Respiratory Care
Physicians have traditionally written
orders for respiratory therapy that were specific and allowed no variation
by the Respiratory Care Practitioner administering the treatment. If there
was a change in patient condition, the physician would be called to have
the orders adjusted. However, nationally referenced appropriateness
indicators, such as the AARC Clinical Practice Guidelines, have now become
widely accepted as practice standards and guides to rational respiratory
care.
Recently, protocols have been designed to allow assessment by properly
trained and credentialed respiratory care practitioners, and for
initiation and adjustment of treatment within guidelines previously
decided by the physician. In a number of hospitals these protocols have
proved highly efficient, safe, and cost-effective.
They cover a variety of clinical circumstances
including:
B. Bronchodilator Medications Protocol
F. Post-Op Respiratory Care Plan
G. Determining Need for Modified Pulmonary
Stress Test
H. Modified Pulmonary Stress Testing
I. ETC Bronchodilator Protocol
J. Peds ER Bronchodilator Protocol
K. Self-Administration of Medical Modalities (SAMM)
M. Mechanical Ventilation Albuterol Protocol
N. Extubation
There are several clear
advantages to using protocols (called “assess and treat”
protocols in some institutions):
A. Therapy can be adjusted
more frequently in response to changes in patients condition.
B. Physicians can still be contacted for major clinical changes,
but not minor therapy adjustments, thus reducing nuisance calls.
C. Consistency of treatment can be maintained and
non-pulmonary physicians can use appropriate up-to-date methods by
simply requesting that protocol therapy be instituted.
D. Respiratory care practitioners become actively involved in
achieving the goal of good patient outcome instead of performing
rigid tasks. This enhancement of responsibility attracts and retains
better educated and qualified practitioners.
Elements of successful
Respiratory Care Protocols include:
A. Clearly stated objectives
B. Outline of the protocol including a
decision tree or
algorithm.
C. Description of alternative choices at
decision and action
points.
D. Description of potential complications and
corrections.
E. Description of end-points and
decision-points where the
physician must
be contacted.
Implementation and
maintenance of Respiratory Care Protocols requires:
A. Use of written protocols
with sound
scientific basis.
B. Strong medical director support.
C. Intensive education of respiratory care
practitioners
D. Medical staff approval and confidence in
the protocol.
E. Frequent auditing of outcomes and
continuing education.
F. Adjustment of protocol to meet needs
and new scientific
evidence.
Respiratory Care Protocols provide an
opportunity to enhance the medical care of patients with timely, safe, and
cost-effective therapy. Use of protocols meeting these criteria are
encouraged by the American College of Chest Physicians.
*Accepted
by the Respiratory Care Section Steering Committee, Chicago, Illinois,
10/27/92
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