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Pulmonary / Critical Care Fellowship Program

University of Mississippi

Jackson, MS

Demondes Haynes, MD

Since my training as a fellow in pulmonary and critical medicine, i have been well aware of the potential conflict between the enthusiasm of the fellows to make ventilator adjustments and the responsibilities of the respiratory therapists taking care of the patients in the intensive care unit. After discussions with the fellows and respiratory therapy department, we instituted a plan so that all of our faculty and fellows are certified to change mechanical ventilator settings and document on the respiratory care sheet. The plan includes:

• Lectures on mechanical ventilation given by faculty:
• First week of July, a lecture on the basics of mechanical ventilation - This lecture is dedicated to modes of ventilation, including the history of mechanical ventilation. This gives first year fellows an opportunity to ask basic mechanical ventilation questions while preparing for the MICU. This serves as a refresher course for the 2nd and 3rd year fellows.
• Second or third week of July, a lecture on mechanical ventilation and salvage therapies - This lecture focuses on more advanced mechanical ventilation and salvage therapies.
• 3-4 months later, a lecture focused on high frequency oscillatory ventilation.
• In-service training: An in-service with hands on experience, with the different mechanical ventilators available in our hospital, is provided to the fellows by our MICU RT supervisor. This is an intense course which must be completed by all fellows. There is a didactic and hands on practical session approximately 4 hours in duration. During this session, basic mechanical ventilation is reviewed including waveform analysis, ventilator setup and adjustment, troubleshooting, etc. The fellows are free from other duties during this time. The fellows are educated on the various ventilators which we use in this institution and at the VA (SERVO-i® and occasionally Servo 300). The fellows receive instruction and hands on experience with making adjustments on each ventilator. They are also instructed on documentation on the respiratory care flow sheet that is usually completed by the RT.
• Written Exam: The fellows must take and pass a written exam after the in-training session. A score of 80% is required for passing. If fellows do not pass the exam on the 1st attempt, they are allowed a 2nd attempt. If they do not pass on the 2nd attempt, they are required to participate in the in-service session again.
• Practical Exam: After completing the written test, the fellows schedule individual appointments with the MICU RT supervisor for a hands-on practical exam. After successful completion of the practical exam, the fellows are deemed competent to make ventilator manipulations. Their certification for ventilator adjustments is approved by the medical director of respiratory therapy. Only fellows (and faculty) who receive this certification are allowed to manually manipulate mechanical ventilators in our institution.

This has improved the communication and relations between the fellows and respiratory therapists. We believe this is a best practice as it teaches the fellows about manipulating the mechanical ventilators, working as a part of the healthcare tea and promotes life-long learning.