Authors (including presenting author) :
TAI CE, SIN KM, HONG YF, LEE JS, SZE CW, TSUI WO, CHAN KF, LIU KN, CHAN SY, CHAU TY, LIU YT, WAN TL, TAI CL, Aggie Kwan, Ray LI, Sandy Leung
Affiliation :
Department of Medicine and Geriatrics, Tuen Mun Hospital
Introduction :
Based on cluster-wide manual stocktake, the number of patients under invasive mechanical ventilation (IMV) and non-invasive ventilation (NIV) in acute medical wards was 350/year (90 percentiles in HA 2017-19). The first diagnosis was respiratory-related in 70% of these patients, among which 80% were classified as category 2 & 3 and cared by respiratory team (47%) or parent team (33%) in acute medical wards. The high ventilators load in acute medical wards poses not only extra care burden to colleagues and results in persistently high ventilators and bed occupancy, but also arouses safety concern to patients in the congested ward environment. Mobile Assisted Ventilation Service (MOVES): CC(COPD) in 2016 planned to enhance the service model of existing 42 “enhanced beds in ventilator area” by providing ward round service to ventilator cases in acute medical wards outside ventilator area via a mobile respiratory share-caring team approach. - To improve standard of care for patients on NIV/IMV in acute general medical wards. - To improve service quality by strengthening service coordination & collaboration. After the pilot studies in 4 selected HA hospitals (including TMH) during 2018/2019, the MOVES team was officially established in TMH M&G since Oct 2020.
Objectives :
Proactive consultation – To optimize settings in ventilation, to perform on-site respiratory intervention, to formulate nursing care plan in ventilator therapy Skill transfer – To transfer knowledge and practical skills in ventilator management from MOVES team to parent team Liaison role – To establish rapport with relatives of patient, and thus to facilitate their involvement in treatment planning, to enhance the effectiveness of communication with parent team / allied health
Methodology :
The MOVES team comprises respiratory specialists, respiratory nurses, physiotherapists, PCA, etc. Our routine includes daily round to all new cases on IMV/NIV in acute medical wards, and the weekly multi-disciplinary team case conference. Respiratory specialists, being the team leader, provide specialist input in all aspects in ventilator care and weaning management, and perform ventilator-related respiratory interventions e.g. chest drain, bed-side bronchoscopy and home NIV prescription Respiratory nurses: assess ventilator cases and provide nursing care plan. Provide education e.g., endotracheal tube care, VAP prevention, etc. to the parent team and support respiratory interventions & monitoring weaning. Respiratory nurses also give counselling to patients or relatives. Physiotherapists: provide intensive chest and other limbs physiotherapy. They also prepare weaning & post-weaning mobilization.
Result & Outcome :
Totally 734 patients had reviewed by MOVES team during October 2020 to Aug 2021 inclusively 70% on IMV and 30% on NIV. The MOVES team managed to cover 96% of all these cases. The data showed a reduction in number among various indices when compared to the data captured from Jun 2020 to Sep 2020. The data are categorized and compared as pre (before commencement) versus post (after commencement): Average ventilator days: reduction of 24% or 3 days Average length of stay (ALOS): reduction of 39% or 13 days Weaning percentage: 6% increase in cases weaned off from ventilator While demonstrated a clear reduction in average ventilator days and ALOS, the data did not reveal any significant negative influence on the outcome of the cases. During the 6 months audit period, 491 episodes of counselling was given to 286 cases. Out of the 61 cases where there was thorough discussion on ACP, DNACPR decision could be clarified earlier: accepted (62%) or declined (38%) after aligned with parent team.
