Respiratory Care Protocols

• Respiratory care protocols are developed to enhance the allocation of respiratory care services and reduce misallocated care.
• Can show a decrease in the dollar amount of misallocated care.
• These protocols provide guidelines for appropriate treatments/services, often in outline or algorithm form.
• Well-trained respiratory therapists (RTs) use modalities, assessment, and communication skills to execute protocols effectively.
• Protocols may be written for individual therapies or for a specific purpose.

Key Elements of a Respiratory Care Protocol Program

• Requires strong and committed medical direction.
• Engaged therapists are essential.
• Requires active quality monitoring.
• A collaborative environment among RTs, MDs, and RNs is crucial.
• Responsiveness to address and correct problems is important.

Elements of Acceptable RT Protocol

• Clearly stated objectives are needed.
• Outline includes an algorithm.
• Description of alternatives at action points is included.
• Possible complications and corrections are described.
• End points and decision points for MD contact are defined.

Advantages of RT Protocols

• Better allocation of services without increasing treatment frequency is achieved.
• Cost savings are realized.
• Respiratory care becomes more dynamic.
• Services are adjusted to meet patient needs.
• Services are used more versatilely.

RT Consult Service

• A comprehensive approach for using protocols to evaluate and treat patients.
• The purpose is to evaluate and treat the patient according to established guidelines

Sequence of Events for a RT Consult Service

• MD orders protocol/consult.
• RN/unit secretary notifies the RT evaluator.
• RT assesses the patient according to guidelines.
• RT writes a care plan using indications and algorithms for MD review, and writes plan in the chart.
• RT delivers care.
• Patient status is assessed for changes, and modifications are documented.
• Physician is notified of patient deterioration.
• Treatment is discontinued when no longer needed, with notification in the chart.

Monitoring Quality RT Care

• Requires a quality assurance plan and a system for quality control.
• Involves continuous quality improvement (CQI) to detect/correct factors hindering quality and cost-effective healthcare.

Steps for a Quality Assurance Plan

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

Goals of a RT CQI Plan

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

Methods of Monitoring

• Audit system.
• Must have feedback.
• Case studies.
• Testing RTs.

S.O.A.P. Notes

• Subjective data.
• Objective data.
• Assessment notes.
• Plans.

Subjective Data

• Information from the patient, relatives, or similar sources.
• Example: "My chest hurts when I take a deep breath."

Objective Data

• Information from caregiver observations, physical exams, or diagnostic/lab tests.
• 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 arme, sitting position; body temperature 1010F; bronchial breath sounds in lower posterior lung fields; occasionally expectorating small volumes of mucopurulent sputum

Assessment

• Analysis of the patient’s problem.
• Example: Pneumonia continues

Plan

• Course of action to resolve the problem, including therapeutic, diagnostic, and educational components.
• 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 service allocation and reduce misallocation. They guide treatments and rely on skilled respiratory therapists. Key elements include medical direction, therapist engagement, quality monitoring, collaboration, and responsiveness.