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Friday, July 15, 2011

Protocol lexicon

Protocols Lexicon
The real definition

1.  Protocol:  Synonym:  Capitalism, individualism.  Every patient and every patient situation is treated individually and uniquely given the patient status and the wisdom of the caregivers.  The institution has set guidelines, and the caregivers use their education and wisdom to solve the problem at the bedside. Given proper training and well written protocols, best practice medicine should occur by default because protocols encourage critical thinking.

Ideally, according to Egan, a protocol would work like this:
  1. Therapy can be adjusted more frequently in response to changes in patient status.
  2. Physicians can still be contacted for major changes, but not minor adjustments, thus reducing nuisance calls.
  3. Consistency of therapy can be maintained and non pulmonary physicians can use appropriate up-to-date methods by simply requesting that protocol therapy be used.
  4. RCPs become actively involved in achieving good patient outcomes instead of performing rigid tasks. This enhanced responsibility attracts and retains better educated qualified practitioners.
Types of Protocols:

1. Professional Protocols: Protocols that allow the professional (RN or RT) the opportunity to assess and treat as appropriate based on the guidelines of the protocol (i.e. an RT assesses patient and determines indication and appropriate drug, dose and frequency.)

2. Order Sheet Protocols: Protocols that are basically a list of procedures that are automatically ordered for a particular diagnosis. (i.e. some patients don't meet criteria unless a breathing treatment is ordered. Such is the case with pneumonia and RSV).  They aren't really protocols at all but order sets.

3.  Order sets:  A list of procedures and tests to be ordered automatically for each DRG.  Also referred to as cookbook medicine.  The goal is to make sure patient meets reimbursement criteria.  Order sets that do not come with appropriate RT Driven Protocols may result in unnecessary procedures, burnout and apathy.

4.  Cookbook medicine:  Treating all patients with a given DRG the same.

3. RT Driven Protocols: Protocols that allow the respiratory therapist to use his RT wisdom, skills and experience to do what is most appropriate for the patient in any particular area. Example:  RT Consult that allows the RT to decide who gets treatments; a ventilator protocol that allows the RT to adjust settings based on blood gas results. Studies show these result in improved worker satisfaction, improved patient outcomes, and fewer annoying calls to the doctor.
Advantage of protocols:

1.  Benefits the patient:  The medical professionals working with the patient (RT and RN) decide what the patient needs at the moment the care is needed.

2.  Less calls to physician:  Doctors will receive fewer irritating phone calls

3.  Improved morale and apathy:  RTs and RNs will be able to use the wisdom they obtained by education and through experience, and this will improve their dignity, mercy and self worth.   

4.  Less burnout:  With only those patients who need therapy receiving it, there is a good chance the RT or RN won't feel so run down and overwhelmed. 

Reasons to fear protocols:
1.  Procedure counts:  RT bosses need procedure counts to justify staffing load.  They fear, and often needlessly so, that protocols will result in less work for the department

2.  Reimbursement criteria:  Quality Assurance (see below) wants to make sure government quotas are met for each given patient.  If the RT decides a patient doesn't need certain procedures (such as bronchodilators), then the hospital may not be reimbursed.  This is one of the main reasons many smaller hospitals avoid protocols (note:  see reimbursement criteria below).

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Anonymous said...

Question...i am the only rt in a small critical access hospital. I am also the first. For me to take over giving nebulizer treatments does the physician have to state that he wants rt to do it instead of nursing?


Rick Frea said...

You are actually more trained to do a breathing treatment than a nurse, so you should be able to do it if it is ordered. You may want to talk to your administrator about changing the hospital policy so it recognizes that you are doing this. I'm not sure you'd need to, but it's something you might want to at least look into.