Mechanical ventilation in Australian emergency departments: survey of workforce profile, nursing role responsibility, and education.

Abstract

Background Little empirical data describes emergency nurses’ role in decision-making for ventilation and no Australian standards exist to guide ventilation decision-making in the emergency department (ED).

Methods Self-administered questionnaire sent to nurse managers of 24 Australian EDs participating in a contemporaneous prospective, observational study of ventilation management.

Results Survey responses were available from 21/24 EDs (response rate 87.5%) of which 10/21 (47.6%) were categorized as a principal referral centre. All departments reported a 1:1 nurse-to-patient ratio for ventilated patients, for patients requiring non-invasive ventilation (NIV) nurse-to-patient ratios ranged from 1:1 to 1:3. Nurse managers from 10/21 (48%) EDs reported having guidelines for the management of mechanically ventilated patients; guidelines for management of NIV were more frequently available (13/21, 62%). Nurses independently implemented the majority of ventilator setting changes in some EDs (9/21, 43%). Competency assessment took place prior to un-preceptored care of ventilated patients in 13/21 (62%) EDs.

Conclusions Australian nurses participate actively in ventilation decisions but guidelines for ventilation decision-making are not always available. Nurse-to-patient ratios for patients receiving invasive ventilation appear consistent; lack of uniformity in ratios for NIV was common. Further work is needed to identify safe staffing levels for patients receiving NIV in the ED.

This study was undertaken with survey results obtained from Ballarat Health Services.