ATS GUIDELINES Bundle

6 Management Table 2. Proposed Standardized Criteria for Discharge of an Invasively Ventilated Child to Home 1. e child must be medically stable for discharge. No significant change to ventilator settings or oxygen requirement for at least several days and preferably several weeks before discharge. No acute decompensation events (e.g., PICU transfers) within the few days to weeks before discharge. Ventilator and oxygen requirements compatible with long-term medical stability and equipment available for home setting. Home respiratory equipment trialed and tolerated in the hospital for at least 24–48 h before discharge. Must tolerate the transport to and from hospital. 2. Family caregivers must demonstrate the willingness and ability to care for the patient. Caregivers must demonstrate competency in delivering all prescribed therapies (e.g., medication administration, feeding, respiratory care, CPR, home ventilator use, responding to monitors). Caregivers must demonstrate competency in the care and replacement of their child's tracheostomy, and caregiver education must include recognizing and responding to urgent issues such as tube obstruction, decannulation, and bleeding from tracheostomy. At least two family caregivers must be fully trained in all aspects of the child's care. Caregivers must understand the importance of the continual presence of an alert caregiver who can respond to alarms and emergencies. Caregivers must agree to care for their child in situations when additional services (such as in-home nursing ) are not available even for extended periods of time. Caregivers should complete an independent stay before hospital discharge during which they are responsible for all aspects of the child's care (including responding to simulated emergencies). Routine hand washing is essential; its importance cannot be overemphasized. Caregivers must be able to safely transport the child in both routine and urgent situations (a "Go Bag" with all necessary travel items, including an extra tracheostomy tube and obturator, a size smaller tracheostomy tube, suction catheters, scissors, tracheostomy tube ties, and lubricant, will remain with the child at all times. Disability parking privileges should be considered). Family caregivers should understand that if the child improves and no longer requires the same amount of professional caregiver support, they will be required to assume increasing responsibility for the child's care.

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