| Mechanical ventilators measure and display information related to a patient's respiratory function. Respiratory therapists periodically observe variables such as respiratory rate and minute ventilation and record these in the patient's chart. Variation exists in what is recorded, how measurements are obtained, and how frequently charting is performed. Such variation is disturbing because access to accurate and timely data is necessary for optimal patient care, especially when protocols are used to control mechanical ventilation.; Three studies were performed to assess problems associated with manual respiratory care charting and to identify advantages of acquiring ventilator data automatically. Over a 12-month period, data were collected from 678 ventilated patients (1,736 ventilator days) in four intensive care units at LDS Hospital in Salt Lake City, Utah. Approximately every two hours, respiratory therapists recorded ventilator settings, ventilator-measured variables, and other observations using a computer charting application. Data were acquired every five seconds from ventilators using an implementation of the International Organization for Standardization/Institute of Electrical and Electronics Engineers (ISO/IEEE) 11073 Medical Information Bus (MIB). Four hundred sixty-nine of the patients (65%) were enrolled in a computerized ventilator management protocol that used data entered by respiratory therapists to generate patient-specific treatment instructions. Data pertaining to the protocol were also collected.; The first study evaluated the data quality of manually-charted ventilator settings, and assessed the impact of incorrect data on protocol instructions. The study showed that automatic data collection can eliminate charting delays, improve charting efficiency, and reduce errors caused by incorrect data entry, even at institutions where manual charting of ventilator settings is performed well. The objective of the second study was to determine how well manual documentation of physiologic variables represented real-time ventilator data. The mean differences between manual and MIB values were small, but the limits of agreement (mean +/- 2SD) were wide enough to be of clinical importance. The final study used MIB data to identify trends of tachypnea that were not documented in the patient chart, and to determine whether weaning instructions obtained from the computerized protocol would be affected by such trends. The study concluded that tachypneic episodes were frequently not detected or acted upon by clinicians. |
