The Science Journal of the American Association for Respiratory Care

2007 OPEN FORUM Abstracts

ASSIMILATION OF GRADUATE RESPIRATORY THERAPISTS INTO PEDIATRIC CARE

D. Donelly1, P. Betit2

Background: The role of the respiratory therapist (RT) in our institution has been critical care including all aspects of mechanical ventilation and airway care. A minimum of one year of critical care experience has been a preferred requirement for employment, and therefore new graduates have not been considered. In 2003 a 12 bed Intermediate Care Program (ICP) was developed for the treatment of disorders that were too acute for general wards but not critical enough to warrant admission to ICUs1. The role of the RT in this setting includes administration of less invasive therapies such as aerosolized medication delivery, airway clearance techniques, and non-invasive ventilation. We considered the scope of practice in this new area to be more suitable for a Graduate Respiratory Therapist’s (GRTs) skill level, and speculated that a good foundation of pediatric respiratory care could be gained and subsequent orientation to an ICU accomplished.

Methods: In 2005 we expanded the recruitment pool to include GRTs primarily from 2-year AS degree programs. GRTs who were hired received a 4 week competency-based orientation to the ICP. Orientation consisted of a general hospital and department overview, basic respiratory care equipment training, didactics in asthma, bi-level ventilation, and respiratory assessments, and one-on-one instruction in the clinical setting. Once all competencies were completed RTs were solely assigned to the ICP. After the GRT demonstrated proficiency in the ICP, orientation to one of the ICUs was initiated, and following demonstrated proficiency training occurred in the remaining ICUs.

Results:
Since 10/05 15 GRTs have been employed of which 7 have assimilated to the ICU setting. The table describes the stages of orientation. Discussion: Using the ICP as an initial training arena for GRTs has been successful in providing an introduction to pediatrics and a transition for pediatric critical care. With the continued expansion of our ICUs, the general shortage of RTs, and the shortage of RTs with pediatric experience, the evaluation of traditional recruiting, hiring, and training practices is necessary.
1. Donelly D, Betit P, Agus M. Expanded RT role in a new step-up unit and the impact on ICU admissions in a children’s hospital. Respir Care 2004;49:1413.

ICP/ICU ORIENTATION
3 initial stages of ICP orientation
2 ICP proficient; solely assigned to the ICP
4 ICP proficient; in initial stages of ICU orientation
1 ICP proficient; oriented and assigned to 1 ICU
2 ICP proficient; oriented and assigned to 2 ICUs
1 ICP proficient; oriented and assigned to all ICUs
2 did not attain ICP proficiency; employment ended



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