Facilitating research projects in schools and clinical respiratory care departments.
(9/22)
As the profession of respiratory care evolves, greater demands are being placed on educators, managers, and practitioners as they encounter a mass of new literature and the latest technology. Respiratory care schools and clinical departments are under increasing pressure to prepare students and staff with the skills needed to efficiently and effectively consider the numerous primary research investigations, systematic reviews, consensus practice guidelines, and institutional continuous-quality-improvement data. A classroom and work environment that encourages openness and discussion and rewards inquiry is of fundamental importance. Cooperative efforts from school and workplace can provide both student and practitioner with courses on scientific methodology, journal clubs, and equipment seminars. A student body and clinical staff that receive foundational and ongoing education in empirical methodology will respond by assisting in the development and implementation of practice protocols, quality assurance programs, and clinical research. A school and workplace that embrace these attitudes and practices will provide an environment that enhances learning, stimulates professional development, and ultimately provides the most current and best care for its patients. (+info)
Do medical outpatients want 'out of hours' clinics?
(10/22)
BACKGROUND: Patient choice is a major theme in current healthcare delivery. Little is known about patients' wishes regarding the timing of medical outpatient clinics. METHODS: A questionnaire survey of 300 sequential patients attending cardiac and respiratory clinics to determine patients preferences for out of hours and weekend outpatient clinics. (Out of hours defined as a clinic after 5 pm on Mon - Fri) RESULTS: Two hundred and 64 patients completed the survey of which 165 (62.5%) wanted either an out of hours clinics or a weekend clinic. Sixty four (38.8%) specifically stated that this was because of work commitments but for many others, the reasons given were easy to justify. CONCLUSION: Current provision for outpatient consultation may not be convenient for many patients with heart and lung disease. A fuller evaluation of the cost and benefits of more flexible clinic hours is now needed. (+info)
Impact of an annual retreat on process improvement in a respiratory therapy section.
(11/22)
BACKGROUND: In order to fulfill the mission of providing superb respiratory care, managing respiratory care services requires communication and collaboration. To enhance communication and collaboration in our Section of Respiratory Therapy at the Cleveland Clinic Foundation, and to generate ideas for improvement, since 1996 we have conducted annual retreats for the Section, during which important challenges and opportunities are discussed in a large-group forum. The current report describes the retreat process and outcomes, namely the ideas generated during these retreats and the frequency with which ideas were implemented successfully. METHODS: The annual retreat brings together all clinical specialists, supervisors, and managers in the Section of Respiratory Therapy, along with the medical director of Respiratory Therapy and representatives of the staff from each shift. In advance of the annual half-day retreat, supervisors and clinical specialists are asked to write a brief description of things that need improvement and actionable proposed solutions to these challenges. These documents are reviewed by the supervisors, managers, education coordinator, and medical director, and a list of discussion topics for the retreat is formulated. The retreat day begins with a brief introduction and summary of the year's activities and then encourages open-ended discussions regarding the various topics, with the explicit, repeated goal of generating solutions. Minutes are kept to identify specific action items, a list of which is visited repeatedly throughout the year, to assess progress toward successful completion of each action item. In the current analysis, the primary outcome measures are the number of ideas generated as action items during the retreats and the frequency with which these ideas have been implemented. RESULTS: Over the 8 years of annual retreats, 103 action items have been generated, of which 84% (n = 87) have been successfully implemented or completed. As evidence of the importance of this group-based activity, we cite several examples of suggestions and action items that were felt to uniquely represent group process and wisdom and which were not proposed beforehand by individuals. CONCLUSIONS: On the basis of this experience, we recommend conducting annual respiratory therapy department retreats. We believe the benefits include collective problem-solving in a public forum to identify solutions not advanced by individuals. Also, we believe that the direct communication in such retreats contributes to enhanced morale, further evidence of which is the very low turnover rate among our respiratory therapists during the 8 years in which we have conducted annual retreats. (+info)
Home discharge of technology-dependent children: evaluation of a respiratory-therapist driven family education program.
(12/22)
BACKGROUND: Initial hospital discharge to home of technology-dependent children requires extensive training and education of the family caregivers. Education of adult family members should promote positive interactions in a nonthreatening manner while facilitating the development of the knowledge and skills to competently and independently provide all aspects of the medical care. We utilize a training program for adult family members of children who have undergone tracheostomy to facilitate long-term mechanical ventilatory support and who are being prepared for their initial discharge from the hospital to home. A dedicated respiratory therapist family educator directs this program. Multiple teaching tools, activities, and training sessions, based on adult learning theory, are utilized to develop appropriate clinical skills to manage children with tracheostomies and the associated technological supports. METHODS: We evaluated the effectiveness of our program by administering a written test to caregivers, at the start and the conclusion of their training. We also surveyed the caregivers about their satisfaction with the educational program and the respiratory therapist family educator's performance. We also surveyed employees of the durable medical equipment companies used by the families, regarding the caregivers' knowledge and competency in the home one month following discharge. RESULTS: Our program was associated with a statistically significant improvement in caregiver test performance, and the caregivers expressed a high degree of satisfaction with the program. The employees of the durable medical equipment companies perceived a high degree of knowledge and competence on the part of the home caregivers. CONCLUSION: Our training program appears to have a positive impact on the educational preparation of caregivers. (+info)
Do supervised weekly exercise programs maintain functional exercise capacity and quality of life, twelve months after pulmonary rehabilitation in COPD?
(13/22)
BACKGROUND: Pulmonary rehabilitation programs have been shown to increase functional exercise capacity and quality of life in COPD patients. However, following the completion of pulmonary rehabilitation the benefits begin to decline unless the program is of longer duration or ongoing maintenance exercise is followed. Therefore, the aim of this study is to determine if supervised, weekly, hospital-based exercise compared to home exercise will maintain the benefits gained from an eight-week pulmonary rehabilitation program in COPD subjects to twelve months. METHODS: Following completion of an eight-week pulmonary rehabilitation program, COPD subjects will be recruited and randomised (using concealed allocation in numbered envelopes) into either the maintenance exercise group (supervised, weekly, hospital-based exercise) or the control group (unsupervised home exercise) and followed for twelve months. Measurements will be taken at baseline (post an eight-week pulmonary rehabilitation program), three, six and twelve months. The exercise measurements will include two six-minute walk tests, two incremental shuttle walk tests, and two endurance shuttle walk tests. Oxygen saturation, heart rate and dyspnoea will be monitored during all these tests. Quality of life will be measured using the St George's Respiratory Questionnaire and the Hospital Anxiety and Depression Scale. Participants will be excluded if they require supplemental oxygen or have neurological or musculoskeletal co-morbidities that will prevent them from exercising independently. DISCUSSION: Pulmonary rehabilitation plays an important part in the management of COPD and the results from this study will help determine if supervised, weekly, hospital-based exercise can successfully maintain functional exercise capacity and quality of life following an eight-week pulmonary rehabilitation program in COPD subjects in Australia. (+info)
Attitudes of respiratory therapists and nurses about measures to prevent ventilator-associated pneumonia: a multicenter, cross-sectional survey study.
(14/22)
OBJECTIVE: To understand the reported practices of and adherence to evidence-based guidelines for the prevention of ventilator-associated pneumonia (VAP) among respiratory therapists (RTs) and registered nurses (RNs) in academic and nonacademic intensive care units. METHODS: We conducted a multicenter, cross-sectional survey. We first obtained demographic information about health care professionals in a nonidentifiable method. We next questioned the practice patterns of RTs and RNs for preventing VAP based on evidence-supported guidelines. The participants were RTs and RNs working in academic and nonacademic intensive care units; 278 respondents participated in this study (172 RTs and 106 RNs). There were no interventions. RESULTS: The 3 major findings were: (1) both the RTs and the RNs reported that they frequently practice VAP-prevention measures, (2) the rate of adherence to ineffective measures (eg, routine changes of the ventilator circuit, disposable catheters) is also relatively high, which suggests that the evidence is not translated into bedside practice, (3) a substantial proportion of participants did not know the VAP rate in their institution, which might make it difficult to convince bedside practitioners to apply evidence-based practice, and might reflect a lack of infection-control/surveillance programs at hospitals. CONCLUSION: Consumers, the Centers for Disease Control and Prevention, and other organizations are currently trying to implement mandatory reporting of hospital infections, including VAP rate. Without a definition of VAP suited to individual institutions, an organized data-collection and reporting method, and team-based approaches to preventing and treating VAP, hospitals may not be able to meet these requests and track improvement efforts. Prevention measures need to be translated to bedside practice to improve the outcomes of critically ill patients. (+info)
The conversion to metered-dose inhaler with valved holding chamber to administer inhaled albuterol: a pediatric hospital experience.
(15/22)
BACKGROUND: Metered-dose inhalers with valved holding chambers (MDI-VHCs) have been shown to be equivalent to small-volume nebulizers (SVNs) for the delivery of bronchodilators in children. At Seattle Children's Hospital and Regional Medical Center we sought to implement the conversion from SVN to MDI-delivered albuterol in nonintubated patients receiving intermittent treatments. METHODS: There were 4 distinct interventions used to plan and implement this conversion program: (1) literature review, (2) product selection, (3) policy and operational changes, and (4) staff training. Bronchodilator administration guidelines and clinical pathways for asthma and bronchiolitis were revised to recommend MDI-VHC use in lieu of SVNs. Computerized physician order sets were amended to indicate MDI-VHC as the preferred method of delivering inhaled albuterol in children with asthma and bronchiolitis. Data from administrative case mix files and computerized medication delivery systems were used to assess the impact of our program. RESULTS: MDI-VHC utilization increased from 25% to 77% among all non-intensive-care patients receiving albuterol, and from 10% to 79% among patients with asthma (p < 0.001). Duration of stay among patients with asthma was unchanged after conversion to MDI-VHC (p = 0.53). CONCLUSIONS: Our program was very successful at promoting the use of MDI-VHC for the administration of albuterol in our pediatric hospital. Duration of stay among patients with asthma did not change during or since the implementation of this program. (+info)
A comparison of respiratory care workload with 2 different nebulizers.
(16/22)
Aerosol therapy via small-volume nebulizer (SVN) accounts for a large proportion of the respiratory care workload. Treatment time is mostly nebulization time, which is highly variable, depending on SVN design. We studied the workload effect of adopting a faster nebulizer. We hypothesized that time saved by faster SVN treatment can be used by respiratory therapists for other patient-care activities. METHODS: We compared day-shift workload distribution in a post-thoracic-surgery ward during 2 consecutive 30-day periods. To deliver bronchodilators (3 mL unit dose), during the baseline period we used the VixOne nebulizer (average nebulization time 9 min), and during the intervention period we used the NebuTech HDN (nebulization time limited to 3 min). We recorded the per-shift number of various respiratory-therapy procedures, which have been assigned standard treatment times, and compared the per-shift numbers of procedures during the baseline and intervention periods. RESULTS: The per-shift number of procedures were similar during the baseline and intervention periods (33.8/shift vs 33.3/shift, P = .68), as was the per-shift number of SVN treatments (11.9/shift vs 11.8/shift, respectively, P = .81). The per-shift time required for the procedures was greater during the baseline period (4.7 h vs 3.6 h, P < .001). The per-shift time available to deliver optional value-added respiratory therapies was higher in the intervention period (0.75 h vs 0.50 h, P < .04). The time savings from the faster nebulizer corresponded to 1.8 full-time equivalents and theoretical net annual savings of $66,491. We did not use treatment "stacking" (ie, simultaneous administration of SVN treatments to multiple patients). CONCLUSIONS: The NebuTech HDN substantially reduces SVN-administration time, without adverse effects or events, and the time savings were used for value-added patient-care activities. Shorter treatment times can play a role in coping with the national shortage of qualified respiratory therapists. (+info)