Documentation Issues in Mechanical Ventilation Reflection

Documentation Issues in Mechanical Ventilation Reflection ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Documentation Issues in Mechanical Ventilation Reflection I need a tutor who’s knowledged about Mechanical Ventilation and it’s modes. The tutor only needs to read the research paper and write one page on the most important thing that should be learned. West Chester Univ HEA 476 Documentation Issues in Mechanical Ventilation Reflection This should be so easy but I don’t have enough time to do it Documentation Issues in Mechanical Ventilation Reflection alhassan_research_paper.docx Running Head: JOURNAL ARTICLE SUMMARIES Documentation Issues for Mechanical Ventilation Alhassan, Hussain West Chester University. HEA 476. Professor Murray, E 1 DOCUMENTATION ISSUES FOR MECHANICAL VENTILATION Introduction Technological advancement in healthcare care has enabled healthcare facilities to save and prolong life. One of such advancement is the mechanical ventilators. Many hospitals across the globe have advanced their utilization of these technologies and continue to equip their facilities with these technological advancements. Moreover, they have gone an extra mile to train their medical staff on the effective and efficient use of mechanical ventilators. However, despite the important role the mechanical ventilation system continue to play in hospitals and other healthcare facilities, advancement in these technologies have outstripped our nomenclature. Confused terminology used in these systems continues to raise issues of documentations that necessitate advanced knowledge in their use. Against this backdrop, this article review summary provides an in-depth evaluation of mechanical ventilation from the perspective of different research in a bid to understand the documentation issues in mechanical ventilation and whether it is a blessing or a necessary evil in disguise. Documentation Issues for Mechanical Ventilation in Pressure-Control Modes Technological innovations in ventilator development offer healthcare professionals a range of options to back the task of the respiratory system and enhance gas exchange. Typically, to effectively and securely create and sustain mechanical ventilation, the healthcare provider must be knowledgeable about the ventilator design and method capacity to suitably align the ventilator’s output with that of the patient’s physiologic need. Nonetheless, the development in ventilator technology and creative marketing approaches has stripped out the framework of language for mechanical ventilation. Specifically, confusing phrases can cause issues, particularly when related terms are applicable to differing ventilation modes, or different phrases are applicable to similar mode. West Chester Univ HEA 476 Documentation Issues in Mechanical Ventilation Reflection 2 DOCUMENTATION ISSUES FOR MECHANICAL VENTILATION Discrepancies of this form are evident in the literature are cause misinterpretation of results and erroneous reporting. For instance, Karakurt et al utilize the abbreviation “IMV” to mean both intermittent mandatory ventilation and invasive mechanical ventilation. Similarly, Carvalho et al ambiguously define bi-level and pressure-support ventilation (PSV) paradigms as “frequently used modes of spontaneous breathing” in an article that compared the impact of bilevel ventilation and PSV on pulmonary blood flow as well as oxygenation. Moreover, inaccurate definitions of ventilator modes arise often and are not only irritating from a learner’s standpoint but also establishes obstacles to the learning process, thus inhibiting the clinician from effectively knowing how to correctly control the ventilator (Chatburn, Volsko, 2010). Specific Problems with Documenting Pressure-Control Modes Inadequate generally accepted phrase for mechanical ventilation causes confusion to the assessment procedure. Documentation mistakes in the health record increase the susceptibility of medical decision mistakes thus causes negative patient outcomes. Documentation Issues in Mechanical Ventilation Reflection The problems are two major classes, documenting the inspiratory pressure of mandatory breaths and documenting the pressure support of spontaneous breaths. Mandatory breaths entail those inspirations that are machine-instigated. On this equipment, the convention is to show the peak inspiratory pressure (PIP) a gauge pressure as opposed to atmospheric pressure. Initially, the pressure control was only available on infant ventilator but when it expanded to adult ventilators, the convention shifted to showing PIP as relative to the set end-respiratory pressure (PEEP). The major problem arises when some clinicians assume that “inspiratory pressure” is collectively defined as a shift in airway pressure during breath aided by a ventilator. West Chester Univ HEA 476 Documentation Issues in Mechanical Ventilation Reflection Nonetheless, the standard reference pressure can either be PEEP or atmospheric pressure (Patm) based on the ventilator. Also, 3 DOCUMENTATION ISSUES FOR MECHANICAL VENTILATION spontaneous breaths entail those inspirations that are both patient-instigated and patient-cycled (Chatburn, Volsko, 2010). Consequences of Inconsistent Terminology One of the effects is that it increases the risk of accidentally setting the incorrect inspiratory pressure thus leading to adverse outcomes. Another effect is that the patient is susceptible to ventilator-induced lung injury and cardiac arrest because of the unintentional increase in ? P and mean airway pressure. A patient is also at risk of hypoventilation is a clinician provides a lower ?P and loss of oxygenation because of reduced mean airway pressure. Potential Solutions for Documenting Pressure-Control Modes One of the solutions is to make an explicit differentiation between mandatory and spontaneous breaths. Documentation Issues in Mechanical Ventilation Reflection The latter refers to the breath that the patient can significantly impact its timing, either passively via lung mechanism or actively by ventilator assistance. The former, on the other hand, entails that the patient has lost a significant level of control to the timing of breath. Another possible solution is to normalize the phrase “inspiratory pressure” denoted IP, for mandatory breaths. IP for inspiratory pressure developed relative to PEEP and PIP for “peak inspiratory pressure” established relative to atmospheric pressure. Also, a training program is recommended to train clinicians on how to use the recommended terms and abbreviations (Chatburn, Volsko, 2010). Mechanical ventilation in medical departments: a necessary evil, or a blessing in bad disguise? In the article, Schwartz, Jarjoui and Yinnon (2019) evaluated whether mechanical ventilation in medical departments is a necessary evil of a blessing in disguise. West Chester Univ HEA 476 Documentation Issues in Mechanical Ventilation Reflection They argued that 4 DOCUMENTATION ISSUES FOR MECHANICAL VENTILATION Intensive Care Unit beds’ availability are minimal compared to the number of cases that need to access the ICU. It is a prevailing condition in Israel hospitals. It has been listed as the top country that has been affected by this condition among the OECD countries. The increase in demand for mechanical ventilation has been caused by the rise in the number of ventilated patients. This tragic situation has led to the development of other challenges facing the healthcare organizations, such as the developing and spreading of resistant organisms, lack of adequate treatment to patients, nosocomial infections, and lack of guaranteed patient safety (Schwartz, Jarjoui & Yinnon, 2019). In this article, several interventions that might help minimize these challenges and help increase the number of mechanically ventilated patients in the medical center have been explained. These policies are vital for there are no signs of reimbursements in the ICU soon. First, Introducing augmented care rooms in all hospitals are a significant step, especially for patients’ critical conditions, including the already ventilated patients who have no access to ICU beds. Several managing directors from different hospitals have claimed to lack augmented care rooms in their hospitals, while others do not know their significance. An expanded care room has five beds, electronically modified equipment, and an attending nurse in each shift. These rooms are limited so that they will have fewer costs than the services in the ICU. Generating an augmented care room might help reduce the hospital’s and patients’ expenses of offering and accessing health care, respectively (Schwartz, Jarjoui & Yinnon, 2019). Therefore, the Israel Medical Association Scientific council has initiated programs to equip each hospital with these rooms as they go to the extent of assisting the critically ill patients.West Chester Univ HEA 476 Documentation Issues in Mechanical Ventilation Reflection Second, End-of-life care and advance directives can significantly impact the patients, especially those with less than a six-month life expectancy. Studies have indicated that social 5 DOCUMENTATION ISSUES FOR MECHANICAL VENTILATION pressure on the patient and family members leads them to ask the physician to do everything possible to save the patient. Thus the patient ends up being put under mechanical ventilation and intubation to prolong their life expectancy. The elderly and chronically ill patients end up suffering severe challenges due to some complications caused by mechanical ventilator conditions (Schwartz, Jarjoui & Yinnon, 2019). Therefore, a complicated conversation on the adverse outcomes caused by this intervention is necessary, especially among the family members and the physicians. During the conversation, the physician can point out some of the adverse outcomes such as paralysis and high cost before using mechanical ventilators and intubations. Third, Terminal extubating is an intervention whereby patients who don’t seem to regain their independent respiration are withdrawn from mechanical ventilation, allowing nature to play its role. The intervention is vital as it reduces the patients suffering time with the expected result being known to be death. In other parts of the world, terminal extubating has been recommended and justified ethically, medically, and morally. Schwartz says that “Although exceptions and caution should be borne in mind, we submit that physicians can judge a treatment to be futile and are entitled to withhold a procedure on this basis.” However, this intervention has been challenged, primarily due to cultural and religious beliefs, which suggest that a person’s life should not be shortened no matter the condition (Schwartz, Jarjoui & Yinnon, 2019). Physicians and society mean that the Israel Ministry of Health should develop a clear strategy concerning this matter. West Chester Univ HEA 476 Documentation Issues in Mechanical Ventilation Reflection For example, they ask the family physicians to discuss end-of-life wishes with their patients and sign an official document during critical situations. Having a legal platform before performing the terminal extubating can decrease the blame situation among family members and physicians. These policies are expected to change the negative thoughts about mechanical ventilators; thus, the physicians can comfortably use them to save lives where possible. 6 DOCUMENTATION ISSUES FOR MECHANICAL VENTILATION Issues in weaning from mechanical ventilation: literature review Despite being a key practice in Intensive Care Units (ICUs), mechanical ventilation has been associated with grave complications whose effects contribute to the patients’ morbidity and mortality. The financial resource, human resource, and organizational makeup of ICUs affect the operation and efficacy of weaning processes. Against this background, this paper provides a summary of key concepts in mechanical ventilation and weaning, including; the weaning process, the role of nurses in weaning, and contextual issues in North America, the United Kingdom, and Australasia. Weaning The author defines weaning as the transition or liberation from ventilatory support into impetuous breathing. The basic objective of the weaning activity is to accelerate the client towards the uptake of a higher ventilatory workload, usually by gradually reducing ventilatory support. The weaning process has three phases, namely; pre-weaning stage, weaning stage, and the outcome stage (Rose & Nelson, 2006). The initial stage is characterized by gradual cutback on ventilatory support from the ventilators. Documentation Issues in Mechanical Ventilation Reflection The second stage is characterized by trials of unassisted breathing and activities in the third stage include extubation and close monitoring. The author points out that, “Prompt recognition of the time at which ventilator treatment can be withdrawn has been shown to reduce the likelihood of adverse events.” The degree of wellness in patients under ventilatory support is contingent upon the underlying pathophysiological processes of the illness and the timeliness of responses against ventilatorrelated conditions. Some of the most common complications include; endotracheal tube obstruction, physical trauma on the airway epithelium, pneumonia, and inadvertent extubation. 7 DOCUMENTATION ISSUES FOR MECHANICAL VENTILATION From the findings of two randomized controlled research trials, the author proposes a list of possible weaning methods, including; “T-piece weaning, weaning under synchronized intermittent mandatory ventilation mode, and pressure support ventilation weaning.” West Chester Univ HEA 476 Documentation Issues in Mechanical Ventilation Reflection The authors imply that the utilization of the weaning guidelines can securely and expeditiously liberate clients from the ventilators. The patient needing prolonged mechanical ventilation The levitating global life expectancy rate is closely coupled with the ever-rising prevalence and incidence of chronic illnesses and other related critical conditions. An annual global estimate of up to twenty million clients are admitted into the Intensive Care Unit (ICU) and put under mechanical ventilation. The increasing global short-term survival rate, as well as the growing demand and dependence on mechanical ventilation, has occasioned to intricate clinical and organizational problems, including high human and financial resource needs. Against this background, this paper provides a summary of key concepts in prolonged mechanical ventilation, including successful weaning strategies, nutrition in patients under ventilatory support, and end of life patient care. Successful weaning strategies Recent progress in weaning patients from ventilatory supports has been marked by key ingenuities such as; early mobilization and physiotherapy, ventilatory approaches, weaning guidelines, and specialized weaning units. Ventilatory strategies 8 DOCUMENTATION ISSUES FOR MECHANICAL VENTILATION The most common approaches include; gradual cutbacks on the degree of assistance from “pressure-support ventilation,” (PSV) progressively increasing the phases of “Spontaneous Breathing Trial” (SBT) to evaluate the client’s capacity to respire under marginal or no ventilatory aid, “Non-invasive mechanical ventilation,” “High-flow oxygen,” “Neurally adjusted ventilatory support,” (NAVA) whereby the ventilator relies on the electoral activity of the diaphragm to apply a positive inspiratory pressure that is proportional to the patient’s effort, and “Synchronized Intermittent Mandatory Ventilation” (SIMV) whereby the respirator delivers a predetermined number and volume of breaths and at the same time allows for the generation of spontaneous breaths (Ambrosino & Vitacca, 2018).West Chester Univ HEA 476 Documentation Issues in Mechanical Ventilation Reflection Guidelines on the application of noninvasive mechanical ventilation are summarized as; its use is contraindicated in clients with “acute respiratory failure after extubation,” and its use regarding the prevention of postextubation “acute respiratory failure” (ARF) should only apply in high-risk clients. Weaning protocols The application of protocols on the weaning process has been found to cut back on the weaning time, notwithstanding the mode put into operation. The success of some protocols surpasses the effectiveness that recorded in automated systems. The authors of this excerpt hold the position that a comprehensive strategy that is characterized by constant edification and systematic feedback can enhance a practitioner’s conformity with a weaning protocol. Early mobilization and physiotherapy A projected twenty-five percent of patient s in the ICU exhibit general and recurrent muscle weakness including; muscle dystrophy, deconditioning of the muscle tissue which occasions from early bed rest, a regression in muscle-mass, aerobic efficiency and strength, and 9 DOCUMENTATION ISSUES FOR MECHANICAL VENTILATION changes in the baseline structure muscle fibers. For adults whose duration under mechanical ventilation exceeds 24 hours, guidelines by the American Thoracic Society call for the early use of mobilization protocols. Ineffective cough and retention of secretions contribute to weaning failure. Therefore, the cough strength evaluation through the evaluation of the “cough-peak expiratory flow-rate” helps foresee respiratory failure after extubation. This helps reduce the patient’s length of stay in the ICU, outlay, and mortality rate. Common cough augmentation methods include, “lung volume recruitment and mechanically-assisted cough”. The authors, however, caution the reader that despite there being preset recommendations on early mobilization and physiotherapy, there is limited knowledge on the clinical benefits of these strategies and a high disparity exists regarding the bearable highest levels of activity in seriously ill clients. West Chester Univ HEA 476 Documentation Issues in Mechanical Ventilation Reflection Specialized weaning unit Specialized weaning units offer care to difficult-to-wean clients. An example of such a unit is the Respiratory-Intermediate Intensive Care Units (RIICU). RIICUs are less expensive and offer acceptable levels of care, including multifaceted rehabilitation. Nutrition in patients under ventilatory support In critically ill clients, malnutrition may be associated with poor wound healing, nosocomial illnesses, and the underlying disease pathophysiological processes. Key nutritional factors include; route of administration (parenteral or enteral nutrition), type of nutrients, and calorie amounts. End of life management 10 DOCUMENTATION ISSUES FOR MECHANICAL VENTILATION This includes ethical end-of-life resolves such as withholding ventilatory support, palliative care, weaning attempts, and the possible value of the care provided (Ambrosino & Vitacca, 2018). This also includes the respect and executions of orders such as do-not intubate orders and, do-not-resuscitate orders. End of life care also includes the appointment of a surrogate decision-maker whenever the patient’s decision-making capability is compromised. This article calls for the inclusion of all relevant stakeholders in the course of devising of strategies that are aimed at enhancing patient care in the ICU. The authors also caution and call for more research in prolonged weaning. Conclusion From the review, it is evident that mechanical ventilators have played a significant role in advancing health and wellbeing of individual across the globe. Although constant innovation in this area has created confusion when it comes to documentation, the researchers contend to the fact that inaccurate definitions of ventilator modes arise often and are not only irritating from a learner’s standpoint but also establishes obstacles to the learning process, thus inhibiting the clinician from effectively knowing how to correctly control the ventilator. Moreover, documentation mistakes in the health record increase the susceptibility of medical decision mistakes thus causes negative patient outcomes. West Chester Univ HEA 476 Documentation Issues in Mechanical Ventilation Reflection The problems are two major classes; documenting the inspiratory pressure of mandatory breaths and documenting the pressure support of spontaneous breaths. Nonetheless, nurses have additional roles from the expanded scope of practice including; interpretation of the clients changing disease process, making pressure and volume titrations and adjustments, and monitoring systemic responses as per the ventilator adjustments. 11 DOCUMENTATION ISSUES FOR MECHANICAL VENTILATION References Chatburn, R. L., & Volsko, T. A. (2010). Documentation issues for mechanical ventilation in pressure-control modes. Respiratory care, 55(12), 1705-1716. Schwartz, Y., Jarjoui, A., & Yinnon, A. M. (2019). Mechanical ventilation in medical departments: a necessary evil, or a blessing in bad disguise?. Israel Journal of Health Policy Research, 8(1), 48. Hirano, Y., & Yamazaki, Y. (2010). Ethical issues in invasive mechanical ventilation for amyotrophic lateral sclerosis. Nursing Ethics, 17(1), 51-63. Rose, L., & Nelson, S. (2006). Issues in weaning from mechanical ventilation: literature review. 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