Extubate Patient, Planned / Version 0.1

Detailed Clinical Models,Medical Devices Domain

Use Case

Extubate Patient, Planned

Revision History

Date / Version / Description / Author / SMEs
7/16/2010 / 0.1 / Initial Draft / Jay Lyle

1.Document Purpose

This is an interoperability use case designed to define interactions between clinicians and ventilators and other devices and systems in the interest of developing a generic static clinical model for the ventilator. Other devices and systems will be addressed as they interact with the processes staked out by ventilator use. Neither clinical practice nor system functionality is addressed in detail.

2.Use Case Description

In response to a physician's order, a team of clinicians weans a patient from a ventilator and removes the endotracheal tube. The clinician performs a respiratory assessment on the patient.

3.Actors

  • Clinician with intubation privileges – a clinician of any title who is permitted to perform intubations
  • Response team member: other clinician, including
  • Nurse – a nurse, with or without intubation privileges
  • Respiratory Therapist – a respiratory therapist, with or without intubation privileges, typically responsible for setting up the ventilator and modifying settings
  • MD – A physician, with or without intubation privileges, who may have ordered the intubation and may assist

4.Systems and Devices

  • Ventilator
  • Arterial Blood Gas monitor
  • Vital signs monitor
  • Capnometer
  • Electronic Health Record (local, partial, or comprehensive)

5.Trigger

The patient’s condition improves to the point where a credentialed clinician decides to evaluate for weaning and extubation.

6.Pre-Conditions

  • Patient on ventilator
  • Assessment shows improvement to clinically defined level

7.Post Conditions

If the use case was completed, then

  • Patient condition
  • Patient has met criteria for weaning
  • Patient has met criteria for extubation
  • Patient has been successfully extubated and assessed
  • Ventilatory status
  • Ventilator has been disconnected from patient
  • Ventilator has been disconnected from information channel
  • Ventilator should undergo processes for cleaning and return to use
  • EHR documentation
  • All readings and changes in settings in EHR
  • Ongoing monitoring
  • Ventilator-specific alarms have been suspended

8.Workflow

8.1Workflow

This workflow is based on the clinical scenario referenced in section 11.

Actor / Action / System Response
1. / Clinician / Assess patient / Vitals Monitor: display vital signs
Lab:
2. / Confirm observations / ABG: record SaO2, pH, paCO2
Vitals Monitor: record HR, Hemodynamics, Temperature
3. / Confirm settings appropriate / Vent: record PEEP, FiO2
4. / Desist from medication
Is this logged?
5. / Set ventilator mode for trial / Vent: record mode, RR
Respirometer: record volume
6. / Score RSBI
7. / Assess patient / ABG: as above
Vitals Monitor: as above
Capno: EtCO2
Manual: breath sounds
8. / Assess intubation difficulty / EHR: display intubation recording
9.
10.
11.
12. / Extubate patient
13.
14.
15.
16.
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21.

Notes:

  1. All steps: information regarding these steps to be recorded manually after intubation is noted below, based on the VA National template.
  2. Step 1:

9.Data

Case Step: 2 Confirm Observations

Device ABG

Field Name / Data type / Typical Value / Constraints & Notes
SaO2 / Percent / 95%
pH / Float / 7.5
paCO2 / mmHg / 35 mmHg

Case Step: 2 Confirm Observations

DeviceVital Signs Monitor

Field Name / Data type / Typical Value / Constraints & Notes
HR / Int (1/min) / 70
Hemodynamics / How do
Temperature / Float / 37.2

Case Step: 16 Enter Settings

Device: Ventilator

Field Name / Data type / Typical Value / Constraints & Notes
Mode / Enumerated / Pressure Support / Mode affects required settings
FiO2 – fraction of inspired O2 / Percent / 100%
RR - Respiratory rate / Integer (1/min) / 20
Vt - Tidal volume / Integer (mL) / 4-10 mL/kg; .3 to .7 L
Inspiratory flow rate / Peak value
PEEP - end pressure
PS - Pressure Support
I:E - In-to-out ratio
Setting effective time
Setting provider name

10.Issues

Issue Description / Responsible Party / Status

11.Sources

  • Clinical Scenario drafted by Donna DuLong and Catherine Hoang
  • Meeting with subject matter experts, 13 July 2010
  • Meeting with subject matter experts, 16 July 2010
  • Meeting with subject matter experts, 20 July 2010
  • Endotracheal Intubation Template from National, provided by Warren Rose RRT, Critical Program Leader, Tampa, Florida

Last updated 10/20/20183:52 PM / 1 of 8