Ventilator Charting in Nigeria: What ICU Software Should Record

Night shift, SIMV, FiO₂ 60%, PEEP 8, peak climbing, RASS -4. The charge nurse can see the screen. The 07:00 question is whether anyone can show what was set, what the machine reported, who suctioned, and whether a weaning trial was attempted. Ventilator charting is that record. It is not the ventilator.

For medical directors, intensivists, ICU charge nurses, and administrators buying EMR or HMS in Nigeria. Pair it with SOFA, NEWS2, FASTHUG-BID, and ICU-ready HMS. Score the chart on a named ICU admission, not a slide titled "AI ventilator."

What is ventilator charting in a Nigerian ICU EMR?

A ventilator chart is a time-stamped document on one admission: mode and set parameters, measured values, sedation score, alarms, interventions, and (when relevant) a weaning trial. The clinician still decides settings. The software stores what was written, by whom, at what time.

Buyers mash four products into "ventilator software": the machine (waveforms and alarms), the paper or WhatsApp log, the EMR chart, and a device interface (HL7 or serial, no retyping). If a vendor says "we do ventilators," ask which they opened. Then make them mark a named patient ventilated, save one row, and show the same numbers after a refresh.

On DawaHQ this sits on the critical care ICU module (addon, enable-per-clinic) on an ICU-placed bed. The admission can be marked ventilated, with an optional typed machine label such as VENT-01. That is not a live device identity.

How is a ventilator chart different from controlling the ventilator?

Staff already know the split. Vendors blur it.

The machine delivers the breath. Changing AC/VC to PSV, raising PEEP, or silencing a high-pressure alarm happens on the ventilator (or by bagging). Software should not remotely drive a Nigerian ICU ventilator unless a separately certified interface exists.

The chart is the memory of that shift: mode, FiO₂, PEEP, tidal volume, set and measured rate, pressures, SpO₂, EtCO₂, RASS, and what was done about an alarm.

DawaHQ does not send settings to a ventilator. There is no HL7 or serial ingest from the machine into the vent row (lab HL7 via Mirth is a different, analyser path). The nurse or doctor types what is on the screen. Treat "closed-loop ventilation," "ARDSNet auto-titration," and "the EMR weans the patient" as brochure language until you see the cable.

Mark as ventilated / mark extubated updates admission status and optional machine id. It does not start or stop a device.

What settings and measured values should the software record?

At minimum you should see, on one named ICU admission:

| Item | Why it matters | |------|----------------| | Mode | AC/VC vs PSV vs CPAP is a clinical decision, not a vibe | | FiO₂ (%) | Feeds later organ-failure math if PaO₂ is in the labs | | PEEP (cmH₂O) | Weaning talk needs a number, not a memory | | Tidal volume (mL) | Lung-protective intent lives in a number | | Set vs measured RR | Dyssynchrony hides in the gap | | Peak / plateau / mean airway pressure | High peak after suction is not the same as a stiff lung | | Minute ventilation, SpO₂, EtCO₂ | The numbers the round actually argues about | | Who recorded, when | A shared ward login is not a signature |

DawaHQ's Ventilator tab stores those as structured fields. Mode is one of AC/VC, AC/PC, SIMV, PSV, CPAP, APRV, Manual. FiO₂ is 21-100%. There is no NAVA, HFOV, or dedicated NIV-BiPAP enum. If your unit lives on those modes, write the limitation into the SOP.

Measured SpO₂ and EtCO₂ use abnormal-value highlighting (range plus severity cue). Peak and plateau are typed numbers. The form does not auto-calculate driving pressure or a PaO₂/FiO₂ ratio on that screen. Alarm chips (high pressure, low SpO₂, dyssynchrony, apnea, suction, sedation change) append text. They do not poll the ventilator alarm log.

Does the EMR run RASS, SBT, and weaning for you?

No product a Nigerian board should trust auto-sedates or auto-extubates.

RASS (Richmond Agitation-Sedation Scale, -5 unarousable to +4 combative) is a clinician score. DawaHQ stores the integer and derives the label (for example -1 Drowsy, 0 Alert and calm). It does not watch a camera or infer RASS from GCS.

Spontaneous breathing trial (SBT) pre-criteria on the form are a prompt (FiO₂ ≤ 40% with SpO₂ ≥ 95%, PEEP ≤ 5, RASS -1 to 0, cough, haemodynamic stability, secretions, follows commands). Ticking them does not compute eligibility. Checked items are appended into weaning notes as text. They are not a protocol engine and not a NICE or WHO certificate.

Weaning this shift is a checkbox plus outcome: tolerated, not tolerated, extubated, or not attempted, with notes. Saving "extubated" on that row does not flip the admission off the ventilator. Mark Extubated is a separate doctor/admin/owner action.

A flag to doctor stores a reason on the row. A doctor, clinic admin, or owner can acknowledge it in the chart. That is not a pager, SMS, or Telegram escalation. Do not buy "AI weaning."

How does ventilator charting connect to SOFA?

SOFA respiratory scoring uses the PaO₂/FiO₂ ratio when both exist. DawaHQ's SOFA computation reads the latest FiO₂ on the ventilator chart and PaO₂ from labs (names such as PaO₂ / arterial oxygen). If either is missing, there is no invented P/F. See SOFA at the bedside.

NEWS2 is a different score from ward vitals. DawaHQ's NEWS2 path does not currently take supplemental-oxygen points from the ventilator row. Do not let a vendor treat "ICU scores" as one blob. See NEWS2.

Sepsis bundle and FASTHUG-BID sit on the same ICU admission. Ticking a vent chart does not start a Hour-1 bundle or complete the daily safety checklist. Sedation on FASTHUG is a checklist item; RASS on the vent row is a number. Buy both.

Theatre anaesthesia FiO₂ and dialysis machine serials are different surfaces. Keep them honest in the demo.

Who should chart, and who marks ventilated or extubated?

The person at the bedside writes the numbers. The person who owns the airway decision marks ventilated or extubated. Those are not the same click.

On DawaHQ, the Ventilator tab is shown to owner, clinic admin, doctor, and nurse when the patient is on an ICU bed (or an ICU ward when bed type is empty). Nurses and doctors can add and edit entries (IPD module on; ICU addon required to save). Mark as ventilated, Mark extubated, and acknowledging a doctor flag are owner, clinic admin, and doctor. Reception and cashier do not get the tab.

An HDU bed type does not currently paint the Ventilator tab. If your step-down unit charts invasive ventilation, ask to see that bed in the demo.

If the patient is in an ICU bed but the ICU addon is inactive, the tools can still appear with a billing warning; saves may be blocked until the addon is on. That is the procurement question: bed placement plus paid ICU module, not a hidden flag on a general ward.

What about NDPA, NHIA, and ventilator-device integration?

Do not buy "NDPA-certified ventilator EMR" or "NHIA-integrated ventilation."

NDPA. Chart rows are patient data. Prefer NDPA-oriented consent logging and a patient-access audit trail. We do not sell "NDPA certified" or "fully NDPA compliant."

NHIA / HMO. Vent hours are clinical documentation, not an e-claims submit. Prefer HMO claim workflows if the stay will be billed to a panel. See HMO claims.

Devices / NDHI / FHIR. A typed machine label is not a national HIE, not FHIR, and not a certified medical-device interface. Lab HL7 ingest (Enterprise, Mirth) is for analysers, not this tab.

PCN / NAFDAC. A sedation note on the vent row is not a controlled-drug register and not a MAR dose.

This is operational practice, not legal advice, and not a ventilator-competency certificate.

What should you test in a ventilator-charting demo?

Run this morning's ICU, not a brochure.

1. Place a named patient on an ICU bed with the ICU addon on. Confirm the Ventilator tab. Repeat on an HDU bed and write down whether the tab appears.
2. As a doctor, Mark as ventilated. Enter a machine label. Confirm the banner and elapsed time. As a nurse, confirm they can chart but cannot mark extubated.
3. Save a row: AC/VC, FiO₂ 60, PEEP 8, TV 420, set RR 16, peak 28, SpO₂ 94, EtCO₂ 48, RASS -2. Refresh. Confirm the same numbers and the recorder's name.
4. Log a high-pressure alarm plus suction in interventions. Confirm it is text on that row, not a device alarm feed.
5. Tick weaning trial, tick two SBT prompts, outcome not tolerated. Confirm notes contain the ticked text. Confirm the admission is still ventilated until Mark Extubated.
6. Flag to doctor. As doctor, acknowledge. Confirm the nurse cannot acknowledge.
7. Open SOFA on the same admission. If a PaO₂ lab exists, confirm FiO₂ came from this chart. If PaO₂ is missing, confirm P/F is not invented.
8. Ask the vendor to show the EMR changing the physical ventilator, or an HL7 waveform. If they cannot, do not let "ventilator integration" pass.
9. Confirm the path: book a demo, request access, custom quote. No self-serve trial.

Bring the Medical Director and the ICU charge nurse, not only IT. Use the ICU-ready buyer checklist.

How does DawaHQ support ventilator charting today?

On clinics that run IPD plus the critical care ICU addon, on an ICU-placed bed: admission ventilated flag and optional machine label; structured chart (listed modes, set and measured fields, RASS with derived label, alarm/intervention text, weaning checkbox and outcome, SBT prompts stored as notes, flag-to-doctor with acknowledge); edits; timeline by date; SOFA reads latest charted FiO₂. Qualified wording: ventilator documentation in the EMR. Not a ventilator, not closed-loop control, not device HL7, not NEWS2 O₂ from this row, not HDU-tab by default, not "NDPA certified," not NHIA e-submit.

Same HMS as ICU beds and HMO claim workflows. Pricing is sales-led from ₦25,000/month, then a scoped quote.

What to do next

Count last night's paper: missing FiO₂ on the round printout, WhatsApp photos of the vent screen, and the registrar who could not say when PEEP last changed.

Then book a demo or request access. Walk one Mark as ventilated, one saved row, one flag, one SOFA P/F, and one Mark extubated. Explore HMS for Nigeria, EMR for Nigeria, and ICU & critical care. If the product cannot show the numbers on the machine and the same numbers in the chart, without pretending to drive the machine, it will not help when the consultant asks what happened at 03:15.