6509 VENTILATOR CARE DISCHARGE

6509.1 Each provider shall ensure that residents are weaned from the ventilator when weaning is determined to be medically appropriate.

6509.2 A provider shall discontinue weaning and resume mechanical ventilation if the resident experiences any of the following:

1. (a) Blood pressure elevation of more than twenty (20) millimeters of mercury (mmHg) systolic or more than ten (10) mmHg diastolic;
2. (b) Heart rate of more than ten percent (10%) above the baseline or a heart rate of one-hundred twenty (120) beats per minute;
3. (c) Respiratory rate increase of more than ten (10) breaths per minute or a rate above thirty (30) breaths per minute;
4. (d) Arrhythmias;
5. (e) Reduced tidal volume;
6. (f) Elevated partial pressure of arterial carbon dioxide;
7. (g) Extreme anxiety;
8. (h) Dyspnea; or
9. (i) Accessory muscle use in breathing or an otherwise deteriorating breathing pattern.

6509.3 Each nursing facility shall have an appropriate program for discharge and weaning from the ventilator.

6509.4 The nursing facility shall ensure that the resident and all caregivers be trained in all aspects of mechanical ventilation and demonstrate proficiency in ventilator care techniques before a ventilator-dependent resident can be discharged home on a mechanical ventilator.

6509.5 The physician and respiratory team shall arrange a schedule for follow-up visits, as indicated by the needs of the resident.

6509.6 A written discharge plan shall be provided to and reviewed with the resident and resident's caregiver and shall include at a minimum the following information:

(a) Name, address, and telephone number of the primary physician;

(b) Address and telephone number of the local hospital emergency department;

(c) Name, address and telephone number of the physician for regular respiratory check-ups, if different from the physician identified in § 6509.6(a);

(d) The responsibilities of the resident and caregiver in daily ventilator care;

(e) Identification of financial resources for long-term care;

(f) Identification of community resources for health, social, educational and vocational needs;

(g) An itemized list of all equipment and supplies needed for mechanical ventilation;

(h) Names, addresses and telephone numbers of mechanical ventilation equipment dealers and a list of services that they provide; and

(i) Contingency plans for emergency situations.

6509.7 The nursing facility shall notify DHCF of the date of discharge from the facility.

SOURCE: Final Rulemaking published at 53 DCR 1370 (February 24, 2006); as amended by Final Rulemaking published at 66 DCR 13663 (October 18, 2019).