RCP Ch. 2: Quality

• Quality is a characteristic that reflects a high degree of excellence, fineness, or grade.
• Quality is never an accident; it is always the result of intelligent effort.

Medical Director Responsibilities

• A medical director is responsible for the clinical function of the respiratory care department.
• They are typically a pulmonologist or anesthesiologist.
• They oversee general medical, surgical, and respiratory nursing wards.
• Also, the intensive care units, ambulatory care, pulmonary function laboratory, development of clinical policies, quality assurance activities, and respiratory care in-service.
• They also participate in the selection and promotion of technical staff and the preparation of the department budget.

Respiratory Therapists

• Training provides students with the ability to perform a task at a competent level, although clinical education is what gives a solid knowledge base.
• Equipment impacts the respiratory therapist's ability to provide the best possible care.
• Respiratory therapists are the primary source of quality care within the department.

Credentialing in Respiratory Care

• Quality respiratory care departments are staffed with respiratory therapists that hold appropriate credentials.
• Individuals must graduate from CoARC-approved educational programs to be eligible for credentialing.
• Graduates can then sit for the certification and registry exams that the NBRC (National Board for Respiratory Care) offers.
• The CoARC committee is sponsored by four organizations: AARC (American Association for Respiratory Care, ACCP(American College of Chest Physicians, ASA (American Society of Anesthesiologists, and ATS (American Thoracic Society).

Credentialing vs Licensure

• Credentialing is a general term for recognizing someone in a particular occupation or profession.
• Licensure is the process in which a government agency gives an individual permission to practice an occupation.

Professional Characteristics of a Respiratory Therapist

• Completing an accredited respiratory therapy program.
• Obtaining professional credentials.
• Participating in continuing education activities.
• Adhering to the code of ethics put forth by their institution and/or state licensing board.
• Joining professional organizations.

Technical Direction

• Quality respiratory care depends on strong leadership.
• The department manager usually provides the technical direction.
• This includes overseeing the policies, procedures, an equipment that is used in order to provide safe and effective patient care.

Respiratory Care Protocols

• Enhance appropriate allocation of respiratory care services.
• They represent guidelines to deliver care only when indicated, by the correct method, and discontinued when no longer needed.
• Key elements include: strong medical direction, capable therapists, active quality monitoring, a collaborative environment among RTs, nurses, and physicians, and responsiveness of participants to address and correct problems.
• A typical sequence of events for a respiratory care consult starts with an order from a physician for a respiratory care protocol for consultation.
• A nursing unit secretary notifies an RT evaluator who then assesses the patient using specific guidelines.
• The evaluator writes a care plan with indications and algorithms and documents it in the patient's chart for review.
• The RT then delivers the care, and they assess the patient shift-by-shift, documenting any modifications to plan.
• The physician is notified of any deterioration in the patient's condition.
• When indications for respiratory care no longer exist, it will be discontinued, and notification will be placed in patient's chart.

Monitoring Quality Respiratory Care

• After all the elements are in place, quality respiratory care is maintained by monitoring.
• Voluntary accreditation is one method to monitor the quality of care.
• Accreditation by The Joint Commission is most important.
• The current joint commission standards call for continuous quality improvement (CQI).
• CQI detects and corrects factors that are hindering quality care.
• The AARC has developed four goals should be included in the CQI plan.
• The federal government has peer review organizations(PROs) . These PROs evaluate the quantity of care given to medicare beneficiaries.
• PROs evaluate care provided to individuals in real time to ensure compliance with federal guidelines.

Hospital Restructuring and Redesign

• Tries to provide more patient care with less overhead.
• This is done by cross-training employees using unlicensed assistive staff, training multi-skilled assistive personnel to perform basic patient care, downsizing and decentralizing high-budget labor-intensive units, and deploying RT's to individual nursing units

Disease Management

• Delivering care to manage patients with chronic diseases to improve outcomes and reduce costs.
• Disease Management Programs comprise integrated healthcare systems.
• Also; comprehensive knowledge of prevention, diagnosis, and treatment, clinical and administrative information systems, and commitment to continuous quality improvement.
• Disease management programs may be developed for patients with asthma, diabetes, COPD, or congestive heart failure.

Evidence-Based Medicine

• An important concept regarding quality respiratory care.
• Determining optimal clinical management is based on evidence found in the scientific literature.
• The Clinical Practice Guidelines produced by the AARC provide recommendations based on an expert review of the evidence.

Quality is a characteristic of excellence resulting from intelligent effort. A medical director oversees the respiratory care department's clinical functions, often a pulmonologist or anesthesiologist. They manage various units and labs, develop policies, and participate in staff selection and budgeting.