The reason I say this, is that bronchodilators should, technically speaking, only be given when a patient is having trouble breathing secondary to bronchospasm, and the only way you can tell if this is occurring is to be in the room assessing the patient.
In other words, it is not possible to know in advance when a patient will be short of breath. You cannot schedule SOB time. Therefore, Dr. should use all the recourse's that are available to them, which are their respiratory therapists. RTs can go into the room at scheduled times to assess the patient to determine if the treatment is needed.
This is why I am such a proponent of protocols. Or, at the least, I think all treatments should be ordered every four hours as needed (Q4prn) . We go into the room, assess the patient, and give the treatment only if there are signs of bronchospasm.
Thus, here is RT Cave Rule #20:
Why force your RT to wake a patient up in the middle of the night to give a treatment that is not indicated. Use your RT, have him assess the patient every four hours if you think that is necessary, and determine if a breathing treatment is really indicated.
RT Cave Rule #20: You cannot schedule SOB time. You cannot know in advance that a patient will be short of breath every four hours. Therefore, unless the patient is chronically SOB due to asthma or COPD, treatments should not be ordered Q4, they should be ordered Q4 prn.
And this brings us to RT Cave Rule #21:
That concludes today's class.
RT Cave Rule #21: You cannot know in advance when a patient is going to be SOB, and SOB due to bronchospasm is the only indication for a bronchodilator.