Authors: (including presenting author): :
Ho KM (3), Tang PY (1)(2), Poon ST (4), Yuen WS (2), Lo PL (3), Ng ML (3), Yeung WS (3), Yeung WY (2), Lo SY (2), Lee KW (1), Ho WSE (4), Lam KN (4)
Affiliation: :
(1) Intensive Care Unit, Alice Ho Miu Ling Nethersole Hospital, (2) Intensive Care Unit, North District Hospital, (3) Department of Intensive Care, Prince of Wales Hospital (4) Department of Intensive Care, New Territories East Cluster
Keyword 1: :
Intensive Care Unit ICU
Keyword 2: :
Patient Safety
Keyword 3: :
Mechanical Ventilation
Keyword 4: :
Temporary disconnection
Introduction: :
Temporary disconnection of mechanical ventilation is a high-risk, high-volume procedure in daily ICU care. Failure to promptly and properly resume ventilatory support can cause severe, preventable hypoxaemia, hypoxic brain injury, or death. NTEC ICUs therefore adopted a zero-tolerance risk for failure to recognize proper connection and initiation of mechanical ventilation.
Objectives: :
To ensure safe and effective nursing practice during temporary disconnection of mechanical ventilation
Methodology: :
In August 2025, NTEC ICU Quality Assurance team established a clear workflow to minimize risks during/after temporary disconnection of mechanical ventilation, emphasizing safe and effective reconnection. The workflow clearly defines “short procedure” as mechanical ventilation interruption less than 2 minutes (STANDBY function is strictly prohibited) and “extended procedure” as interruption over 2 minutes. Key steps include: • Pre-procedure assessment and preparation • Monitoring during disconnection • Reconnecting the ventilator circuit to resume mechanical ventilation • Using “VCC, We see see” as mnemonic with pointing-and-calling: - (V) ventilator waveforms, - (C) visible chest rise, and - (C) end-tidal CO₂ (presence, waveform, and value) by 2 staffs with independent double check This workflow ensures safe ventilation resumption and supports the zero-tolerance policy for preventing adverse or fatal outcomes. It has been applied to NTEC ICUs at Alice Ho Miu Ling Nethersole Hospital (AHNH), North District Hospital (NDH), and Prince of Wales Hospital (PWH) in September 2025, followed by audits (22 standard criteria), return demonstrations, knowledge quizzes, and surprise checks from November to December 2025.
Result & Outcome: :
In NTEC ICUs, 225 staff completed the audit of temporary disconnection of mechanical ventilation, achieving 100% compliance. Surprise checks on 27 samples also showed 100% compliance. In the knowledge quiz, 90.3% of staff scored above 80% (ranging 84.5%–100% by hospital). Ongoing new staff education through orientation programs, periodic reviews, and surprise checks remain essential to sustain high standards of practice. As concluded, this structured check on disconnection of mechanical ventilation circuit was implemented in NTEC ICUs successfully.
