Patient Care

Mission: "Breathing hope into people's lives."

Madonna's Pulmonary Program is recognized by the American Association of Respiratory Care (AARC) as a "Quality Respiratory Care Provider" and meets the CARF standards relating to serving patients on ventilators.

Scope of Services: Children and adults who are dependent on mechanical ventilation and or a tracheostomy tube for breathing successfully participate in meaningful life activities that are intrinsically motivating. A trans-disciplinary approach is delivered by skilled clinicians and utilizing state of the art technology, results in a high percentage of successful weaning. Regardless of weaning outcome, individuals are able to communicate, control their environment, be mobile and actively participate in the management of their lives.

Each patient in the Pulmonary program has an individually tailored rehabilitation plan aimed at helping him or her gain the highest level of functional independence as possible.

Clinical Expertise: Madonna's Pulmonary Program is led by Dr. Doug Fielder. Madonna nurses and therapists receive additional training and competency testing specific to ventilator and tracheostomy tube management , and the rehabilitation of children and adults who are ventilator dependent. Madonna is fully staffed with respiratory therapists on-site 24 hours per day, seven days per week.

Environment: Madonna's environment affords individuals with many opportunities to interact and support one another, whether it is in the spacious gym area during therapy, sharing a meal in the congregate dining area, or participating in a leisure activity outside in one of many garden areas. Madonna is the only facility in the region to have a simulated community, called Independence Square, where patients may practice real life tasks such as grocery shopping, banking, climbing up and down from a tractor, or going to a movie theater. A teaching kitchen with a variety of adaptive equipment is available for patients to learn how to prepare simple meals in preparation for returning home.

Passy-Muir Center of Excellence: The Passy Muir Valve is the standard of care for our pediatric and adult ventilator and/or tracheostomy tube patients. Passy-Muir Inc. is committed in their efforts to offer these patients a step towards independence and dignity through speech, and has designated Madonna a Center of Excellence. The use of the Passy Muir Valve by our interdisciplinary team has contributed significantly to the success of our ventilator and trach wean outcomes.

Treatment Equipment: In addition to our patient driven protocols and evidence based clinical practice guidelines, Madonna incorporates some of the latest technology to provide the best possible patient outcomes. Examples of this technology include:

• Ventilators that provide wave forms and graphics to enhance patient-ventilator synchrony, facilitate collection of ventilator weaning parameters and promote ventilator weaning.

• A respiratory profile monitor that provides vital objective data including carbon dioxide elimination (VCO2) for safe, comfortable patient weaning.

• A high flow oxygen delivery device that delivers 100% relative humidity to the patient. It has been used here successfully as a non-invasive system as well as a ventilator weaning tool to ease the patient's transition from mechanical ventilator support to independent breathing.

In addition to the ventilator related equipment, Madonna offers a variety of assistive technology, seating systems, and related services that make it possible for patients to get out of bed and into a wheelchair and out of their rooms, able to communicate needs, and control their environment.

Interdisciplinary Treatment Approach: Madonna's trans-disciplinary approach involves different disciplines all working toward common goals that are based upon those things that are most important to the person served, maximizing the patient's chances of successful return to home and community. The interdisciplinary team is made up of:

• Internal Medicine Physician, who rounds daily on LTACH

• Physiatrist consulting on LTACH or rounding daily on ARU

• Pulmonary Physicians round weekly on ARU/LTACH and serve as the primary physician for patients on VAU

• Rehabilitation nurses with special training in pulmonary care

• Pharmacist

• Physical Therapists

• Occupational Therapists

• Respiratory Therapists

• Neuropsychologist or Rehabilitation Psychologist

• Nutrition Therapist

• Recreation Therapist

• Speech Therapist

• Case Manager

• Social Worker

• Spiritual Care

Training & Education Knowing what has happened and what to expect next adds to the rehabilitation experience and helps ensure success. Pulmonary patients, families and caregivers receive individualized training sessions on a variety of topics aimed at helping them become as independent as possible. Patients are taught how to manage and direct their care, and are provided with opportunities to practice these skills, ending in a 2-3 night stay in Madonna's transitional apartment. This apartment is located on the unit, with easy access to medical staff if needed, with the expectation that a family member or other caregiver will assist with the personal care required during their stay. The patient will direct his/her care and independently follow his/her therapy schedule.

Madonna offers a variety of very specialized services and unique environments that assist the people we serve to return to their home, community and lives. A few examples are listed below:

Community Re-Entry: Rehabilitation does not stop when the patient gains basic skills of self-care and mobility. Participation in a variety of adaptive sports and recreational outings can be integrated into therapy or just for fun. Patients may also work on specific goals related to return to driving, school re-entry, or visit with a vocational rehabilitation counselor about work re-entry.

Long Term Success: Madonna offers many ways to help individuals and their family members continue to improve and maintain their functional gains, therefore maximizing their participation throughout the rest of their life. Some ways we do this are:

• Structured Independence Program It is important for individuals completing their rehabilitation to stay active and exercise safely. Learning how and what to do in a community based fitness environment, with trained staff and specially adapted equipment available promotes success.

• Home Assessments This service is offered on inpatient or outpatient basis. Identifying barriers in the home environment early on gives therapists an opportunity to address these issues through therapy or with recommendations for architectural changes or adaptive equipment. Often very inexpensive changes can result in a person's ability to remain in their own home.