The Science Journal of the American Association for Respiratory Care
Background: A study of the Patient Driven Protocol (PDP) and Respiratory Consult Service (RCS) was performed to determine its effectiveness in ensuring the delivery of appropriate therapy as defined by the AARC Clinical Practice Guidelines. PDPs were developed in 1995 and 1996 for the following modalities: Medicated Aerosol Therapy, Volume Expansion, and Chest Physiotherapy. Within 24 hours of the initiation of physician ordered therapy, a PDP Evaluator assesses the patient, using a symptom-based scoring tool, for appropriateness of therapy. Therapy may be continued as originally ordered or changed based on the PDP Evaluator's assessment. The RCS, implemented 12/97, gives physicians an option of directly consulting with a Respiratory Care Practitioner (RCP) regarding a patient's need for therapy. All therapy is reevaluated at least every 72 hours for appropriateness. The oxygen protocol, developed in 1995, enables RCPs to titrate supplemental O2 usage to maintain a patient's SpO2
Results: There were a total of 1,654 initial and 1,893 re-evaluations performed on 2,896 ordered therapies. The total number of patients qualified for the O2 protocol was 2,227. The PDP interventions resulted in a significant number of treatments (38%) and oxygen (71%) to be either changed or discontinued.
(FIG)=(See Original for Figure)
Experience: Since the inception of PDPs and the RCS, the delivery of inappropriate therapy has decreased while physician approval of the protocols and requests for RCs have increased. Conclusion: The number of changes made in treatments and oxygen therapy, in addition to feedback received from physicians, suggest PDPs have been successful in ensuring the appropriate delivery of respiratory therapy. A reduction in FTEs in Respiratory Services has not been realized; however, the decrease in the delivery of unnecessary therapy may have reduced cost by decreasing equipment, medication and oxygen usage. Additionally, because treatments are given to those patients who actually require them, the quality of patient care seems enhanced.