Training activity information
Details
Use monitoring to troubleshoot clinical issues with mechanical ventilation
Type
Entrustable training activity (ETA)
Evidence requirements
Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion.
Reflection at multiple timepoints on the trainee learning journey for this activity.
Considerations
- Monitoring parameters
- Common clinical issues
- Training with respect to use of monitoring parameters
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
What does success look like?
- Identify what is expected of you in relation to accurately diagnosing clinical issues (e.g., patient-ventilator asynchrony or changes in lung mechanics) using advanced ventilator monitoring.
- Consider how the learning outcomes apply, specifically in relation to interpreting monitoring techniques and assessing clinical issues using appropriate alarm settings.
- Discuss with your training officer to gain clarity of what is expected of you in relation to systematic analysis of monitoring data (waveforms, loops) to pinpoint the root cause of a clinical problem.
What is your prior experience of this activity?
- Think about what you already know about how various clinical issues (e.g., increased airway resistance, decreased lung compliance) manifest in ventilator monitoring parameters (waveforms, loops, pressures, volumes).
- Consider possible challenges you might face during the activity, such as ambiguous monitoring signals or complex patient interactions with the ventilator.
- Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom. You will need to seek advice from your Training Officer when required, for example if monitoring data suggests a rapidly deteriorating clinical status (e.g., severe auto-PEEP) that requires immediate intervention.
- Acknowledge how you feel about the responsibility of identifying and addressing clinical issues based on monitoring.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as interpreting advanced ventilator graphics (waveforms, loops) to diagnose clinical problems.
- Identify the specific insights you hope to gain into the relationship between ventilator settings, patient physiology, and monitoring displays.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of interpreting complex physiological monitoring data or troubleshooting equipment.
- Identify important information you need to consider before embarking on the activity, such as reviewing resources on advanced ventilator monitoring interpretation, and practicing interpreting simulated data (waveforms, loops).
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst reviewing monitoring data (waveforms, loops, numeric data) to identify a problem?
- Are you encountering situations such as:
- The ventilator graphics (waveforms or loops) present an unexpected pattern (e.g., an abnormal flow-volume loop suggesting auto-PEEP)?
- The numeric data (e.g., compliance or resistance values) points to a clinical issue you hadn’t initially suspected?
- The patient’s physical appearance seems inconsistent with the complex monitoring data?
How are you reacting to the unexpected development?
- How is this impacting your actions? For example, are you responding to the situation appropriately? Did you change your interpretation of the data? Did you adapt your troubleshooting approach based on the unexpected findings? Did you seek immediate input from a colleague?
- Consider the steps you are taking in the moment, such as:
- Immediately adjusting the display or switching montages/scales to verify the unexpected pattern in the waveform/loop
- Consulting a resource or senior colleague to help link the unexpected monitoring findings to potential patient physiology
- How are you feeling in that moment? For instance, did the unexpected finding affect your confidence in using monitoring to troubleshoot? Were you able to adapt your thinking quickly?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully linking the monitoring data to a clinical diagnosis and recommending a setting change? Or are you needing support because the complexity of the issue requires escalation, such as interpreting a pattern suggesting severe acute lung pathology?
- What are you learning as a result of the unexpected development? For example, did you improve your skill in interpreting specific waveforms or data, or in linking monitoring findings to patient physiology?
On action
What happened?
- Begin by summarising the key steps you took when using monitoring data (e.g., waveforms, loops, pressures) to troubleshoot a specific clinical issue with mechanical ventilation.
- Consider specific events, actions, or interactions which felt important, such as accurately diagnosing patient-ventilator asynchrony from the flow/volume loop or successfully identifying decreased compliance leading to intervention.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately scrutinising and troubleshooting monitoring when a flow-volume loop presented an unexpected pattern (e.g., suggesting auto-PEEP).
- How did you feel during this experience, e.g., did you feel confident in applying monitoring techniques or challenged by the ambiguity of the data?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding using monitoring to troubleshoot clinical issues. What strengths did you demonstrate, e.g., systematic interpretation of pressure/time scalars?
- What skills and/or knowledge gaps were evident, e.g., difficulty linking complex waveform features to the diagnosis of a patient’s clinical respiratory condition?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in applying monitoring techniques and identifying potential clinical issues?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding interpreting a pattern that suggested severe acute lung pathology or required escalation to the senior clinician due to the complexity of the issue, and how you reacted to this.
What will you take from the experience moving forward?
- Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to refining the use of monitoring data (waveforms, loops) in the diagnosis of a patient’s clinical respiratory condition.
- What will you do differently next time you approach troubleshooting clinical issues using monitoring, for instance, by proactively reviewing resources on advanced ventilator graphics interpretation?
- Do you need to practise any aspect of the activity further, such as systematic analysis of ventilator graphics or key learning outcomes related to assessing clinical and technical issues?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of using monitoring to identify and resolve clinical issues with ventilated patients since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how an instance where a subsequent case presented abnormal flow/volume loops suggesting patient-ventilator asynchrony forced you to re-evaluate the depth of your initial waveform analysis during your first attempt at this training activity.
- Considering what you understand about waveform and loop interpretation and root cause analysis now, were the actions or considerations you identified after your initial reflection on this training activity sufficient? How have you since implemented or adapted improvements in your systematic data interpretation for ventilation troubleshooting based on further learning and experiences? For example, how you proactively reviewed and integrated specific criteria for recognising auto-PEEP patterns in volume-time graphs based on further learning.
- Has discussing troubleshooting ventilation using monitoring or the impact of misinterpreting specific ventilator graphics (e.g., loops) with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a colleague about a case where abnormal graphics led to an inappropriate therapeutic change refined your understanding of the criticality of integrating multiple data sources.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent monitoring and troubleshooting experiences for clinical issues, contributed to your overall confidence and ability in data interpretation, pattern recognition, and integrating information from various sources (e.g., waveforms, loops), particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated ability to recognise abnormal patterns in waveforms and conduct root cause analysis now enables you to confidently interpret advanced ventilator graphics (e.g., loops) and identify the root clinical problem during DOPS or Case-Based Discussion assessments.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to ventilator monitoring and clinical diagnosis? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, how your evolved approach means you now routinely seek advice from the Training Officer or Senior Clinician immediately when monitoring data suggests a rapidly deteriorating clinical status (e.g., severe auto-PEEP) or acute lung pathology, recognising this requires immediate clinical decision-making outside your current scope.
- Looking holistically at your training journey, how has this initial using monitoring to troubleshoot clinical issues experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to selecting appropriate alarm settings, interpreting monitoring and assessing clinical issues/troubleshooting? For example, how this foundational experience has supported your development in data interpretation, pattern recognition, root cause analysis, and integrating information from various sources to inform clinical decisions.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 3 |
Outcome
Select the appropriate alarm settings on the ventilator with respect to patient safety and monitoring. |
| # 4 |
Outcome
Interpret and apply monitoring techniques on high specification ventilators. |
| # 6 |
Outcome
Assess clinical and technical issues with ventilators and troubleshoot accurately. |