slideshow widget

Wednesday, April 23, 2014

The idea RT Aerosol Protocol

I'm not a fan of protocols that are based on an algorithm.  I also do not like utilizing points systems to determine frequency of therapy.  I think the best approach is simple common sense.

In a points system you assess the patient and review the chart to determine breath sounds, pulse, respiratory rate, and level of shortness of breath.  Then you give the patient a points based on what you find.  The total points score will be between 0 and 12.  This will help you determine the frequency of therapy.

  • A total point value of 0-4 = PRN
  • A total point value of 5-7 = QID
  • A total point value of 8-10 = Q4/ PRN
  • A total point value of 11-12 = Q2
I'm not a fan of these systems at all.  First off, wheezes are totally over rated.  You could have someone with a throat wheeze, or laryngospasm, or a cardiac wheeze, and that can completely be confused for bronchospasm wheeze.  Plus dyspnea can be caused by an assortment of disorders, bronchospasm being just one.  

I think a better approach would be to determine need for treatment by giving one treatment, assessing whether or not it did any good, and then ordering subsequent treatments based on that.  

I also think that no one should get a treatment unless they are short of breath.  If you go into a room to assess a patient and he is sleeping, or otherwise is breathing fine, then you should not give the treatment.  If the doctor wants to give prophylactic beta adrenergic medicine, then he can order long acting beta adrenergic therapy.  

Bronchodilator aerosol therapies should be ordered as prn for most patients, and QID for patients who are difficult to assess, or who cannot tell you how they feel.  The only aerosolized medicines that should be given on a frequency are medicines like Pulmocort and Brovana, which need to be given twice a day.  

No comments: