From Task Oriented Therapy to Protocols and Respiratory Therapy Care Plans. Jane Reynolds, MS, RN, RRT. Protocols. Scientific basis for ordering respiratory therapy provided with AARC Clinical Practice Guidelines
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Jane Reynolds, MS, RN, RRT
When respiratory therapists are allowed to provide respiratory therapy via protocols:
Value Respiratory Therapists as
in knowing the indications for therapies and assessing the efficacy of the therapy for the patients receiving respiratory care
Top Ten Reasons why patients get albuterol
10. Because the patient has lots of secretions
9. Because the patient is intubated
8. Because the patient is going to surgery
7. Because his attending, Dr. _ _ _ _ said so
Top Ten . . .
6. Because the pt’s cousin has asthma
5. Because the patient is desaturating
4. “It is my philosophy”
3. The patient is DNR.
2. The patient has terminal CA
And the Therapy Care Plans
# 1 reason
why patients get albuterol IS . . .
It won’t hurt ! Therapy Care Plans
What is the last thing most patients taste or smell, if they die in the hospital?
Words of wisdom when studying for your your boards . . .
“Don’t approach the questions the way you would at work; think about what you learned in school.”
AARC Clinical Practice Guidelines have been available for over 20 years.
AARC recommendations are made as to:
A visit to WWW. AARC.org on line provides all the tools needed
Protocol ResourcesThis is a collection of all resources provided by the AARC on helping you establish protocols. It includes a bibliography of peer-reviewed articles, a bank of algorithms and protocols to use as models, and a story about one health system's implementation of protocols.
Clinical Practice GuidelinesThese AARC's guidelines enhance respiratory practice and provide a framework for RT protocols
Position StatementsThe AARC has adopted a number of statements regarding the provision of services or the practice of respiratory care.
Services offered by Respiratory Care:
Protocols and Care Plans Therapy Care Plans
Quality Assessment for the Respiratory Care Evaluation Form
Protocols and Care Plans
Respiratory Care - ProcessImprovement
“Not indicated therapy”
A 50-year old white male was admitted to a telemetry unit from the ED at 0430 with a chief complaint of severe shortness of breath.
He is 5 feet 10 inches tall and weighs 185 lbs. His vital signs on admission are: T 101.1, P 114, RR 26, B/P is 166/110.
He has digital clubbing and cyanosis of his extremities. He has pedal edema and JVD is also noted. He uses pursed lip breathing and is audibly wheezing. He has a productive cough of small amounts of thick yellowish green sputum. Auscultation reveals bilateral wheezing with decreased aeration in both bases.
He states he has been taking antibiotics for almost a week. He was not feeling any better so he came to the ED because ‘he couldn’t take it any more.’
He is receiving O2 therapy via nasal cannula at 2 lpm.
A well known asthmatic 20 year old white female is admitted to the ED in a severely agitated state. She is 5 feet 6 inches tall and weighs 120 lbs. Her vital signs are: T 97.4, P 110, RR is 32, B/P is 98/50.
Her respirations are shallow and her chest appears hyperinflated. Breath sounds reveal minimal wheezing and decreased aeration in both lungs. She is receiving oxygen therapy via venturi mask, 0.4 FiO2.
A 49-year old African American male was brought to the ED at 0500 with a chief complaint of shortness of breath.
He is 5 feet 10 inches tall and weighs 180 lbs.
Vital signs on admission: T 99.3, P 124, RR 14, B/P 160/90.
Breath sounds are markedly reduced bilaterally with some high pitched wheezing.
He is using inspiratory and expiratory accessory muscles of ventilation.
He is receiving O2 therapy via nasal cannula at 4 LPM. He has never been hospitalized before and states he has had a ‘cold’ for two weeks.