Independent Care Guidelines (1533)

Key points below

Independent Care Guidelines

You and your child are almost home! The final step of your teaching is Independent Care. Two caregivers will provide all of the child’s care. Each will do this over a different time. One shift will happen over a several hour period and one will be overnight. You and your Trach/Vent team will agree on the dates and times. You will use your home equipment. Monitors in the room will be turned off, but the nurse (RN) will still respond if you need help. A respiratory therapist will check on the trach collar or ventilator during your shift. Your child’s feeding and medicine schedule will be posted in the hospital room.

Before Starting Independent Care

Before you can start your shift of Independent Care, the following checklist must be complete:

 ☐ All bedside education completed

  • Trach cares:
    - Signs of infection or problems
    - Routine trach changes (3 times)
    - 1-person/emergency trach change (1 time)
    - Suctioning
    - Giving breaths with the ambu bag
    - GO BAG contents
    - G-Tube cares (if needed):
    - Signs of infection or problems
    - Medicine information. Show how to give, how much, and why it is needed
    - Feeding recipe and schedule
    - Button exchange (if used)

 ☐ All home equipment teaching completed, and in your child’s room, if used:

  •  Ventilator
  • Portable O 2 (oxygen)
  • Humidity systems
  • Suction machine
  • Pulse oximeter monitor (and apnea monitor if used)
  • Feeding pump

 ☐ Trach CPR training completed
 ☐ Complete a walk with stroller and home equipment on the unit and off the unit.

During Independent Care

At least 2 caregivers must complete a shift of care. One will spend 4 to 8 hours. One will spend an overnight. These are your tasks during your shift

 ☐ Use all home equipment without help.

  • This includes fixing problems. You may need to call your DME (durable medical equipment) provider.

 ☐ Ask for all medicines when they are due.

  • Ask the nurse to bring you the medicine that is needed.

 ☐ Ask for all feeds when they are due.

  • Ask the nurse to bring you the formula/milk/food that is needed.

 ☐ Respond to alarms without nurse help.
 ☐ Suction your child when needed.
 ☐ Provide all cares for your child.
 ☐ Answer questions about your child.
 ☐ Do any emergency care as needed.

☐ You may take a 30 minute break.

☐ Practice taking a walk with your child.

☐ If you are completing a night shift, please do not try to stay awake. Sleep like you would at home. You do have to wake up when your child needs anything.

After Independent Care

After each caregiver completes their shift, the nurse will talk about how things went. The nurse will ask how you felt. They will write a note in your child’s chart that will look like this:

Date/Time: Caregiver arrived for independent cares. Expectations outlined and home schedule accessible in patients room. Caregiver independently set up home equipment. Independent cares
started at _____________________. Caregiver (did/did not) provide cares to patient independently. Caregiver (did/did not) respond to all alarms appropriately. Caregiver (did/did not) ask for feeds and meds prior to time due. Caregiver interacted with patient by

__________. [RN can provide specific examples related to medical cares and personal interactions]. Independent cares concluded at __________________. [Indicate when switch between caregivers occurs and repeat note format]. RN reviewed report card with Caregiver A and B;
Caregiver A (was/was not) successful and Caregiver B (was/was not) successful.

You need to do Independent Care again if one or more of these happened:

◻ RN needed to remind caregiver to give a medicine or feeding.
◻ RN needed to remind caregiver to suction.
◻ RN needed to answer an alarm.
◻ RN needed to help with cares. This does not include cares like trach or tie changes that do need 2 people.
◻ Caregiver did not know how to do cares.
◻ Caregiver was not able to answer questions about child.

For other health and wellness information, check out this resource:


Call your child’s doctor, nurse, or clinic if you have any questions or concerns or if your child has special health care needs that were not covered by this information.