Respiratory Care and Patient Ambulation

RT-108 BSRT-2A Objectives

• Define quality and patient safety
• Understand the importance of quality and patient safety
• Know how to safely move a patient
• Know different hazards and how to respond
• Understand record-keeping and its importance

Quality and Patient Safety

• Quality refers to the sum of a service's or product's properties that satisfy its consumer.
• High-quality services result in high demand and financial success for the provider.
• Patient safety is critical in respiratory care.
• Key safety risks include patient movement, electrical hazards, fire hazards, and general safety concerns.

Proper Lifting Technique and Patient Movement

• Basic Body Mechanics: Posture relates body parts to each other.
• Poor posture can cause stress on joints and tendons.
• Correct technique involves a straight spine and using leg muscles for lifting.
• Steps for proper lifting include: planning, a clear route, facing forward, keeping back straight, bending knees, appropriate footwear, good grip, keeping object close to body, and feet shoulder-width apart.
• Moving patients in bed: conscious patients assume comfortable positions; bedridden patients often assume an upright position; patients may need specific positions for procedures such as postural drainage.
• Ambulation: assists with maintaining normal body function; preventing complications like bedsores and atelectasis is important; patients should be evaluated to determine their stability level prior to ambulation.

Safe Patient Movement Steps

• Place the bed in a low position, lock the wheels.
• Place all equipment close to the patient to prevent dislodgment during movement.
• Assist patient to sitting position, supporting shoulders and armpits.
• Gently rotate patient to position for ambulation.
• Patients should remain in position until dizziness subsides.
• Encourage ease of breathing, and use minimal to moderate support while initiating ambulation.
• Restrict ambulation time for the first exercise (5-10 minutes).
• Monitor patient color, breathing, strength, and complaints during ambulation.
• Document the date, time, duration, and patient tolerance of the ambulation session.

Electrical Safety

• Electrical hazards, including shocks, exist in hospital settings due to electrical equipment.
• Invasive devices like internal catheters and pacemakers increase the potential for shock risk.
• All electrical equipment brought into patient care areas needs expert approval and regular checks.
• Electrical equipment should be connected to grounded outlets via three-wire cords.
• The third (ground) wire prevents voltage buildup.

Fire Safety

• Health care facilities experience significantly reduced fires due to education and strict fire codes.
• Hospital fires often start in kitchens.
• Hospital fires are often in areas using oxygen, making them intense, faster burning, and more difficult to extinguish
• Three conditions for fire: flammable material, oxygen, and heat.
• Fire extinguishers use acronym PASS: pull, aim, squeeze, sweep.
• RACE is a core fire plan acronym for response: Rescue, Alarm, Contain, Evacuate
• RTs play a crucial role in hospital fire safety: shut off oxygen, evacuate patients, and treat smoke inhalation victims.

Medical Gas Cylinders

• Compressed gas cylinders used in respiratory therapy require special storage and handling methods.
• Improper storage/handling increases the risk of fire, explosive releases, and toxic effects.
• Cylinders must be stored on appropriate racks or chained containers and without support.

Record-Keeping

• Electronic health records (EHR) changes the way care is documented but overall content remains the same.
• Patient records provide a snapshot of events and situations during patient stay.
• Records are considered property of institutions, strictly confidential, and legal documents.
• Accurate charting throughout a patient's stay in the health care institute is essential, whether for documentation purposes, or legal reasons.
• Charting should be relevant, meaningful and for use for days, months, or years to come.

Components of a Traditional Medical Record

• Healthcare facilities have their own specific medical record keeping standards.
• Records in acute care settings have similar sections.
• Documentation sheets are designed to be brief and decrease time spent on documentation.
• Entries include measurements allowing tracking of trends in patient status

General Sections in a Patient Medical Record

• Details like admission data, history and physical exams, immunizations, physician orders, progress notes, nurses' notes, medication records, allergies, and vital signs are included.
• Additional details such as I/O sheets, laboratory results, consultation notes, surgical or treatment consent forms, anesthesia & surgical records, specialized therapy, specialized flow data, and advanced directives
• A detailed, current set of records is useful for a variety of future purposes

Legal Aspects of Recordkeeping

• Accurate documentation of patient care means that the care was or was not given.
• Records are legal documents that can be used to prove care was administered, or not
• Incomplete or absent records may lead to accusations of neglect.
• Records should reflect standards of care.

Practical Aspects of Recordkeeping

• Documentation is needed for treatments; procedures and activities should be charted in clear terms.
• Clarity and brevity in the record is essential, though, it is crucial to comprehensively document each encounter.
• Documentation of consultations must include date and time.
• Data should be within the professional domain.

General Rules

• Entries typically need to be printed or handwritten, though some facilities use an electronic format.
• Some facilities require supervisor review for student hand-written records
• Do not use ditto marks and avoid erasures.
• Record entry should follow specific time requirements, treatment specifics, complaints, behaviors, and avoid blank lines.
• Writing tasks should always use present tense, rather than future tense.
• Important and meaningful conversations should be recorded.

Problem-Oriented Medical Record (POMR)

• An alternative record-keeping format in some health care institutions.
• A POMR format consists of four primary parts: Database, Problem List, Plan, and Progress notes.
• Progress notes, which use the SOAP format, contain subjective information (obtained from the patient), objective information (observations of the patient), assessments (analyses of the patient's problem), and plans (actions to resolve the problem).

Additional Guidelines for Progress Notes Using the SOAP Format

• Subjective data is sourced from the patient, family, or similar people - objective data is based on observations, physical exams, or laboratory tests.