Home Ventilation Record
Welcome to your Parent held record for families with children at Home on
Ventilation. This portable folder has been designed to:
 aid communication between you and all the people involved in your child’s
care.
 help different health care professionals to communicate important
information to each other.
Please bring it along to hospital appointments and admissions, in fact, for any
contact with professionals, be it your community nurse, O.T, doctor or social worker,
show them the record.
Information in this record will help you to bring anyone involved up to date with
your child’s condition: their current treatment and equipment settings. It will be
especially useful to introduce new staff to your child and for any team-members who
haven’t been around for a while. Similarly, at clinic appointments, it may save time
by summarising your child’s condition so that you won’t need to repeat yourself too
much.
Using the timeline you can record major events or changes in your child’s
treatment or ventilator settings. Instead of recording every appointment, it will
notify professionals of key changes in your child’s care, which may affect their
management if they are admitted to hospital.
The record is designed to be carried around daily so try to keep it lightweight. Please
customise it to your requirements. As it is a summary of the most recent events,
then older pages can be removed from the file as they become outdated and
replaced.
We hope you find the record useful.
We welcome ideas about how to improve it; contact . . .
Please insert extra sheets as necessary
Page 1
Home Ventilation Record
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Page 2
Home Ventilation Record
This is all about . . .
Insert a photo of your child
here if you wish
Child’s name
Date of birth
NHS
Number
Family
address
Parent or
Carer names
Telephone
Mobile
Please insert extra sheets as necessary
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Home Ventilation Record
Summary of Medical Background:
Your doctor will summarise your child’s medical condition here.
Date:-
Please insert extra sheets as necessary
Completed by:-
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Home Ventilation Record
Current Medications:
Date
Name
Please insert extra sheets as necessary
Route
Dose
Freq
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Home Ventilation Record
Other important information about our child
Feeding: - if your child is NG fed then include information about their
daily regime. Also include any extra important information.
Date:-
Completed by:-
Communication:- Does your child have any special communication
issues or needs that staff should be aware of? Make of note of these here.
Date:-
Please insert extra sheets as necessary
Completed by:-
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Home Ventilation Record
Important people working with us:- Remember to include your
community nurse, consultant paediatrician, physiotherapist, occupational
therapist, speech and language therapist, play therapist, social worker,
CARIN4 families support worker, as well as any other important people.
Name
Professional
role
Phone number
Email address
Date of first
contact
Frequency of
contact
Name
Professional
role
Phone number
Email address
Date of first
contact
Frequency of
contact
Name
Professional
role
Phone number
Email address
Date of first
contact
Please insert extra sheets as necessary
Frequency of
contact
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Home Ventilation Record
Important people working with us ctd
Name
Professional
role
Phone number
Email address
Date of first
contact
Frequency of
contact
Name
Professional
role
Phone number
Email address
Date of first
contact
Frequency of
contact
Name
Professional
role
Phone number
Email address
Date of first
contact
Please insert extra sheets as necessary
Frequency of
contact
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Home Ventilation Record
Timeline
This section helps keep all of the team up to date with your child’s
condition in a concise and easy to read way. Use it to record any
important changes in your child’s medical condition or treatment. e.g. any
significant hospital admissions or changes in ventilator settings or
medications. It can be filled in by yourself or a member of the team.
Date
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What happened or changed?
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Home Ventilation Record
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Home Ventilation Record
Personal Resuscitation Plan (PRP)
IMPORTANT This document is a summary only, please refer to
the detailed PRP held in the patient notes or on NOTIS.
Resuscitation Plan
3.1.In the event of a sudden collapse with respiratory and or cardiac arrest:
Symptoms/signs to expect
Carefully and clearly delete all options not needed and complete boxes as needed:
1. Comfort & support child and family
2.
3.
4.
5.
Suction upper airway
Oxygen for comfort face mask/nasal cannulae
Airway management including oral/nasopharyngeal airway if it helps
Mouth to mouth / bag & mask ventilation whilst heart beat present
trial of five inflation breaths
6. Endotracheal tube & ventilate
7. External cardiac compressions/defibrillation/adrenaline
8. Advanced life support including inotropic drugs and iv access
3.2.
This child is at risk of generalised tonic clonic seizures:
Rescue anticonvulsant medication is:-
Date of implementation:Please insert extra sheets as necessary
Implemented by:Page 11
Home Ventilation Record
Appointments:-This page will help you to keep track of all upcoming
appointments with the professionals involved in your child’s care.
Date
Time
Where?
Please insert extra sheets as necessary
With who?
Extra info
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Home Ventilation Record
Parent Communication Page
Record any questions you have for the health care team so that you can
ask them next time you’re in contact with them.
Date
Question
For
Date
Question
For
Date
Question
For
Date
Question
For
Date
Question
For
Please insert extra sheets as necessary
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Home Ventilation Record
Communication for the Team
Date
Info for…
Date
Info for…
Date
Info for…
Date
Info for…
Date
Info for…
Information
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Signed as seen………………………………………………………
Information
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Signed as seen………………………………………………………
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Signed as seen………………………………………………………
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Home Ventilation Record
Communication from the Team
Date
Response
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Signed as seen………………………………………………………
Date
Response
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Response
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Please insert extra sheets as necessary
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Home Ventilation Record
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Home Ventilation Record
Ventilator Settings
Name
Please insert extra sheets as necessary
Order code
Supplier
Page 17
Home Ventilation Record
Ventilator settings
Please insert extra sheets as necessary
Page 18
Home Ventilation Record
Circuits set up
Please insert extra sheets as necessary
Page 19
Home Ventilation Record
Please insert extra sheets as necessary
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Home Ventilation Record
Physiotherapy – Cough Assist
Your cough assist machine is:- ……………………………………………..
Mode
Insufflation Pressure
Exsufflation Pressure
Inspiratory time
Pause
Expiratory Time
Inspiratory Repeat
(clearway) / number of
“coughs” (Emerson)
Cycle repeat
Date implemented:-..................................
Implemented by: -....................................
Please insert extra sheets as necessary
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Home Ventilation Record
Extra Notes
Please insert extra sheets as necessary
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Home Ventilation Record
Chest Clearance Programme
Normal Daily Programme (when well)
How often…………………………………………………………......................................
Nebulisers pre-physio……………………………………………..................................
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Positioning……………………………………………………….......................................
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Techniques…………………………………………………………....................................
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Suction……………………………………………………………….....................................
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When unwell (increased secretions/signs of worsening
respiratory status) – see detailed chest physiotherapy programme
Date implemented: -
Please insert extra sheets as necessary
Implemented by:-
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Home Ventilation Record
Please insert extra sheets as necessary
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Home Ventilation Record
Extra Notes
Please insert extra sheets as necessary
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Home Ventilation Record
Contacts page
Who to call when?
Flow diagram idea of choices depending on pt condition etc.
For information on ventilator equipment/spare parts call...
If your child needs medical assistance call....
Please insert extra sheets as necessary
Page 26
Home Ventilation Record
GLOSSARY OF TERMS – ADD YOUR OWN AS YOU BUST OPEN THE JARGON !
Term
Non-invasive
ventilation
Invasive
ventilation
Tracheostomy
Bilevel ventilation
Abbrev Meaning
NIV
Breathing support via a mask
IV
Breathing support via a
tracheostomy
Trachy Surgical airway through the neck
BiPAP Two levels of pressure to support
breathing
CPAP Single level of pressure to support
breathing
Continuous
positive airway
pressure
Inspiratory
IPAP
positive airway
pressure
Expiratory positive EPAP
airway pressure
High flow alarm
Low flow alarm
Leak
Trigger
Breath stacking
Cough assist
Please insert extra sheets as necessary
Commonly
Mask
ventilation
Trachy
ventilation
Trachy
BiPAP
CPAP
Top (peak) pressure given by
machine for breathing in
Top
pressure
Bottom pressure (valley) pressure
given by machine for breathing out
Machine alarm when flow from
machine increases above normal,
usually as a result of air leak from
mask
Machine alarm when flow from
machine reduces below normal,
usually as a result of a kink/blockage
Escape of airflow generated by the
ventilator – wasted gas
When the ventilator follows the
effort of the attached human to
breathe – in or out.
A technique of breathing when
several breaths are held in on top of
each other then released to improve
cough.
A machine designed to help clear
secretions away from the lungs.
Bottom
pressure
Leak alarm
Blockage
alarm
Leak
Trigger
Stacking
Clearway
Emerson
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Home Ventilation Record
Pressure support
ventilation
PSV
Pressure
controlled
ventilation
PCV
Volume controlled
ventilation
VCV
Please insert extra sheets as necessary
The ventilator is set to deliver
breathing assistance triggered by the
patient, achieving a target pressure.
The ventilator is set to deliver
breathing assistance irrespective of
the patients breathing effort. Target:
a given pressure.
The ventilator is set to deliver
breathing assistance, aiming to
achieve a target volume.
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Home Ventilation Record
Please take a minute to give some feedback about the parent
held record .This will allow us to make improvements to it in
the future.
Was there anything you particularly liked about the record? Specifically
any sections you found most useful?
Was there any section that you disliked or did not use? Why was this?
Is there anything else you would like to see in the record?
Any other comments?
Please insert extra sheets as necessary
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