critical care management

It’s more than vent settings and airway management

In addition to knowing the ideal body weight for tidal volumes and appropriate ventilator settings, new graduates must stay up to date on what the hospital is doing to promote various initiatives.

Infection Control

Best practice states to keep the HOB elevated at least 30 degrees, use in-line suction catheters (who doesn’t), and hand hygiene between patient contact and handling of equipment or bodily fluids.

The new RT must be on guard not only from their director or hospital administrator for job performance, but he or she must see eye to eye with the infection control nurse.In a nutshell, if your mask or tube causes skin breakdown, or if your equipment is cultured with Pseudomona, chances are that the insurance company may not pay the claims.  

In order to keep best practice, the therapist should follow guidelines that are often stated in the manuals of the accrediting bodies (Joint Commission or HFAP). Knowing these will bring relief to your manager and less micromanaging on his or her part!

VAE

No VAP in the unit was something to celebrate, especially in MAGNET accredited facilities. Over time, this quality measure became too easy to avoid, or the cause of VAP was too subjective. The new upgrade from VAP is ventilator associated events (VAE). This monitors more closely the reason for the patient’s rapid deterioration of oxygenation. This surveillance monitors the increments of PEEP in a given period, body temperature, and the administration of antibiotics. The new graduate should become familiar with the ventilator bundle set.