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Policies,Clinical,UW Health Clinical,General Care and Procedures,Procedures

Ventilator Parameter Adjustments (2.3.28)

Ventilator Parameter Adjustments (2.3.28) - Policies, Clinical, UW Health Clinical, General Care and Procedures, Procedures

2.3.28


UW HEALTH CLINICAL POLICY 1
Policy Title: Ventilator Parameter Adjustments
Policy Number: 2.3.28
Category: UW Health
Type: Inpatient
Effective Date: July 25, 2017

I. PURPOSE

This policy describes a partnership in the provision of patient care among Critical Care physicians who
practice in the Intensive Care Unit (ICU) and respiratory therapists in ventilator management. It is the
responsibility of all UW Health employees involved in ventilator management to understand and be in
compliance with this policy.

II. DEFINITIONS

Physicians privileged in Advanced Ventilator Management are defined as Adult Medical Critical Care
physicians who have completed advanced ventilator competency training with Respiratory Care Services
and have been approved for privileges in “Advanced Ventilator Management”.

III. POLICY ELEMENTS

A. Ventilator adjustments throughout UW Health will be made by a respiratory therapist in accordance with
provider orders with the following exceptions:
i. Physicians privileged in Advanced Ventilator Management. These changes may only occur in the
Trauma and Life Support Center (TLC).
ii. Fellows with subspecialities in Anesthesiology/Critical Care and Pulmonary/Critical Care who have
been endorsed by their supervising attending and have completed the advanced ventilator
competency.
iii. Registered nurses can make adjustments to FIO2 for suctioning or in the event of an emergency.
B. Ventilator parameter adjustments performed by privileged physicians and endorsed fellows will be exclusive
to the Servo I Ventilator. This privilege/endorsement does not extend to other UW Health ventilators.
C. Authority to manually adjust ventilator controls cannot be delegated to physicians who have not completed
the advanced ventilator competency.
D. If the patient is not tolerating current settings and there are no respiratory therapists or physicians
credentialed in ventilator management available, the patient must be manually ventilated with a resuscitation
bag until a qualified person arrives to adjust the settings.

IV. PROCEDURE

A. Mechanical ventilator adjustments can be made by:
i. Respiratory therapists licensed by the state of Wisconsin, who have earned the certified respiratory
therapist (CRT) or registered respiratory therapist (RRT) credential from the National Board for
Respiratory Care.
ii. Attending physicians with subspecialties in Critical Care Medicine, Anesthesiology/Critical Care and
Pulmonology/Critical Care who are privileged in Advanced Ventilator Management at University
Hospital.
iii. Fellows with subspecialities in Anesthesiology/Critical Care and Pulmonary/Critical Care who have
been endorsed by their supervising attending and have completed the advanced ventilator
competency.
B. Physicians privileged in Advanced Ventilator Management, fellows endorsed to make ventilator adjustments,
and respiratory therapists
i. Education:
a. Respiratory therapists will receive annual competency training to ensure up to date
knowledge of ventilatory modes and the function of all ventilators used at UW Health.
b. Physicians privileged in advanced ventilator management and fellows endorsed to make
ventilator adjustments (see section IV.A.iii) will participate in annual competency training
through Respiratory Care to assure up to date knowledge of the designated Critical Care
ventilator used the in the TLC.
ii. Ventilator Adjustments:
a. Physicians privileged in ventilator management and endorsed fellows will collaborate with



UW HEALTH CLINICAL POLICY 2
Policy Title: Click to enter text
Policy Number: 2.3.28

respiratory therapists when manually adjusting ventilator parameters.
b. Physicians privileged in advanced ventilator management and endorsed fellows may
make adjustments in the following circumstances. (See related link titled Process for
Mechanical Ventilator Setting Changes by Physicians):
1. A non-sustained trial to gather information.
2. In coordination with the respiratory therapist/fellow when the need for a sustained
changed is identified.
3. When an emergent change is required and the respiratory therapist is not
available.
iii. Documentation and Communication:
a. Anytime ventilator adjustments are made, alarm settings will be modified to meet the
guidelines in UWHC policy #8.14, Guidelines for Administration of Continuous Invasive
and Non-Invasive Respiratory Support.
b. Ventilator adjustments made by the respiratory therapist are concurrently documented in
the medical record and reconciled with the active ventilation orders.
c. When sustained ventilator adjustments are made by a physician:
1. Documentation will be completed on the MD Ventilator doc flowsheet before
leaving the room.
2. All orders will be updated in the electronic medical record.
3. Changes will be communicated to the registered nurse and respiratory therapist.

V. COORDINATION

Author: Director of Respiratory Care and ECMO Services
Senior Management Sponsor: Chief Nursing Officer, Inpatient
Reviewers: Medical Director Respiratory Care Services, Medical Director for Quality, Respiratory Care
Manager
Approval committees: Respiratory Care Committee, UW Health Clinical Policy Committee, Medical Board
UW Health Clinical Policy Committee Approval: June 19, 2017

UW Health is a cohesive, united and integrated academic medical enterprise comprised of several entities.
This policy applies to facilities and programs operated by the University of Wisconsin Hospitals and Clinics
and the University of Wisconsin Medical Foundation, Inc., and to clinical facilities and programs
administered by the University of Wisconsin School of Medicine and Public Health. Each entity is
responsible for enforcement of this policy in relation to the facilities and programs that it operates.

VI. APPROVAL

Peter Newcomer, MD
Chief Clinical Officer

J.Scott McMurray, MD
Chair, UW Health Clinical Policy Committee

VII. REFERENCES

A. UWHC policy #8.14, Guidelines for Administration of Continuous Invasive and Non-Invasive Respiratory
Support
B. Process for Mechanical Ventilator Setting Changes by Physicians (Related Link)
C. "SAFE INITIATION AND MANAGEMENT OF MECHANICAL VENTILATION." American Association for
Respiratory Care, 2016.

VIII. REVIEW DETAILS
Version: Original
Last Full Review: July 25, 2017
Next Revision Due: July 2020