RESPIRATORY THERAPY. STUDENT HANDBOOK (Revised December 2011) All academic policies apply to all students and faculty regardless of program location.

RESPIRATORY THERAPY STUDENT HANDBOOK (Revised December 2011) All academic policies apply to all students and faculty regardless of program location.

2 TABLE OF CONTENTS PROGRAM INFORMATION... 4 PROGRAM GOAL... 4 PROGRAM OBJECTIVES... 4 PROGRAM STATISTICS... 4 RESPIRATORY CARE TECHNICAL STANDARDS... 5 AARC... 7 CODE OF ETHICS... 7 AARC... 8 ROLE MODEL STATEMENT RESPIRATORY CARE PRACTITIONERS... 8 PROGRAM POLICIES & PROCEDURES... 9 TRANSPORTATION AND PARKING REGULATIONS... 9 TUTORING... 10 ORAL EXAMINATION POLICY... 10 PHYSICAL EXAMINATION POLICY... 11 READING ASSIGNMENTS/HOMEWORK... 11 REMEDIATION... 11 STUDENT ADVISING... 11 GRADING/SATISFACTORY PROGRESS POLICY... 12 ABSENCE REPORTING POLICY... 13 STANDARDS FOR EXIT FROM RESPIRATORY THERAPY PROGRAM... 14 STATEMENT OF COMMITMENT TO PROGRAM COMPLETION... 15 STATEMENT OF RECEIPT OF RESPIRATORY THERAPY STUDENT HANDBOOK... 16 CLINICAL EDUCATION... 17 ETHICS AND PROFESSIONALISM... 17 Class Outline... 17 Professional Etiquette for Hospital Clincials... 20 Ethics and Professionalism in the Clinical Setting... 21 TIME CARD (STUDENT CLINICAL ATTENDANCE SHEETS)... 22 CLINICAL POLICIES AND PROCEDURES... 23 Assigned Clinical Hours... 23 Clinical Tardy/ Absence... 23 Time Cards... 23 Dress Code (Clinic)... 23 Clinical Competency Manuals... 23 Supervision in the Clinical Setting... 24 CLINICAL ROTATION ORIENTATION CHECKLIST... 25 CLINICAL EVALUATION PROCEDURES... 26 WEEKLY STUDENT CLINICAL PERFORMANCE EVALUATION... 28 Procedure: Weekly Student Clinical Performance Evaluation... 29 CLINICAL CHART EXAM... 30 PHYSICIAN CONTACT LOG... 32 CLINICAL COMPETENCIES CHECK OFF FORM... 34

3 CLINICAL CONDUCT... 36 CLINICAL ROTATION "DO / DON'T" LIST... 37 OSHA CLINICAL ORIENTATION HANDBOOK... 38 HIPPA TRAINING... 39 UNIVERSAL PRECAUTIONS... 40 CAMPUS SPECIFIC DOCUMENTS... 41

4 PROGRAM INFORMATION Program Goal To prepare graduates with demonstrated competence in the cognitive (knowledge) psychomotor (skills), and affective (behavior) learning domains of respiratory care practice as performed by registered respiratory therapist (RRTS). Graduates of this program will be eligible to sit for the Certified Respiratory Therapist (CRT) and Registered Respiratory Therapist (RRT) examinations of the National Board for Respiratory Care. Program Objectives 1. To provide a learning environment which correlates well with the actual workplace; 2. To provide clinical experience which correlates with classroom instruction; 3. To instill in the student a sense of professional behavior, attitude and dress consistent with medical standards; 4. Will provide the student with entry-level knowledge and skills in the field of respiratory care; 5. Will prepare the students for advanced level competency as Respiratory Therapists; 6. Will supply competent Respiratory Therapists to the national work pool. Program Statistics Information regarding the program s statistics including, but not limited to admissions, student retention rates, graduation rates, national board passing rates, and employment rates can be obtained by contacting the Program Director, Campus President or Academic Dean. Programmatic outcomes data statistics may be accessed by clicking on the direct CoARC link found within the Concorde website -Respiratory Therapy page.

5 Respiratory Care Technical Standards These technical standards represent the non-academic demands associated with the respiratory care discipline. The standards result from information obtained from industry sources, instructional faculty, and published occupational references. Successful program completion is, in part, contingent upon students' ability to meet the physical and cognitive demands represented by these standards. General Job Description: Utilizes the application of scientific principles for the identification, prevention, remediation, research, and rehabilitation of acute or chronic cardiopulmonary dysfunction thereby producing optimum health and function. Reviews existing data, collects additional data, and recommends obtaining data to evaluate the respiratory status of patients, develop the respiratory care plan, and determine the appropriateness of the prescribed therapy. Initiates, conducts, and modifies prescribed therapeutic and diagnostic procedures such as: administering medical gases, resuscitation; providing support services to mechanically ventilated patients; maintaining artificial and natural airways; performing pulmonary function testing, hemodynamic monitoring and other physiologic monitoring; collecting specimens of blood and other materials. Documents necessary information in the patient's medical record and on other forms, and communicates that information to members of the health care team. Obtains, assembles, calibrates, and checks necessary equipment. Uses problem solving to identify and correct malfunctions of respiratory care equipment. Demonstrates appropriate interpersonal skills to work productively with culturally diverse patients of all ages, families, staff, and co-workers. Accepts directives, maintains confidentiality, does not discriminate, and upholds the ethical standards of the profession. Physical Standards: Lift/carry objects weighing up to 40 lbs; assist moving or repositioning patients weighing in excess of 300 lbs (with or without assistance) Stand/walk for prolonged periods of time. Walking on hard surfaces and climbing stairs. Bend and twist for prolonged periods of time (involved with nearly every task). Kneel, stoop, and crouch when performing such tasks as adjusting equipment, plugging in electrical equipment, or performing CPR. Push/pull large wheeled equipment (such as beds/ventilators) weighing in excess of 200 lbs. Manual dexterity sufficient to manipulate patients and equipment; grasp syringes, laryngoscopes, and endotracheal tubes; handle small and large equipment for storing, retrieving, and moving; manipulate knobs and dials; and assemble, disassemble, correct malfunctions, perform maintenance and evaluate various pieces of medical equipment

6 Ability to hear verbal instructions, hear gas flow through equipment, and perceive warning signals. Visual acuity sufficient to read typed, handwritten, or computer information; see patient conditions such as skin color, work of breathing, and mist flowing through the tubing; and accurately read gauges, dial settings, and digital and analog displays Tolerance to a clinical environment that may include noisy and/or crowded conditions, sterile surroundings, exposure to blood-borne pathogens, and exposure to chemicals/solvents. Cognitive and Behavioral Standards: Calculate, analyze, interpret, and record numbers and physical data accurately from observation, charts, radiology screens, and computer information systems Apply theory to clinical practice, maintaining competence under challenging and sometimes stressful situations Communicate effectively, utilizing written and spoken English when interacting with patients, their families, and other health care professionals Interact professionally and effectively with patients, families, and coworkers as a health care team member Carry out orders accurately and in a timely manner Function safely, effectively, and calmly under stressful situations Prioritize effectively and maintain composure while managing multiple tasks Accept and apply constructive criticism Maintain a positive and constructive manner with peers, coworkers, and instructors Persons with Disabilities: As outlined in the school Catalog.

7 AARC Code of Ethics As health care professionals engaged in the performance of respiratory care, respiratory care practitioners must strive, both individually and collectively, to maintain the highest personal and professional standards. The principles set forth in this document define the basic ethical and moral standards to which each member of the American Association for Respiratory Care should conform. The respiratory care practitioner shall practice medically acceptable methods of treatment and shall not endeavor to practice beyond his or her competence and the authority given by the physician. The respiratory care practitioner shall continually strive to increase and improve knowledge and skill and render to each patient full measure of his or her ability. All services shall be provided with respect for the dignity of the patient, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems. The respiratory care practitioner shall be responsible for the competent and efficient performance of the assigned duties and shall expose incompetence and illegal or unethical conduct of members of the profession. The respiratory care practitioner shall hold in strict confidence all privileged information concerning the patient and refer all inquiries to the physician in charge of the patient s medical care. The respiratory care practitioner shall not accept gratuities for preferential consideration of the patient and shall guard against conflicts of interest. The respiratory care practitioner should uphold the dignity and honor of the profession and abide by its ethical principles. The practitioner should be familiar with existing state and federal laws governing the practice of respiratory care and comply with those laws. The respiratory care practitioner shall cooperate with other health care professionals and participate in activities to promote community and national efforts to meet the health needs of the public. American Association for Respiratory Care 9425 N. MacArthur Blvd. Suite 100, Irving, TX 75063-4706

8 AARC Role Model Statement - Respiratory Care Practitioners As health care professionals engaged in the performance of cardiopulmonary care, the practitioners of this profession must strive to maintain the highest personal and professional standards. A most important standard in the profession is for the practitioner to serve as a role model in matters concerning health. In addition to upholding the code of ethics of this profession by continually striving to render the highest quality of patient care possible, the respiratory care practitioner shall serve as a leader and advocate of public respiratory health. The respiratory care practitioner shall participate in activities leading to awareness of the causes and prevention of pulmonary disease and the problems associated with the cardiopulmonary system. The respiratory care practitioner shall support the development and promotion of pulmonary disease awareness programs, to include smoking cessation programs, pulmonary function screenings, air pollution monitoring, allergy warnings, and other public education programs. The respiratory care practitioner shall support research in all areas where efforts could promote health and could prevent disease. The respiratory care practitioner shall provide leadership in determining health promotion and disease prevention activities for students, faculty, practitioners, patients, and the general public. The respiratory care practitioner shall serve as a physical example of cardiopulmonary health by abstaining from tobacco use and shall make a special personal effort to eliminate smoking and the use of other tobacco products from the home and work environment. The respiratory care practitioner shall strive to be a model for all members of the health care team by demonstrating responsibility and cooperating with other health care professionals to meet the health needs of the public. American Association for Respiratory Care 9425 N. MacArthur Blvd. Suite 100, Irving, TX 75063-4706

9 PROGRAM POLICIES & PROCEDURES Transportation and Parking Regulations It is expected that you will have reliable transportation for your use during the program. You may be assigned a Clinical some distance from your home and the Campus. Therefore you must have reliable transportation. While public transportation is available, schedules may not always match your educational needs, so a car would be the most likely, and reliable form of transportation. In the interests of cleaner air, we recommend that you car pool with your colleagues whenever possible to both school and clinical facilities. The following information relates to parking at the school and at your clinical facilities: 1. Please arrive early enough to your class or clinical to get a parking space. Lack of parking space is not a valid excuse for lateness to class or clinical. 2. Do not park your vehicle in such a way as to block other vehicles. Illegally parked vehicles may be ticketed and towed away. 3. Park only in valid and appropriate parking lots or areas. These will be pointed out to you upon your acceptance in the program. Adherence to all parking rules is expected as professional behavior and as common courtesy to the school s faculty and the other businesses in the area. 4. Some hospital clinical facilities have parking set aside for employees and students. You must determine if this is the case at that particular hospital before the first day at the site. Please have some money with you to cover possible parking fees at the hospital. 5. Some hospital clinical facilities may provide parking for your use during your rotation there. Their permits are on loan to you, and must be returned upon demand of the school or the hospital.

10 Tutoring If a student scores less than 75% on an exam, they are to ask their instructor for their review assignment. The review assignment is to be completed during the tutoring session for that test. Upon successful completion of the review assignment and attendance at the review session, the student will be allowed to retest the material for a maximum score of 75% the following day. Retest must be completed by the 5 th day after the original test. If the test is not completed the student will receive their original test score for averaging the final grade. Only re-testers may attend the day of retesting. There are tutoring sessions available to ALL RT students. Additional tutoring is available upon request. Please speak with the Program Director if additional tutoring is needed. It is the policy of the respiratory therapy department to mandate attendance at tutorial sessions for the following students: 1. Students who request extra help. 2. Any student who scores below 75% on any examination. 3. Any student who has been identified as weak in any previous area of training during a classroom session or clinical visit. 4. Students who are assigned by the Program Director, Director of Clinical Education, or any instructor for extra help. Oral Examination Policy As part of your Respiratory Therapy Program, it is necessary to demonstrate oral communication skills that ensure your ability to communicate at a safe and appropriate level. Oral examinations will be given through out your training in the Respiratory Therapy Program. These examinations will be graded by comparing the total number of correct answers to the number of questions asked. A score of 75% is set as the minimum standard for passing. Failure to achieve or exceed this requirement may cause a delay in your progress through this course. You will be given an additional chance to repeat any oral exam failure if it results in course failure.

11 Physical Examination Policy In order to be prepared to function in the clinical setting, the student must have a current physical (within past 12 months) on file with the Program Director. The physical must consist of a tuberculin skin test, Rubella titer and a hepatitis B vaccination series (students must sign a waiver if they choose not to have this series). We recommend that each student have all immunizations current. You may have this done by your personal physician. If any clinical affiliate requires testing or immunization other than what is on file at the school, it will be the responsibility of the student to provide for this. Reading Assignments/Homework It is a requirement of the RT program that all students are assigned to write 10 questions and answer cards from each daily reading assignment. The questions are to be referenced to the content Matrix from the NBRC and the answers are to be referenced by the book, page and paragraph number used for the answer. The question and answer should be on opposite sides of a 3 x 5 note card. The student s name and the date need to be included on each card. Any reading assignments from the textbooks that have a workbook are to include the completion of the workbook section on the same topic as the reading assignment. All assignments made during a term MUST be completed by the end of the term for a student to progress into the next term. This may require students that pass the term final to come in for the P&R session between terms to complete the incomplete assignments. Remediation Policies regarding remediation are found within each of the course syllabi distributed at the start of each course. Student Advising All program faculty, including the Program Director and Director of Clinical Education, are readily available for assistance and counseling on any student academic concerns or problems. Student Services is available to assist with any non-academic issues. See catalog for full description of Student Advising and Student Services.

12 Grading/Satisfactory Progress Policy Unit test failures will result in remedial assignments, retesting, and mandatory attendance at "practice and review" sessions until competency is demonstrated. A retest score will only raise the Unit Test grade to maximum of 75%. Final Exam/Lab Practicum failures will result in remedial assignments, retesting, and mandatory attendance at "practice and review" sessions until remediation is complete or until 5 days after the final exam All students are required to pass the current term in order to advance to the next term. The student will be allowed to remediate up to the day before a new term starts or 5 days after the end of term, whichever is shorter. If the term is not remediated the student will not be allowed to progress in the program and will be withdrawn or set back on a space available basis. Failed tests may be retaken within 5 days or the day before the start of the next term, whichever is shorter. At no time will a student be allowed to retake any test more than twice. Any absence on test day will result in a 0% for that test, unless appropriate documentation is provided. A passing score on the final exam is required to advance to the next term. Final exams may also be remediated under the same policy (within 5 days of test date or by the day before the start of a new term, whichever is shorter). All tests, quizzes, and assignments are graded on the basis of percentages: A = 90% - 100% B = 80% - 89% C = 75% - 79% D = 74% - 60% F = 59% - 0% To pass any term all students are required to receive a 75% or higher theory and lab grade and a pass rating on all clinical objectives for that course. Students are required to pass the secured written registry final in RT250, practicum and oral examinations to graduate the program. Any person who is unsuccessful on the final examinations will have up to the day before a new term start to remediate the low test scores. If still unsuccessful the student must repeat the final term. To maintain satisfactory academic progress, credit hours attempted cannot exceed 1.5 times the credit hours the program requires for graduation. Student Signature Date

13 Absence Reporting Policy Students may miss no more than 10% of the total scheduled class time per term, including classroom, lab and clinical hours. Any student whose absences exceed 10% of scheduled class time will be placed on Attendance Probation. For an explanation of Attendance Probation, see the school Catalog. Departmental policy requires students to call into the school and the clinical site when they will be late or absent. For class days, it is necessary for you to contact the Program Director by calling the school and asking to speak with them. For clinical days, it is necessary for you to contact the clinical site and then the Director of Clinical Education (DCE). The student is to call the school at least an hour before their scheduled shift and leave a message on the DCE s voicemail that the student will not be at site. For the clinical site, a student needs to contact the department supervisor (or their designee in the department) at least an hour before their scheduled shift. A student should not leave a voice mail message at the clinical site; they need to speak to a real person. This policy is designed to promote professionalism and to protect you from accruing absences by accident. This information is also necessary so that we can inform the clinical instructor of any absences, so they do not drive to a clinical site where there are no students in attendance. Thank you for your adherence to this policy. Student Signature Date

14 Standards for Exit from Respiratory Therapy Program The following list of standards must be completed before the student will be granted a diploma: 1. Passing grades of all RT courses 2. All homework assignments must be completed 3. Clinical competency manual must be completed with objective verification form turned in and signed by instructor 4. All written agreements and standards set by any instructor and approved by program director must be completed as agreed upon 5. Clinical evaluations must be completed 6. Passing score on the NBRC secure RRT written exam in RT250, practicum and oral final exams Student Signature Date Instructor Signature Your current status is: 1. You have completed the above standards and may receive your diploma. 2. You have not completed the above standards and must contact the program director immediately. 3. You have not completed the above standards and are being withdrawn effective. Program Director Signature Director of Clinical Education Signature

15 Statement of Commitment to Program Completion I have read the accompanying information about the Respiratory Therapy Program at Concorde Career Institute, and have had the opportunity to discuss this information with my instructor. I am also aware that a Respiratory Care Practitioners credential may not be granted to me if I have been convicted of a crime. Any petitions to the appropriate boards under these conditions are to be filed on my own. I do understand that I will not be able to work in the state without a license and a credential. With my signature below, I herewith make a commitment to this school, my instructors, the medical profession, and myself to devote the attention and efforts necessary to complete this course of study, and to take and pass the appropriate respiratory care practitioner examination. Student Name (printed) Student Signature Date Class Start Date

16 Statement of Receipt of Respiratory Therapy Student Handbook My signature below signifies that I have received the respiratory therapy student handbook. I understand that I must read and bring this policy booklet to class the first day. At that time you will have the opportunity to discuss the policies in this handout. Additionally, other sheets will be detached, signed, and turned in from this booklet on that day. Student Signature Date Concorde Representative

17 CLINICAL EDUCATION Ethics and Professionalism Class Outline Goal: The goal of this class is to familiarize the student with school clinical policies and to enlighten the student on some of the attitudes and conducts that do and do not constitute professional behavior. Objectives: The student will: 1. Have knowledge and understanding of school clinical policies including attendance and the correct time card procedure 2. Maintain realistic expectations of clinical sites. 3. Recognize the role of Supervisors and Department Head. 4. Recognize the role of Nursing. 5. Recognize their role as they relate to other health care professionals. 6. Have an awareness that respiratory therapists perform a service. 7. Portray a willingness to work both in their attitude and demeanor. 8. Portray an eagerness to learn. 9. Have an awareness of the image portrayed by their manner of dress. 10. Understand what is ethical in practice and attitude.

18 A. School Policies 1. Competency Manuals and usage 2. Timecards a. Record time on a daily basis only b. Signed only by therapist designated to do so c. Incorrect times or signature may cause dismissal d. Failure to turn in timecard to classroom instructor on class day will result in clinical suspension 3. Clinical Policies and Procedures 4. Clinical Competencies Form 5. Clinical Behavioral Objectives 6. Clinical Rotation Orientation Checklist 7. Clinical Evaluation Procedures 8. Clinical Homework 9. Clinical Chart Exam 10. Physician Contact Form 11. Clinical Rotation Do/Don't List 12. Dress code 13. Chain of command 14. Clinical attendance policy 15. Communicating Clinical absence 16. Clinical absence policy 17. Clinical Conduct 18. Probation notice

19 B. Realistic expectations 1. What is seen at one site versus another site 2. First rotation versus second and third rotation C. Supervisors & Department Heads 1. Refer to chain of command, recognizing that the supervisors and directors have the right to dismiss from their site any student they deem unprofessional for any reason. 2. Relationship to future employment D. Nursing 1. Value to the Hospital 2. Political power E. Ancillary Services and RCP's 1. Importance to the Hospital 2. Expectations F. Respiratory Care as a Service 1. RCP's are in the clinical site to care for very sick people. The patients are not always pleasant. The work is not always pleasant. It is the responsibility of the RCP to appear always pleasant. G. Willingness to work 1. Site expectations H. Eagerness to learn 1. Site expectations. I. Manner of dress 1. How you dress can affect perception of individual as a potential employee J. Ethical practice & attitude 1. Open discussion on what is ethical or unethical behavior

20 Professional Etiquette for Hospital Clinicals 1. Avoid heavy perfumes and after-shaves. The scent can sometimes be offensive to patients. 2. Avoid excessive jewelry; germs love to hide under rings. This is not only for your protection and the patient, but for your family also. 3. Avoid interdepartmental conflicts. 4. Avoid discussing your personal life, with patients or staff 5. Be neat, clean, and courteous at all times. Make sure you abide by the hospital's dress code. 6. Be on time, call each day that you can't make it or if you will be late. Remember your clinical station may by your future employment. 7. Read the patient's chart that you are treating. The clinical instructor assigned to you will be asking for the diagnosis. 8. If you remove O 2 from a patient who is to have a treatment, make sure you place the O 2 back on the patient with the correct liter flow, then chart it. This is for your own protection. 9. Do not read any books other than respiratory therapy books during clinical hours. 10. Discuss problems and conflicts with the clinical instructor who visits your clinical site. 11. Always use proper hand washing techniques before and after therapy. 12. Always adhere to isolation technique procedures. 13. Record time on time card daily only. Card should be signed only by the therapist designated to do so. Time cards must be turned in to classroom instructor on class day or student will be suspended from clinical until it is received by the RT Department. Any card turned into the school that has incorrect times recorded or an incorrect signature may be grounds for dismissal from the program.

21 Ethics and Professionalism in the Clinical Setting It is very important that you understand your role in the clinic as a RCP student. You are in the clinical setting at the courtesy of the hospital. It is very important that you conduct yourself in a professional manner. It is very important that you understand that each clinical site has its own way of doing things and that it is not your job to judge. You may find that in the beginning of your rotation you may be left to read manuals, sit in the department or whatever. It is expected that you do this. Different clinical settings may have their own procedures as to how to introduce you to their facility. It is expected that you follow their procedure without complaint. This may be more apparent on your second rotation as your duties in the second clinical site will be more intense and the sites may be more concerned that you are fully oriented and understand exactly what is expected of you and what you are doing. What is professionalism? 1. Dress 2. Attitude 3. Willingness to work 4. Showing up consistently and on time and staying the entire shift 5. Communication with peers and staff 6. Handling conflicts in an adult manner and the ability to stay out of them 7. Eagerness to learn 8. Ethical practice and attitude. Remember, these sites may be your future employment. Please, treat them as such. Even if you are not employed by the clinics that you are rotated to, when you apply for employment these sites will probably be your references. How you conduct yourself in clinical will have a profound impact on your ability to find employment in Respiratory Therapy.

22 Time Card (Student Clinical Attendance Sheets) Respiratory Therapy Rotation Number Practitioner Record of Clinical Attendance 1 2 3 4 Student Name: Date Time Total Hours Monday In out Tuesday In out Wednesday In out Thursday In out Friday In out Saturday In out Faculty Authorization: Respiratory Therapy Rotation Number Practitioner Record of Clinical Attendance 1 2 3 4 Student Name: Date Time Total Hours Monday In out Tuesday In out Wednesday In out Thursday In out Friday In out Saturday In out Faculty Authorization: Week Number: Facility: Daily Preceptor Verification Week Total: Week Number: Facility: Daily Preceptor Verification Week Total:

23 Clinical Policies and Procedures Assigned Clinical Hours Students may not change assigned clinical hours without the permission of the Respiratory Therapy Director of Clinical Education. Clinical Tardy/ Absence Students who will be late or absent MUST phone the clinical site at least ONE hour BEFORE the start of the assigned shift. Students will also need to call the Director of Clinical Education to report an absence. Weekend shift absences (if applicable) must be called into Concorde on Monday morning. You are making TWO phone calls for each day you are absent. Time Cards Time cards must be signed by the supervisor or designee of the department you are assigned on a DAILY BASIS. Dress Code (Clinic) A supervisor of the assigned department must send students not in acceptable dress code and/or equipped with the required materials home. Dress code and required materials are: Apparel appropriate to the Respiratory Therapy Department dress code Stethoscope Clean, pressed white lab coat with school patch and name tag Clinical Competency Manual Time card Physician contact form Clinical chart exam form Watch with a second hand Clinical Competency Manuals Students must have clinical competency manuals with them in the clinical setting at ALL times. These manuals must be presented to the clinical instructor or preceptor/therapist for sign-off on competency procedures before being assigned any unsupervised modality in which the student has not proven competency. After the sign-off, the student may work with minimum supervision as designated by R.T. department protocol. Student competency manuals will be checked during each clinical instructor visit.

24 Supervision in the Clinical Setting Students are to follow policies and procedures in the clinical setting in accordance to the policies and procedures delineated by Concorde Career Institute and the clinic. There are a few things that students need to remember in regards to supervision and technical practices. 1. Students are NEVER permitted to perform arterial punctures without supervision. 2. Students must not monitor mechanically ventilated patients until RT230 and then only when the supervisor gives the OK. 3. Students shall not be used to substitute for clinical, instructional, or administrative staff. 4. Students shall not complete clinical coursework while in an employee status at a clinical affiliate. 5. Students shall not receive any form of remuneration or compensation in exchange for work they perform incident to their clinical education coursework and experiences. 6. Clinical chart exams, time cards, physician contact forms, and any and all homework are due at the beginning of each class.

25 Clinical Rotation Orientation Checklist The following objectives should be met during the first week at a new clinical site: 1. Locate all areas and services of the hospital. 2. Learn the phone and paging system. Practice paging and answering a page. 3. Know how a CODE is called and the procedure of response. 4. Know the procedure for all disaster drills. 5. Have staff introduce you to Nursing Supervisors, the Medical Director and other staff members. 6. Do a mini-inventory of stock areas to familiarize yourself with where to find supplies. 7. Locate and review the policy and procedure manual. 8. Locate all emergency resuscitation equipment in the hospital. 9. Know where the respiratory care medications are kept, how the hospital dilutes the medications, if the hospital used unit does medications, etc. 10. For home work: Make a list of the ventilators in the respiratory care department at the hospital and bring this list to class and hand in with your time card.

26 Clinical Evaluation Procedures The clinical portion of the Associate Degree in Respiratory Therapy is graded differently than the didactic portion. While you may always know the grade you are getting in the classroom, it will be difficult to say what grade you are getting in the clinical setting. The clinical portion of Concorde Career Institute Associate Degree in Respiratory Therapy is graded as Pass/Fail instead of by percentages (70%, 80%, etc.). You will be graded on how timely you complete your Lab Competency Manual. You will need to show proficiency in the clinical setting (Hospital) before your can be checked off in your comp manual. This means performing a task accurately, safely, and in a timely manner a few times before you ask your clinical instructor or preceptor to check you off. You will be observed until you are checked off in that particular modality. Most of Concorde Career Institute s clinical instructors inform the students when they are planning to visit the students next. Some instructors may have a preset schedule with you for instruction. It is your responsibility to be there when the instructor is there. Some instructors may ask you to come to the hospital early or stay late for clinical instruction. Be prepared. Many clinical instructors give homework in addition to what the classroom instructor does. Your clinical instructor will grade you during each clinical visit. If you are not at clinical when your instructor arrives to spend time with you, the instructor will not be able to assess your needs. If you are absent in clinical and call the hospital before your shift starts, but fail to call Concorde Career Institute, you will fail that clinical day. The Respiratory department at the hospital will evaluate you as well. In addition to the evaluation of your clinical skills, you are being graded on how you approach and treat the patient socially and professionally. You will be graded on time management, professional appearance, motivation, communication, as well as other areas. You will not be held accountable if your facility does not perform certain modalities. If you are unable to learn or perform certain Respiratory Care modalities during one rotation, work on those clinical competencies during the next rotations. Once you have completed a certain modality and have been checked off, you are still required to perform that modality until the end of your schooling.

27 Students are required to have meal breaks. At most hospitals it is one half-hour. Occasionally, even the brightest classroom student may need extra help or remediation clinically. This is true with many students in the last rotations because of the advanced life support situations encountered. You may be assigned to the clinical lab if additional help is needed. It is the student s responsibility to keep current on the clinical check-offs.

28 Weekly Student Clinical Performance Evaluation Clinical Instructor: Class Start Date: Clinical Rotation: Student Clinical Assignment Evaluate 1 2 3 4 5 Information Information Given Name: Site: Appearance Time spent with Time in: Out: Attitude student Hr Min Today s Date: Cooperation Is Student Clinical How does Student Courtesy Manual/ rate Objectives Current? Clinical Experience? Initiative Yes No 1 2 3 4 5 Professionalism Does Site continue to be Matrix Current? Effective & Appropriate? Yes No Yes No Due Date: Communication Work Ethic Clinical rotation provides adequate opportunity for physician/student contact: No What was the specific physician contact? Time Sheet Yes No Yes Questions asked/comments: Problems Noted & Action Taken: Student Signature:

29 Procedure: Weekly Student Clinical Performance Evaluation 1. The Clinical Director is to give every clinical instructor/preceptor a copy of the Weekly Student Clinical Evaluation and go over the procedure for completing the form - including Physician Contact 2. The instructor is to fill out the top portion of the form before the site visit. 3. During the weekly visits, CCC Clinical Instructors are to complete the information for each section based upon the observations and comments made during the visit. 4. Assignment given should reflect problem areas noted during the site visit. 5. Students should be instructed to seek out physician interaction whenever it is possible in order to learn appropriate physician-therapist rapport. The specific type of physician contact will be based off of the following criteria and recorded on the evaluation: Type A: Patient Focused Individual, personal interaction with a physician relating to the management of a particular patient as it pertains to respiratory care. Included are actual procedures with a patient (for example, code blue, bronchoscopy, etc.). Also included are such activities as evaluations, diagnosis, treatment plan and prognosis of a singular patient. The interaction may also include discussion of indications, contraindications and hazards associated with prescribed therapeutic procedures and medication for a singular patient. Type B: Tutorial Individual one on one instruction related to clinical medicine or other areas pertinent to respiratory care. Included are activities such as formal or informal discussions, review of research or recent advances in respiratory care and practical demonstration of procedures or equipment without patient interaction. Type C: Small Group Formal or informal presentation such as in-service, seminars, continuing education meetings, case presentations, physician s rounds, etc. It is necessary for the presentation to be small enough for physician conducting the session to be aware of who is in attendance. Type D: Large Group Formal educational experiences such as lectures or papers presented at professional meetings, conferences, seminars, etc. The size of the meeting would preclude significant audience participation. 6. When the form is completed, it is to be turned in to the Clinical Director for review. After review, the Clinical Director will return the form to the clinical instructor to verify assignments were completed and then file in the Class Book.

30 Clinical Chart Exam To be completed at clinical site and turned in with clinical homework and time card Name of Student Date Primary diagnosis of patient: Describe what this disease entails: Patient s history of this disease plus any previous history that would pertain to present diagnosis: Age, weight, height and physical assessment of patient: What are your patients major respiratory symptoms? How has each symptom been medically treated? What are the major drugs your patient is getting for this disease?

31 Describe the mode of action for the types of respiratory drugs your patient is on. Oxygen device? Total flow of this device. Approximate percentage? What are the x-ray results? What area of the lung is involved? Most recent blood gas results and interpretation. Prognosis or probable outcome of this hospital admission.

32 Physician Contact Log To be completed at clinical site and turned in with clinical homework and time card Name of Student Date Clinical Site Term Objective: To assure respiratory students learn to communicate and work with physicians in a confident, effective an professional manner. Special Procedures: Bronchoscopy Intubation Thoracentesis Chest tube insertion Observations: Surgery Autopsy Emergency Room Physician Rounds: Floor Critical Care In-service Presentations:

33 Classroom Presentations: Physician Lecture Case Studies Pulmonary Disease Reports Other: Do you feel your contact with physicians during this rotation met the objectives? yes no If no, please explain

34 Clinical Competencies Check-off Form (all competencies are required for graduation) Name: Class Start Date: Rotation Inst. Initial Met Name Page Hand washing 11 Isolation procedures 13 Vital Signs 29 Breath Sounds 31 Physical Assessment 45 Chest X-Ray Interpretation 67 Bedside PFT Testing 97 Basic Spirometry 99 ECG 113 ABG 139 Arterial Line Sampling 141 CVP and Pulmonary Artery Catheter Monitoring 161 Arterial Line monitoring 163 Pulse Oximeter 175 Transcutaneous Monitoring 177 End Tidal Monitoring 179 Documentation and Goals Assessment 191 O 2 Supply Systems 213 Liquid Oxygen Systems 215 O 2 Concentrators 217 O 2 Administration 237 MDI Administration 251 DPI Administration 253 Humidity & Aerosol Therapy 273 Small Volume Nebulizer Therapy 275 Patient Positioning 305 Chest Percussion and Postural Drainage 307 PEP Mask Therapy 309 Flutter Valve Therapy 311 HFCWO (The Vest Airway Clearance System) 313 Adjunctive Breathing Techniques 315 Incentive Spirometry 345

35 IPPB 347 Bronchoscopy Assisting 367 Equipment Processing 381 Manual Resuscitation 409 Intubation (Assisting) 411 Extubation 413 Nasaltracheal Suctioning 435 Endotracheal Suctioning 437 Monitoring Cuff Pressures 439 Tracheostomy & Stoma Care 441 43. Chest Tubes 451 44. NPPV 511 45. Initiation of CMV 575 46. Monitoring CMV 577 47. Changing Vent Circuits 579 48. Spontaneous Ventilation Parameters (Weaning) 625 49. PEEP 627 50.CPAP 629 51. IMV/SIMV 631 52. IMV/SIMV with CPAP (PEEP) 633 53. Pressure Support 635 54. Static & Dynamic Pressure Volume Curves 641 55.Wave form Analysis 655 Instructor Signature: Procedure: 1. Clinical Director is to give each student a copy of Competencies Check-Off Form during clinical orientation. 2. Student is to fill out name and class start date, and keep form with Competency Manual. 3. During weekly visits, Clinical Instructor is to verify completion of Competency Manual Performance Evaluation sheets. All verified competencies should be checked-off & initialed on Clinical Competency Form. 4. At end of final clinical rotation, the student is required to turn in completed competency form stapled to all the Performance Evaluation sheets from the Competency Manual. 5. Classroom Instructor is to sign bottom of competency form confirming that all competencies were successfully completed. 6. Competency form with completed performance evaluations sheets are to be turned in to the Director of Clinical Education.

36 Clinical Conduct We at Concorde Career Institute recognize our responsibility in teaching student s Respiratory Care and to help prepare them for the state licensure and the national board examination. We also recognize our responsibility to the health care profession and to the patients. It is, therefore, necessary to state the following policies: Students must be in school designated dress code at all times Students must bring their clinical/skills manual to the hospital Students must call the shift supervisor at least one hour before start of shift, if they are going to be absent or late, then call the Director of Clinical Education and let him\her know that you have called the clinical site and spoken with the supervisor. Students accruing in excess of two days absence will be terminated from their clinical site or at the discretion of the clinical site you may be removed at the first absence. Students accruing in excess of four tardies will be terminated from their clinical site. Students are considered tardy when they report for their shift TEN minutes or more late. Students are REQUIRED to notify the clinical site of any deviation from their set schedule. A NO CALL NO SHOW will be reason for an immediate termination from their clinical site. Students that are removed from a clinical site for any reason will be reassigned another clinical site if available, at the discretion of the Program Director and Director of Clinical Education. If a student is then removed from a second clinical site, this would be grounds for removal from the Respiratory Therapy Program. Sometime an alternate site is unavailable and the student can be with drawn from the RT program. Leaving a clinical site without giving report can be grounds for termination from the clinical site Students shall not be used to substitute for clinical, instructional, or administrative staff. Students shall not complete clinical coursework while in an employee status at a clinical affiliate. Students shall not receive any form of remuneration or compensation in exchange for work they perform incident to their clinical education coursework and experiences. Please recognize that professional behavior while performing patient care and while in the presence of other professional personnel is required. This is a place for you to learn skills of a Respiratory Care Practitioner. You are expected to show initiative and positive motivation to learn clinical skills and competencies during completion of assigned work as well as after all assigned work has been completed. Student Signature Clinical Site Supervisor Signature Clinical Site Date

37 Clinical Rotation "DO / DON'T" List The following procedures may be done without direct supervision after: Completion of the lab competency manual check-off by Instructor A staff therapist has signed off on the student performing the task successfully Approval of the staff therapist overseeing the student for that day DO: Set up any prescribed oxygen therapy (mask, cannula, aerosol, etc.). Analyze the FIO 2 as needed. Small volume nebulizer, IPPB therapy Stock Respiratory Care department and areas in the hospital where respiratory care supplies are kept Instruct/administer metered dose inhalers and incentive spirometery (SMI) Chest physiotherapy for all lung segments Oxygen rounds Cardiopulmonary resuscitation including chest compressions, bag mask ventilation, taping and securing endotracheal tubes Pulse oximetry continuous, spot check, ambulatory with and without oxygen Ultrasonic nebulizers Sputum inductions Equipment cleaning and sterilization Observe Bronchoscopy Observe Pulmonary Function testing Observe arterial puncture, hold the site post puncture Assist with extubation Chart any and all procedures: Bill the procedures performed if applicable DON T: Intubate Draw arterial blood gases prior to approval of the Director of Clinical Education or Program Director Provide patient care to CMV patient s prior to second Clinical Rotation. Carry code beepers or emergency room beepers. Students may carry back-up beepers only. Provide care to Intensive Care patients unsupervised CHANGE CLINICAL HOURS UNLESS APPROVED BY THE DIRECTOR OF CLINICAL EDUCATION

38 OSHA Clinical Orientation Handbook

39 HIPPA Training

40 Universal Precautions

41 Campus Specific Documents