Candidate’s name:   Assessment timeframe Name(s) and designationof assessor(s):   Unit of competency: Perform ventilator hyperinflation (VHI) in an adult intubated patient Elements andperformance criteria Did the candidate provide evidence of the following?   Performance cues Tick appropriate box,date andsign each tick. comments Not yet competent Competent 1.Determine if VHI is indicated Design and conduct an appropriate assessment of the patient Collaterelevant patient information from a variety of sources( health record, obs. chart,treating staff, information systems) Perform an appropriate physical assessment       Accurately interpretassessment findings Accurately interpret chest XR Discern the likelihood of lung collapse and sputum retention from assessment findings       Identifyand prioritise patient’s problems Differentiateand prioritise patient’s problems       Ensure all contraindications and/or precautions to the application of VHI are identified Ensure it was safe to proceed       Appropriately determine a treatment plan   Clearly identify indicators for treatment Treatment plan meets all the client’s needs       2.Prepare for intervention Discern when consultation with the treating medical consultantis required prior tothe intended application of VHI Identify patients requiring consultation with medical staff prior to treatment with VHI Gains permission to proceed       Plan forandaccess available staff to facilitate efficientandsafe treatment Use porters to facilitate treatment time planning Allow for ready location of nursingandother staff during treatment       Position the patient to achieve treatment goals Use appropriatepositioning Maintains patient comfortandsafety throughout       Facilitate medication management of the patient if required Identify need Initiate discussion with Nursing or Medical staff re Meds. Time treatment appropriately with respect to meds.       Prepare the environment Gather necessary equipment before commencing       Explain the technique to the patient Gain consent where able Explain the procedure to the patient       3.Perform VHI when indicated Establish patient’s baseline/normal ventilation settings Include all relevant parameters Vt. MV f PEEP PS RR TInsp Ventilation Mode       Select alarm limits and alter where appropriate to incorporate VHI parameters. Select alarm limits and alter where appropriate to incorporate VHI parameters. Increase PIP>41-45 cmH2O Increase TV alarm to 2L Check other alarm limits with respect to VHI parameters       Alter the ventilation settings as per the VHI clinical guidelines to deliver VHI Alter the ventilation settings as per the VHI clinical guidelines to deliver VHI Decrease f Increase TInsp Increase Vt       Provide appropriate monitoring throughout Provide appropriate monitoring throughout       Perform appropriate suction, as indicated throughout procedure Perform suction according to organisational procedurewhen indicated       Provide appropriate dosageandfrequency of treatment of VHI Provide appropriate dosageandfrequency of treatment of VHI       Return ventilator settingsandalarm limits to baseline/original settings Return ventilator settingsandalarm limits to baseline/original settings       Analyse, generate and apply solutions to troubleshoot unpredictable issues that arise when performing VHI. Discern event requiring troubleshooting Identify anappropriate course of action in response to the identified event       Identify when cessation of VHI within a session may beneeded, andtake appropriate action Discern conditions when cessation is indicated Liaise with senior Physiotherapist / or senior medical staff as appropriate       Evaluate effectiveness of VHI Consider Pts. ability to extubate CXR changes Oxygenation values Lung compliance Secretion clearance       Incorporate VHI into overall treatment plan Incorporate VHI into overall treatment plan Within a session Within further treatments that day / following day       4.Comply with supervisory requirements/operate within individual strengthsandlimitations Identify areas that are outside skillsandexpertise andconsult or refer to a more senior physiotherapist Identify areas that are outside skillsandexpertise andconsult or refer to a more senior physiotherapist       5.Document patient information Document assessment findingsaccording to accepted practice and relevantclinical protocols Document assessment findingsaccording to accepted practice and relevantclinical protocols       Document PT interventions including application of VHI in the patient’s progress notes Include all relevant information about Ventilator mode Patients position Number of breaths delivered Max volumes reached Insp time/plateau time Patients response to treatment Any changes to medication management throughout Secretions Adverse responsesandaction taken Plan for frequencyanddosage of treatment       6.Apply evidence based practice Locateandapply relevant current evidence to own physiotherapy practice Locateandapply relevant current evidence to own physiotherapy practice     7.Apply risk management Minimize risk associated with assessmentandintervention Minimize risk to the patient Minimize risk to the therapist     Identifyadverse events (actual or ‘near miss’)associated with assessment or intervention and take appropriate action Document in health record Log incident on Riskman Seek medical attention as needed     Overall competency result Competency achieved Not yet competent Date: Signature of assessor(s): Comments/further action   Name added to data base/copy in candidate’s file 0 Yes0 No   Author: A. Pearce, E. Skinner Last review date: May 2012   Version: V1_2012 Next review date: May 2013

Table 1: Assessment tool: Perform Ventilator Hyperinflation (VHI) in the adult intubated patient (Monash Health).