The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts

CREATION, IMPLEMENTATION AND EVALUATION OF SECRETION CLEARANCE AND BRONCHODILATOR PROTOCOL.

Peter Saunders, Jeff Ford, Chris Kircher, Matt Davis, Rob Smith, Maria Madden, Hamid Reza, Marlin Martin, Gigi Coviello, Brenda Singer; Respiratory Care Services, University of Maryland Medical Center, Baltimore, MD

Background:Respiratory Care Services at the University of Maryland Medical Center were tasked to develop a protocol to evaluate patients needing secretion clearance and bronchodilator therapy. With a protocolized approach, the respiratory therapist would classify patients in such a manner that would assure necessary care was provided, a plan of care was developed and unnecessary treatments were alleviated. We constructed a scoring method that included patient history, chest x-ray, breath sounds and other indicators. The patients were scored and assigned a therapy level which included treatment modality and frequency. Knowing certain patient populations may require different strategies; therapies were tailored to either a spinal cord/neuro or a general ICU category. The original protocol order is initiated by a physician and the RT is able to modify that order with each re-evaluation. All scoring as well as charting for individual therapies are available to the healthcare team through the computerized flow sheet and are part of physician rounds. Method:The protocol was piloted in the Cardiothoracic ICU and the NeuroTrauma ICU. To evaluate therapist satisfaction with the protocol and their ability to work with the healthcare team to make changes to the plan of care, a 10 question survey was devised. The questions focused on the staffÂ’s opinions regarding secretion clearance and bronchodilation pre and post protocol implementation and overall therapist autonomy. Results:When asked if, prior to initiation of the protocol, there was a well communicated and coordinated approach to orders governing therapy, 65% responded that they disagreed and 21% were neutral. Regarding ease of ordering and modification, again therapists felt this was not the case with 69% in disagreement. Post initiation of the protocol 82% felt that there was an increase in their ability to apply assessment skills. 65% agreed that there was a more consistent approach to communication between therapist and physician teams. 82% agreed that treatment modalities were more appropriately selected. Similar results were also achieved when asked about therapist autonomy and more efficient use of time. Conclusions:Use of secretion clearance and/or bronchodilation therapist driven protocols under physician order can better coordinate patient care, better utilize the respiratory therapistÂ’s time, save money by reducing unnecessary treatments and raises the level of therapist autonomy. Sponsored Research - None