Quality control of home mechanical ventilation equipment is necessary in order to ensure patient safety and that patients are accurately receiving the prescribed ventilatory support. This survey covered 16 European countries and included 326 centres that provided home ventilation to over 20,000 patients. Overall the study showed that there are poor quality standards and little attention to the maintenance of the equipment. Furthermore, considerable inter- and intra-country differences were observed. This survey provides information that will enable the formulation of recommendations of procedures for home-ventilator quality control.

Background: Home mechanical ventilation (HMV) is used to treat patients with chronic respiratory failure caused by lung and airway pathologies, thoracic cage abnormalities, and neuromuscular diseases. Long term HMV improves survival and quality of life, and reduces direct health costs, mainly by decreasing hospital stays. The number of patients currently treated with HMV in Europe is expected to increase progressively, given improvement in the survival of patients with chronic respiratory disease, the ageing of the population, and the widespread use of non-invasive techniques. The criteria and guidelines currently employed by those who implement HMV are not fully standardized including procedures pertaining to the quality control of the ventilation equipment. The aim of the present study was to undertake an extensive and detailed survey of the HMV quality-control procedures employed by the agencies responsible for HMV prescription. The survey was carried out within the framework of the "Concerted Action: The role of home ventilators in the management of chronic respiratory failure" program, funded by the European Commission.

Methods: The survey on HMV quality control collected the following information: 1) the servicing of home ventilators at home; 2) the information that the prescriber receives about the ventilator; 3) the part played by the prescriber in ventilator quality control; and 4) whether the prescriber was aware of the existence of adverse incident centres, which manage information regarding ventilator malfunctions, and patient associations that play a potential role in HMV quality control (last point is wordy and confusing). After defining inclusion criteria, 483 centres providing HMV were identified and 329 responded to the survey. These centres were associated with the treatment of 21,526 patients.

Findings: The survey showed that ventilator servicing was mainly carried out by external companies (62% of centres), with a servicing frequency ranging from three to twelve months. As well, limited interaction was observed between servicing companies and prescribers, as only 61% of centres were always informed of major incidents. Participation of centres in equipment quality control was poor. Only 56% of centres assessed that patients/caregivers correctly cleaned and maintained the ventilator. Finally, only 23% of centres were sufficiently aware of vigilance systems. The data showed considerable inter- and intra- country differences. The size of the centre was an important determinant of many of these quality-control aspects.

Conclusions: Patients and caregivers should play an active role in maintaining the quality of HMV. To this end, the provider should facilitate training and communication channels between the patient/caregiver and the HMV team. The authors suggest that the recommendations that follow from this survey will also address the role that modern technologies of information and communication could play in improving HMV quality control in the future, in particular the manner in which these technologies could be used to: 1) remotely monitor ventilation variables using new-generation home ventilators incorporating data logging and telemetry functions; and 2) facilitate exchange of information on quality control between the different partners involved in HMV. The results from this study and the issues raised should challenge community care providers and policy makers in Canada to evaluate the policies and standards in place pertaining to all home-care health equipment and technology and to ensure proper functioning and safety protocols in the event of malfunctioning. This is a problem that will continue to be of vital importance as more complex medical care continues to be provided in the community and in the patient's home. Anticipating this increasing concern is vital in the early stages of its implementation.

Reference: Farre R, Lloyd-Owen SJ, Ambrosino N, Donaldson G, Escarrabill J, Faroux B, Robert D, Schoenhofer B, Simonds A, Wedzicha JA. "Quality Control of Equipment in Home Mechanical Ventilation: A European Survey". European Respiratory Journal, 2005; 26, 86-94.

Comments

Steve Murphy wrote:

Posted 2015/02/02 at 01:38 AM EST

Now a days home ventilation is very much essential part of life. Due to air pollution, air contains harmful dust and allergens and it create many health diseases. Home ventilation removes these harmful dust and allergens and keep home healthy, warm and dry.