2001 OPEN FORUM Abstracts
EXPANDEDROLE OF RCP?s IN PERI-ANESTHESIA CARE OF PATIENTS IN THE RAPID TREATMENT UNIT
MichellePorter, BA, RRT, Matt Peters, BSN; John Salyer, MBA, RRT, FAARC; QualityCare Assessment Team (QCAT). Respiratory Care Service, Outcomes Research Service,Rapid Treatment Unit. Primary Children?s Medical Center. Salt Lake City, UT.
Introduction:Cross training of RCP?s into non-traditional roles is increasing across thecountry. At our facility, several factors led to the development of the multidisciplinaryteam utilized to provide peri-anesthesia care (PAC) in our Rapid Treatment Unit(RTU). These factors included: 1) PAC was being done in many locations throughoutthe hospital by licensed independent practitioners, 2) there was variation inhow this care was administered including non-standardized dosing and inconsistentmonitoring, 3) many of these procedures were done in operating rooms which wereunder heavy scheduling pressure, 4) what was called ?conscious sedation?, wasdeep or level 1 anesthesia, 5) the RTU had space available for these proceduresdue to seasonal and daily patterns of utilization, and 6) the Quality ManagementDepartment identified this process as problematic and in need of redesign.
ProgramStructure: A multidisciplinary team was formed consisting of an anesthesiologist,RN and RCP to provide peri-anesthesia care in a non-operating room setting.Using the available space and resources in the RTU, patients from Hematologyand Oncology who were anxious about procedures received anesthesia for lumbarpunctures and bone marrow aspirates. As the service became established, otherdepartments utilized the RTU PAC service. Patients needing electro-musculargraphing and botulism toxin injections, minor plastic surgery, and steroid jointinjections used the service. The patients were selected using criteria suchas past medical history, previous reaction to anesthesia, or current illness.More complex or unstable patients were sent to the operating room for procedures.
Trainingand Team Composition: It was determined that RCP?s have the assessmentskills and training to evaluate and monitor these patients and thus would bean interchangeable part of this care team (with RN?s). Training and experiencerequirements included: 1) Member of the QCAT, 2) RRT with 6 months of PICU experience,3)Pediatric Advanced Life Support (PALS) certification and 4) Neonatal ResuscitationProgram (NRP). In addition the RCP?s are required to complete general pharmacology,fluid balance and electrolyte modules which were created by a team member forRCP?s from a nursing curriculum. The RCP must spend 3 shifts with the team formentoring. Some nurse managers expressed concern that RCP?s were not properlylicensed for such care. The Utah Respiratory Care Practice licensure act doesnot specifically limit what an RCP can do, except the administration of bloodproducts, as long as the RCP is acting under the direction of a physician.
Conclusion:By forming this team, we have effectively cross-trained an RT/RN team as interchangeablemembers in this setting as well as improved resource utilization. We speculatethere are several benefits such as 1) parents have better access to the patientsduring the peri-anesthesia period, 2) time in the hospital and cost are bothreduced, 3) scheduling difficulties in operating room is relieved, 4) standardof care is more consistent throughout the hospital for PAC, and 5) RTU resourcesare effectively used. We are currently building data systems to evaluate ourefficiency, in comparison to the OR. Recently acquired follow-up surveys showparents and patients are very satisfied with this service. RCPs are qualifiedto manage the airway, assess vital signs and perform nursing duties when trained.Although we have encountered challenges such as a need for more education andterritorial issues with recovery room nurses, it has been an eye opening, dooropening experience. This expanded role has been viewed as a positive step inprocess improvement in dealing with the variations in sedation/anesthesia practiceas well as increasing the value of the RCPs to the hospital.