Respiratory Care Protocols

• Respiratory Care Protocols enhance the allocation of respiratory care services.
• Respiratory Care Protocols can show a financial loss due to misallocated care.
• Protocols are guidelines for delivering appropriate treatments/services.
• Respiratory Care Protocols are written in outline form or as an algorithm.
• Protocols are based on premise that well-trained RTs possess knowledge of modalities, assessment & communication skills to effectively execute protocols.
• Protocols can be written for individual therapies or for a specific purpose.

Key Elements of a Respiratory Care Protocol Program

• Strong & committed medical direction is needed.
• Engaged therapists are needed.
• Active quality monitoring is needed.
• Collaborative environment (RTs, MDs, RNs) is required.
• Responsiveness of all elements to address & correct problems is necessary.

Elements of Acceptable RT Protocol (ACCP)

• Clearly stated objectives are needed.
• The outline should include an algorithm.
• A description of alternatives at action points is required.
• A description of possible complications & how to correct them is needed.
• A description of end points & decision points where MD contact is needed.
• A Protocol program is necessary.

Advantages of RT Protocols

• Services are better allocated.
• There is no increase in treatment frequency.
• Protocols lead to cost-savings.
• Respiratory care becomes more dynamic.
• Services are adjusted to keep pace with patient needs.
• Services are used more versatilely.
• RT Consult Service uses a comprehensive approach for protocols.
• RT Consult evaluates & treats patients according to established guidelines.

Sequence of Events for a RT Consult Service

• MD writes order for protocol/consult.
• RN/unit secretary notifies RT evaluator.
• RT assesses patient according to guidelines.
• The RT writes a care plan using indications & algorithms, and writes the plan in the chart for MD review.
• RT covering unit delivers care.
• The patient is assessed for changes in status & modifications, which are documented.
• Notify physician of patient deterioration.
• Document treatment discontinuation when no longer needed.

Monitoring Quality RT Care

• JCAHO requires a quality assurance plan.
• Quality assurance plan provides a system for quality control.
• It requires efforts for continuous quality improvement (CQI).
• CQI is an ongoing process designed to detect/correct factors hindering provision of quality & cost-effective healthcare.

9 Steps for a Quality Assurance Plan

• ID problems
• Determine causes
• Rank problems
• Develop strategies to resolve problems
• Develop measurement techniques
• Implement problem-resolution strategies
• Analyze/compile results
• Report results
• Evaluate outcome of intervention

Goals of a RT CQI Plan (AARC)

• Provide a method for ongoing monitoring of quality/appropriateness of care
• Ensure cost-effective methods/procedures
• Ensure effective methods/procedures
• Identify problems, then rank and resolve pt care-related issues

Methods of Monitoring

• Audit system: feedback must be given.
• Case studies: A form of testing RTs to see how they are doing.

S.O.A.P Notes

• Subjective data
• Objective data
• Assessment notes
• Plans

Subjective Data

• Information obtained from the patient, his or her relatives, or a similar source
• Example: “My chest hurts when I take a deep breath"

Objective Data

• Information based on the caregivers’ observations of the patient, the physical exam, or diagnostic/lab tests (ABG, PFT, etc.)
• Example: Awake; alert; oriented to time, place, and person; sitting upright in bed with arms leaning over the bedside stand; pale, dry skin; respirations 26 breaths/min and shallow; pulse 98 beats/min, regular and faint to palpation; blood pressure 112/68 mm Hg, left arm, sitting position; body temperature 1010F; bronchial breath sounds in lower posterior lung fields; occasionally expectorating small volumes of mucopurulent sputum

Assessment

• An analysis of the patient's problem
• Example: Pneumonia continues

Plan

• Course of action to be taken to resolve the problem
• Example:
  • Therapeutic: Assist with coughing and deep breathing at least every 2 hours; postural drainage and percussion every 4 hours; assist with ambulation as per physician order and patient tolerance.
  • Diagnostic: Continue to monitor lung sounds before and after each treatment.
  • Education: Teach to cough and deep breathe and evaluate return demonstration.

Respiratory Care Protocols enhance the allocation of respiratory care services, but can show a financial loss due to misallocated care. Protocols are guidelines for delivering appropriate treatments/services. They are written in outline form or as an algorithm.