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.