The Science Journal of the American Association for Respiratory Care

2001 OPEN FORUM Abstracts

RESULTS OF USE ANDMODIFICATION OF THERAPIST DRIVEN PROTOCOLS RELATIVE TO STAFFING, COMPLIANCEWITH PROTOCOLS, AND MODALITY UTILIZATION.

Michael S. Powers,BS, RRT; John W. Farnham, RRT. University of Tennessee Medical Center, 1924Alcoa Highway, Knoxville, TN 37920.

Background:The history of therapist driven protocols (TDP) for the delivery of respiratorytreatment modalities and of problems associated with inappropriate utilizationhas been documented in the literature. Our institution first began using TDPto ensure appropriate utilization in 1998. Though accepted well by physicians,quality monitors showed low compliance by respiratory care (RC) staff, a lowerthan expected degree of modality changes, and some increase in treatment load.We analyzed those variances, took corrective actions (including implementationof respiratory severity scoring tool, staff re-education, and a standardizedprogress note), and analyzed the results of those actions. Our analysis consistedof spreadsheet comparison of key indicator procedures, staffing patterns, andtreatment omissions because of lack of therapist time (LOT) to perform the procedure(s).Additionally, we continued quality monitors of compliance with TDPs.

Results: Comparisonof key indicators after implementation of modifications to TDPs was encouraging.The comparisons of pre-modification versus post-modification within the samecalendar year revealed a decrease in small volume nebulizer treatments of 2%,a decrease in intermittent positive pressure breathing treatments by 9%, anincrease of metered dose inhaler usage of 529%. Further, there was a 94% decreasein the number of procedures omitted for LOT. Current year to date data representcontinued momentum demonstrated by reductions of overall monitored proceduresof 14.65%. During the same time period following modification of TDPs and theirapplication, the department experienced a manpower decrease of 8.1 Full TimeEquivalents. Workload indicated levels of staffing are now consistently beingmet.

Experience: Theauthors? combined experience includes the initial research into the need forintroduction of TDPs, writing and development of protocols adapted specificallyfor our institution, analyzing performance, and development of modificationsin TDP application.

Conclusions: Useof TDPs can have a positive impact on appropriateness and numbers of procedures.Physician buy-in, RCP compliance, continuing re-education, and ongoing analysisleading to any indicated TDP modification are all essential to the success ofTDPs.

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