Evaluating the Use of a Stability Guideline for Long-Term Ventilator–Dependent Children Discharging to Home: A Quality Improvement Project

Hanks, Jacquie; Carrico, Catherine

doi:10.1016/j.pedhc.2017.04.018

Cited by 7 publications

(5 citation statements)

References 19 publications

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“…1,2,[10][11][12][13]26 The specific duration of stability differs from individual to individual. 27 The VAI should be moved from a critical care ventilator to a home mechanical ventilator, 28 have adequate gas exchange, and, if possible, be able to tolerate brief interruptions in ventilation. 1,4 This period can range from 2-weeks (invasive ventilation) to 48 h (non-invasive ventilation), 1 dependent on the individual.…”

Section: Transition From Hospital To Homementioning

confidence: 99%

Long-term mechanical ventilation and transitions in care: A narrative review

2023

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Objectives Individuals dependent on long-term mechanical ventilation (LTMV) for their day-to-day living are a heterogenous population who go through several transitions over their lifetime. This paper describes three transitions: 1) institution/hospital to community/home, 2) pediatric to adult care, and 3) active treatment to end-of-life for ventilator-assisted individuals (VAIs). Methods A narrative review based on literature and the author’s collective practical and research experience. Four online databases were searched for relevant articles. A manual search for additional articles was completed and the results are summarized. Results Transitions from hospital to home, pediatric to adult care, and to end-of-life for VAIs are complex and challenging processes. Although there are several LTMV clinical practice guidelines highlighting key components for successful transition, there still exists gaps and inconsistencies in care. Most of the literature and experiences reported to date have been in developed countries or geographic areas with funded healthcare systems. Conclusions For successful transitions, the VAIs and their support network must be front-and-center. There should be a coordinated, systematic, and holistic plan (including a multi-disciplinary team), life-time follow-up, with bespoke consideration of jurisdiction and individual circumstances.

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Section: Transition From Hospital To Homementioning

confidence: 99%

Long-term mechanical ventilation and transitions in care: A narrative review

2023

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“…Even formal chronic ventilation programs face barriers in discharging infants and children with chronic respiratory failure including delayed approval from state or private insurers for homecare, efficiently and effectively educating caregivers, obtaining durable medical equipment, and, the single greatest barrier, the paucity of private duty nursing resources for home health care 71‐76 . Programs may benefit from standardizing the discharge process, 43 utilizing the electronic medical record, 77 and adding dedicated expert coordinators to their teams 78,79 . Resources should be devoted to identifying and treating the significant traumatic stress that families experience as a result of the emotional and financial burdens during what many describe as the most difficult challenge of their lives 80,81 …”

Section: Discharge and Outpatient Care With Chronic Ventilationmentioning

confidence: 99%

Chronic respiratory failure in bronchopulmonary dysplasia

Baker

2021

Pediatric Pulmonology

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Although survival has improved dramatically for extremely preterm infants, those with the most severe forms of bronchopulmonary dysplasia (BPD) fail to improve in the neonatal period and go on to develop chronic respiratory failure. When careful weaning of respiratory support is not tolerated, the difficult decision of whether or not to pursue chronic ventilation via tracheostomy must be made. This requires shared decision‐making with an interdisciplinary medical team and the child's family. Although they suffer from increased morbidity and mortality, the majority of these children will survive to tolerate ventilator liberation and tracheostomy decannulation. Care coordination for the technology‐dependent preterm infant is complex, but there is a growing consensus that chronic ventilation can best support neurodevelopmental progress and improve long‐term outcomes.

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“…2,5 Hospital discharge criteria and caregiver training are crucial in ensuring patient safety, optimizing outcomes, and minimizing unplanned healthcare utilization; however, children who need HIMV are a heterogeneous group which presents challenges for standardizing discharge practices. 1,2,[4][5][6][7] Standardizing hospital discharge criteria for children using HIMV is crucial for ensuring consistent evidence-based decision-making, optimizing care, and supporting children and their caregivers. There is neither a standardized national nor international definition of patient readiness, caregiver competence, or success in the transition home.…”

Section: Introductionmentioning

confidence: 99%

“…Upon discharge, shifting the child's care from the hospital to the community healthcare team and caregivers poses various risks. Therefore, the decision to discharge a child using HIMV warrants careful consideration 2,5 . Hospital discharge criteria and caregiver training are crucial in ensuring patient safety, optimizing outcomes, and minimizing unplanned healthcare utilization; however, children who need HIMV are a heterogeneous group which presents challenges for standardizing discharge practices 1,2,4–7 .…”

Section: Introductionmentioning

confidence: 99%

Transitioning children using home invasive mechanical ventilation from hospital to home: Discharge criteria, disparities, and ethical considerations

Henningfeld,

Friedrich,

Flanagan

et al. 2024

Pediatric Pulmonology

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Children using home invasive mechanical ventilation (HIMV), a valuable therapeutic option for chronic respiratory failure, constitute a growing population. Transitioning children using HIMV from hospital to home care is a complex process that requires a multidisciplinary approach involving healthcare professionals, caregivers, and community resources. Medical stability, caregiver competence, and home environment suitability are essential factors in determining discharge readiness. Caregiver education and training play a pivotal role in ensuring safe and effective home care. Simulation training and staged education progression are effective strategies for equipping caregivers with necessary skills. Resource limitations, inadequate home nursing support, and disparities in available community resources are common obstacles to successful HIMV discharge. International perspectives shed light on diverse healthcare systems and challenges faced by caregivers worldwide. While standardizing guidelines for HIMV discharge may be complex, collaboration among healthcare providers and the development of evidence‐based regional guidelines can improve outcomes for children using HIMV and their caregivers. This review seeks to synthesize literature, provide expert guidance based on experience, and highlight components to safely discharge children using HIMV. It further assesses disparities and divergences within regional and international healthcare systems while addressing relevant ethical considerations.

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Evaluating the Use of a Stability Guideline for Long-Term Ventilator–Dependent Children Discharging to Home: A Quality Improvement Project

Cited by 7 publications

References 19 publications

Long-term mechanical ventilation and transitions in care: A narrative review

Long-term mechanical ventilation and transitions in care: A narrative review

Chronic respiratory failure in bronchopulmonary dysplasia

Transitioning children using home invasive mechanical ventilation from hospital to home: Discharge criteria, disparities, and ethical considerations

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