Respiratory Therapist-Driven Protocols

Transcription

1 A Higher Standard! Respiratory Therapist-Driven Protocols Therapist-Driven Protocols are changes made in therapy according to the patients clinical status ordered by the Respiratory Therapist (RCP). Clinical Protocols Therapist-Driven Protocols have made a large impact on Health Care by reducing cost and length of the patient stay in the hospital. A study published in Chest¹ from the American College of Chest Physicians has made some of the greatest strides in demonstrating the effectiveness of respiratory-driven protocols to physicians and other health care providers. 1

2 This study involved 694 consecutive hospitalized patients. The study found that the respiratory care managed by therapists through the use of protocols was safe and showed greater agreement with institutional treatment algorithms than physician-directed respiratory care. Furthermore, as the study indicates, The overall rate of discordant respiratory care orders and the number of discordant orders per patient were significantly less among patients receiving RCP-directed treatments as compared with patients receiving physician-directed respiratory care. The study went on to summarize, the use of RCP-directed treatment protocols decreased the overall use of respiratory care and decreased respiratory care charges without resulting in any detrimental clinical outcomes. Therapist follow these Protocols The Therapist Protocols cover Therapies such as patient assessment, chest physical therapy, bronchial hygiene, aerosolized medications, EZ-PAP, PEP Therapy, IPPB, oxygen, sputum induction, biphasic pressure ventilation, pulse oximetry, and weaning from ventilators including Open Heart! 2

3 Respiratory Therapist Actions The Respiratory Therapist upon seeing clinical changes in the patient will after assessment, place a sticker on the patients chart indicating the change made. The Therapist may not increase therapy or change any medication without a physician order. The Therapist may change the type of therapy given and reduce the physician ordered therapy with patient improvement of their clinical status according to Protocol. 3

4 Assess and Treat Protocols: The Next Wave Why do we need protocols? Misallocation of respiratory care Care given but not needed Care needed but not given Improve the quality of care The right care at the right time Decrease length of stay Improve outcomes Cut costs 4

5 Misallocation of Respiratory Care Summary of 7 Published Reports Oxygen therapy 28-72% of patients: O 2 therapy not needed. 8% - 21% of O 2 needed but not ordered or improper orders Incentive spirometry 20% - 55% not needed 4% needed but not ordered Misallocation of Respiratory Care Bronchodilator therapy 12% - 50% not needed 12% needed but not ordered IPPB 40% - 92% not needed 6.7% needed but not ordered Arterial blood gases 36% - 43% inappropriately ordered 5

6 Misallocation of Respiratory Care Bronchial hygiene/chest physiotherapy 32-61% not needed 8% needed but not ordered Totals 25% not needed 10.5% needed but not ordered Inappropriate care not acceptable in the current health care environment Misallocation of Respiratory Care Protocol based respiratory care reduced inappropriate care by: 60% - SVN, CPT (Ford et al.,) 61% - bronchial hygiene (Shapiro et al,) 58% - aerosol medications (Zibrak et al,) 92% - IPPB (Zibrak et al,) 55% - IS (Zibrak et al,) 57% - USN (Zibrak et al,) with no adverse outcomes due to protocols (Zibrak et al,) From 48% to 11% for basic care (Hart, et al,) 6

7 Respiratory Therapist Treatment Inappropriate ABG orders 3% for RT's 45% for others (Browning et. al,) Respiratory Therapist Treatment Percent of correct MDI use: MDs: 43% - 65% Nurses: 4-83% Respiratory therapists: 85.5% - 100% (Guidry, et al; Interiano, et al; Habania, et al) 7

8 References American College of Chest Physicians Egan s page: EzPap web pages PEP device web pages McPherson s Respiratory Care Equipment Sill s Respiratory care Registry guide Neil L. McCaskill RCP Manager, Internal Medicine, Pulmonary Services International Medical Center nmccaskill@imc.med.sa 8