the state as competent to provide respiratory careservices or hold the CRTor 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 recommendationsregarding the service needs andplan of care for the respiratory-impaired residents to respective physicians.• A policy and procedure manual that is reviewed annually and addresses the provision ofrespiratory care and services isavailable at the facility.•5/10/2012 23 LINDE RSS•A competency-based training program shall be in place for personnel administering respiratoryrelated care.• A doctor of medicine (preferably a pulmonologist) or osteopathy is designated as a medicaldirector 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 andat least monthly infacilities providing only routine respiratory care.• In facilities that provide ventilator management, respiratory therapists are available 24 hours perday within the facility.• All ventilator systems shall have a remote external alarm system and an emergency back-uppower source.I will notify the AARC in writing when any of these standards cannot be upheld.5/10/2012 24 12
  13. 13. Ventilator and High AcuityRC Standards LINDE RSSAmerican Association for Respiratory CarePosition StatementDelivery of Respiratory Therapy Services in Skilled Nursing FacilitiesProviding Ventilator and/or High Acuity Respiratory CareSkilled nursing facilities are increasingly becoming the venue for the management of patientswho require the full array of respiratory therapy services, from oxygen therapy and inhalationmedication management to pulmonary rehabilitation and ventilator management. Skillednursing facilities should recognize the clinical value to the patient of utilizing a respiratorytherapist to provide the complete spectrum of services that respiratory therapists are botheducated and competency tested to provide.The American Association for Respiratory Care recommends that the basic standard of care forskilled nursing facilities be to employ Respiratory Therapists to render care to patients.Additionally, the following basic standards are recommended to ensure the safe and efficientdelivery of respiratory therapy services in skilled nursing facilities delivering ventilator and/orhigh acuity respiratory care:5/10/2012 25 LINDE RSS• 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.5/10/2012 26 13
  14. 14. LINDE RSS Iron lung rides $5 to enter $500 to get back out Iron lu ng ri des $500 !! $55/10/2012 27 LINDE RSS 931-239-01235/10/2012 28 14