Ventilatory Control and Assessment —
Training activity: 3

Details

Evaluate the need for domiciliary non-invasive ventilation in patients with known hypercapnic respiratory failure and document a plan

Type

Developmental training activity (DTA)

Evidence requirements

Evidence the activity has been undertaken by the trainee​.

Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.

An action plan to implement learning and/or to address skills or knowledge gaps identified.

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 are the key criteria for evaluating the need for domiciliary non-invasive ventilation (NIV) in hypercapnic respiratory failure?
• What are the essential components of a documented plan for NIV initiation? Consider the patient pathway for domiciliary NIV.
• What is your current understanding of the indications and contraindications for domiciliary NIV?
• What challenges do you expect in evaluating a patient’s suitability and formulating a comprehensive plan?
• What insights into the practical aspects of long-term NIV management at home are you seeking?
• Will you review national and international guidelines for NIV in hypercapnic respiratory failure?
• Will you familiarise yourself with local protocols for NIV assessment and documentation?
• Have you discussed the assessment process, including required physiological measurements and patient history, with your training officer?
• What are your initial thoughts on the complexities of initiating and managing NIV in a home environment?

In action

• What steps are you taking to evaluate the patient’s need for domiciliary non-invasive ventilation (NIV)? What data are you currently gathering and how are you interpreting it? Why are you focusing on these specific aspects?
• What decisions are you making regarding the criteria for NIV? Are you considering national and international guidelines?
• What parts of this evaluation feel more straightforward, and where are you finding yourself needing to think more carefully about the implications of NIV for this patient?
• How effectively are your actions helping you to determine if domiciliary NIV is appropriate for this patient? What challenges are arising during the evaluation process?
• What insights are you gaining about the complexities of evaluating the need for domiciliary NIV as you proceed?
• Are there other factors or assessments you should be considering? Would seeking advice from a senior colleague be beneficial at this stage? Are you operating within your professional competence?

On action

• Summarise the key aspects of evaluating the need for domiciliary non-invasive ventilation (NIV) in a patient with known hypercapnic respiratory failure. What physiological measurements and other data (e.g., patient history, symptoms) were considered? What were the key factors that indicated the need (or lack thereof) for domiciliary NIV? Describe the documented plan based on your evaluation.
• What specific skills or knowledge related to evaluating the need for domiciliary NIV did you develop or improve? Were there any complexities or ambiguities in the patient’s presentation that you had to consider? What did you learn from navigating these? How did your evaluation process influence the documented plan?
• What areas for continued development in evaluating the need for domiciliary NIV have been identified? How can you apply the learning from this evaluation to future cases or discussions with the multidisciplinary team? What specific actions or ‘next steps’ will you take to further develop your understanding or skills in this area, perhaps by reviewing national guidelines? What support or resources might you need for further development?

Beyond action

• Have you had further opportunities to evaluate patients for domiciliary non-invasive ventilation (NIV)? How have your evaluations evolved?
• Have you been involved in following up with patients who were initiated on domiciliary NIV based on plans similar to yours? What were the outcomes?
• Consider if your understanding of the indications and contraindications for domiciliary NIV has become more nuanced.
• Have you discussed challenging cases of NIV evaluation with senior colleagues?
• Are you now more confident in identifying patients who may benefit from domiciliary NIV?
• Has this experience influenced how you consider patient pathways for NIV?
• How has this training activity contributed to your ability to interpret complex data relevant to NIV assessment?
• What transferable skills, such as critical evaluation, multidisciplinary team working, and understanding patient needs, did you develop?
• How will you approach future evaluations for domiciliary NIV?
• What clear actions for continued development in this complex area have you identified?

Relevant learning outcomes

#	Outcome
# 1	Outcome Interpret blood gas measurements in a range of patients.
# 2	Outcome Use the results of blood gas measurements, in conjunction with other physiological parameters and patient history, to effectively plan appropriate treatment and/or interventions.
# 5	Outcome Employ effective communication skills and compassion with a range of patients enabling patients to understand their treatment pathway.
# 6	Outcome Assess a patient’s requirement for, initiate and evaluate effectiveness of, non-invasive ventilation therapy.
# 7	Outcome Appraise patient pathways from diagnosis to end of life care.
# 8	Outcome Practice effectively as part of a multidisciplinary team to interpret complex scientific and technical data which will form part of the diagnosis and management plan.