Extubate Patient, Planned

Extubate Patient, Planned Version 0.1

Detailed Clinical Models, Medical Devices Domain Use Case Extubate Patient, Planned

Last updated 04/30/2018 7:57 PM 1 of 7 Extubate Patient, Planned Version 0.1

Revision History

Date Version Description Author SMEs 7/22/10 0.2 Changes based on scope Jay Lyle modifications from team meeting 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 an information model to support those interactions. This model may contain or reference one or more “detailed clinical models” (DCMs)--a formalism for representing clinical information currently under development. Confirming the method for using these component models is a key goal of the project sponsoring the use case. The requirement for clinical accuracy in DCMs means that the scope of the information model extends beyond the device interactions to other clinical facts: these facts are bounded in this case by the VA National Template for Intubation and by the Advanced Cardiac Life Support protocol published by the American Heart Association.

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 o Nurse – a nurse, with or without intubation privileges o Respiratory Therapist – a respiratory therapist, with or without intubation privileges, typically responsible for setting up the ventilator and modifying settings o 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  Pulse Oximeter  Electrocardiograph  Vital signs monitor  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.

 Order for 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 o Patient has met criteria for weaning o Patient has met criteria for extubation o Patient has been successfully extubated and assessed  Ventilatory status o Ventilator has been disconnected from patient o Ventilator has been disconnected from medical record system o Ventilator is placed in appropriate state or place for cleaning and return to use  EHR documentation o All readings and changes in settings in EHR  Ongoing monitoring o Ventilator-specific alarms have been suspended

8. WORKFLOW 8.1 Basic Workflow This workflow is based on the clinical scenario referenced in section 11.

Actor Action System Response 1. Clinician Assess patient Vitals monitor: display vitals ABG: display ABGs [note] EKG: display EKG Pulse oximeter: display O2 2. Confirm settings Vent: display settings 3. Desist from medication 4. Set ventilator mode for trial Vent: record mode, RR

5. Connect respirometer Respirometer: record volume 6. Score RSBI 7. Assess patient As above (step 1) 8. Assess intubation difficulty EHR: display intubation recording 9. 10. Incomplete 11. 12. 13. 14.

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: 3.

9. DATA

Case Step: 2 Confirm Observations Device ABG

See data element list for Confirm Observations in use case Intubate Patient, Unplanned.

Case Step: 2 Confirm Observations Device Vital Signs Monitor

See data element list for Confirm Observations in use case Intubate Patient, Unplanned.

Case Step: 16 Enter Settings Device: Ventilator

See data element list for Record Settings in use case Intubate Patient, Unplanned.

10. ISSUES

Issue Description Responsible Status Party

11. SOURCES 1. Clinical Scenario drafted by Donna DuLong and Catherine Hoang 2. Meeting with subject matter experts, 13 July 2010 3. Meeting with subject matter experts, 16 July 2010 4. Meeting with subject matter experts, 20 July 2010 5. Endotracheal Intubation Template from National, provided by Warren Rose RRT, Critical Program Leader, Tampa, Florida 6. ACLS protocol document found here

Last updated 04/30/2018 7:57 PM 7 of 7