Tuesday, October 16, 2007

Protocol's

Well I noticed reading at RT Cave that he is in a smaller hospital were they are not just implementing RT Protocols, well here at my small hospital we are now just starting to implement RT protocols also that started on October 1st.

Our's are just for the delivering of medication, Incentive Spirometers and Oxygen, it goes something like this:

1. Respiratory Order
2. We grab out assessment sheet and assess the patient in the different catagories which are:

  • Respiratory History
  • Surgical/Trauma Status
  • Adult and Peds Respiratory Pattern
  • Chest Xray/Abg/Spo2/Fio2 (All one catagorie, doesn't make sense to me)
  • Cough
  • Breath Sounds
  • Activity (ambulatory, non ambulatory ect)
  • Level of Conconsious

3. Assign points of severity of those catagories and get a total
4. Use total and assesment to adjust therapy as needed.
5. Reassess Q48 or more and adjust therapy as needed.

O2 Protocol is just set up to keep Spo2 >90%, this is nice because of so many Doc's ordering so many different levels, 93%, 90%, 95% ect, how the hell do you keep that straight.

Now the I.S. Protocol is nice, Surgeons would routinely order EZPAP tx's Q4 x48 hours then QID until discharge, crazy I know this would range for any surgeries from Abdominal to foot surgeries. Now we have to ability to just do I.S. or change to EZPAP as needed. If the I.S. is less than 50% of predicted then go to EZPAP until I.S. is over the 50% mark. So far it works pretty good but were still learning its only 2 weeks in.

Anyways I'm all for Therapist driven protocols, let us do what we were trained to do! If this goes off well maybe in a year or so we would work towards Vent Protocols. I did work at a hospital with a great vent protocol, we were in charge of it and the Doc would just write ABG parameters, easy right.

Until next thought, keep em breathing.

9 comments:

Freadom said...

I think this is great that you have this protocol. It's one step in a long process of reform.

My coworker and I have written an RT protocol and, from what you describe here, ours seems similar to yours.

Slowly but surely we Respiratory therapists are gaining the respect we so much deserve.

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Anonymous said...

Thanks for sharing the link, but unfortunately it seems to be offline... Does anybody have a mirror or another source? Please reply to my post if you do!

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Thanks,
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Cindy said...

We have protocols for cariac weaning of vents, it works great. We also have protocols on Bronchiodilators,O2, hyperinflation that covers incentive and Ezpap and trauma. But I am now looking for a protocol for the EC.

Dan the Man said...

I personally seen and used the protocols in a medium sized hospital.
They were great and well observed by all except one therapist which was fired on the spot by the Pulmonary/Intensive Physician for not putting a patient on the ventilator.
Hard core to say the least, but it got the rest to examine how they performed the protocols.

Dan the Man said...

I am opening a website to purchase and entire package for protocols. It will be respiratory therapy first followed by Paramedics, and more.

I have 25years experience and a Bachelor's Degree. I will be pursuing a Masters in Physician Assistant in the near future.

I will be back with a link to my website to purchase the package or partial packages.

Dan the Man said...

I have written a book on 25 protocols in Respiratory therapy and will soon be publishing it with an APP file also.

I would have liked to send a picture to put on your blog, but I don't see how I can.

These are so easy that you can memorize the patterns quickly and will not need the pocket / workstation booklet.