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Respiratory rehab

January 17, 2012
by Sandra Hoban, Executive Editor
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Replacing spontaneous respiration through ventilator therapy can be life sustaining or life saving

Breathe in … breathe out …. This is not always as easy (or comfortable) as it seems. When the respiration process is compromised, a variety of breathing distresses manifest. Whether independent respiration is affected as a result of a disease process, accident, stroke, muscular dystrophy, amyotrophic lateral sclerosis (ALS) or another of many triggering events, restoring efficient breathing is mandatory for patient health, safety and recovery.

In Fincastle, Va., The Brian Center Botetourt, a Kissito Healthcare not-for-profit skilled nursing facility, provides an award-winning ventilator therapy program to this growing patient demographic. Because of its easy-access location, The Brian Center draws patients from not only Virginia, but also West Virginia and North Carolina. Its reputation also attracts patients from around the country—even Hawaii.

Tammy Cauvel, RN, director of nursing, traces the provision of ventilator care at The Brian Center back to 2005. “At that time, we had nine patients on ventilators and that number has grown every year since,” she says. In fact, the program has blossomed to such a degree that now all 60 beds in the facility are vent certified, if needed.

There is no age discrimination on who may require breathing assistance. From the very young to the very old, whether having sharp or limited cognition, respiratory difficulties can happen to anyone at any time. And at The Brian Center, the diversity of its residents is a plus. Residents can range from age 20 to 80 with different ranges of acuity level. However, this disparate age group has bonded well. They participate in activities, dine together, socialize and at times, rehab together. They are far more comfortable in an environment surrounded by others who are receiving similar treatment, thereby removing the stigma of being ventilator dependent. From a short stay to an extended stay, residents are more relaxed and enjoy a vibrant quality of life in a nonrestrictive environment.

Residents can gather to socialize while receiving therapy.

PREPARING FOR THERAPY

When a resident is admitted, Kissito Healthcare’s Collaborative Patient Care Model is initiated to learn about the resident, his or her needs and expectations and the best course of treatment. Held in concert with the patient and family members, this assessment emphasizes the facility’s patient-centered approach with a focus on collaboration, coordination of care and creating a partnership among all parties involved including hospital caregivers, post-acute healthcare teams and others responsible for and interested in the patient’s well-being. This collaboration has resulted in smoother transitions of care, improved outcomes and reduced costs.

When a patient begins ventilator therapy, he or she is confident in the expert care received and understands the process. “Every shift at Brian Center is staffed 24/7/365 by RNs, LPNs, CNAs and respiratory therapists who are trained in respiratory care. Physicians, nurse practitioners and the pulmonologist visit regularly and are on call 24/7/365,” says Jay Easton, CRT, The Brian Center’s external care manager. All staff from clinical to housekeeping to nutrition to maintenance are trained on what steps to take if an emergency arises.

VENTING EQUIPMENT

From continuous positive airway pressure (CPAP) devices to portable ventilator units, residents receive in-room respiratory therapy. “The electrical vent units are small and affordable with battery backups,” remarks Cauvel, “which permits residents to be as mobile as their conditions allow.” With this portability, residents have easier access to other health and rehabilitation services as well as activities and access to the outdoors making for a more pleasant stay as reflected by The Brian Center’s patient satisfaction surveys. Progress is monitored daily and on-site physicians and nurse practitioners are always available to assist with any changes in the resident’s condition.

Safety is imperative. The facility’s generator is checked several times a week to ensure that it will operate under an interruption of electrical services. The units also are designed with a variety of safety devices to alert caregivers of any emergency—mechanical, operational or patient distress. Every employee is trained to respond when a unit triggers an alarm. They know what to do and who to contact for assistance to ensure resident safety.

THE WEANING PROCESS

Getting the patient less dependent or off the ventilator is the ultimate goal at The Brian Center. “We continually attempt weaning. However, the process may progress and stop according to how the resident tolerates,” says Cauvel. Success ultimately depends on the disease process. “For example,” she explains, “if the patient has a disease process such as ALS, there is deterioration of muscle that will cause a continuous decline. Sadly, these types of conditions generally mean that the patient will not tolerate the weaning process.” On the other hand, she advises that someone who has had pneumonia can be a good candidate for successful total weaning. “Once the pneumonia has cleared, the patient has a better chance of recovering lung function, enabling the elimination of ventilator breathing,” she says. After transitioning to independent breathing, the patient is closely monitored to establish respiratory stability before being released home or to another level of care.

A WINNING PROGRAM

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