1996 OPEN FORUM Abstracts
PATIENT CARE TECHNICIANS' PERFORMANCE IN ADMINISTERING INCENTIVE SPIROMETRY FOLLOW-UP.
Irene Michnicki RRT, Lucy Kester MBA RRT, Shannon Jarancik BS RRT, Marianne Potts RRT, Andy Young RRT, James K. Stoller MD, The Cleveland Clinic Foundation, Cleveland, Ohio
Background: Patients care technicians (PCTs) are health care extenders who perform simple patient care tasks as members of work-redesign or patient-focused care teams. Since January 1995, pilot studies of work-redesign have been undertaken at the Cleveland Clinic Foundation with PCTs assuming simple respiratory care tasks such as patient follow-up visits to assure compliance and correct use of incentive spirometers. As part of their multi-task training, PCTs undergo a six hour course on respiratory care topics (including incentive spirometry) administered by respiratory therapists. Back-demonstration of appropriate incentive spirometry (IS) technique was required for successful course completion. Methods: To evaluate PCTs' performance in conducting incentive spirometry follow-up and to compare their performance with respiratory therapists, random spot check audits were implemented. Using a check list of 5 steps deemed necessary to correctly conduct an IS follow-up (Was the patient instructed to: 1. Inhale slowly? 2. Keep indicator between arrows? 3. Raise the blue float as far as possible? 4. Repeat maneuver at least 10 times? 5. Use the incentive spirometer every hour while awake?), respiratory therapist auditors observed 16 PCTs and 16 respiratory therapists as they performed IS follow-ups. Auditees were unaware of the specific study goal and were rated on the number of items (of 5 total) that were correctly performed. Results: Of a maximum of 80 correct items, PCTs scored 45 (56% correct) vs 69 (86% correct) by therapists (p=0.007). Two of 16 PCTs (12.5%) achieved correct ratings on all 5 items vs. 9/16 (56%) of respiratory therapists. Conclusions: We conclude that: 1. Despite prior training, performance by PCTs in conducting incentive spirometry follow-up visits showed less proficiency than respiratory therapists. 2. Respiratory therapists' imperfect performance suggests the need for remedial training and emphasizes the importance of ongoing quality management in respiratory care. 3. Successful implementation of work-redesign programs will require increased attention to assuring patient care technicians' proficiency in performing patient care tasks.