How respiratory therapists care for patients has not changed throughout the COVID-19 pandemic. However, COVID-19 has changed the way we approach patients and has changed a lot of the procedures we use in our everyday jobs. We are more cautious than before about the pandemic and have implemented safety precautions in keeping with a virus that is spread through respiratory droplets. Many of our non-clinical colleagues are working offsite remotely, in order to stay away from others and keep themselves and others safe. Meetings are often held via virtual meeting applications; at Spectrum Health, we use Microsoft Teams. There are not as many people in the hospital as there typically are. Visitors have been restricted, and staff members who can work at home must work at home, so the hospital—while never empty—is less populated. It can feel odd since we are used to passing people in the hallways and seeing more people in our department and on the nursing units.
Although respiratory therapists, as with most health care workers, have always taken safety seriously and have employed what is called “universal precautions,” meaning that we assume patients could be infectious so we employ safety precautions such as gloves and masks, those precautions have amplified in the face of COVID-19. In 2021, we wear masks all day, even when we are not with patients. As soon as we walk in the doors to our workplace, we use hand sanitizer and put on surgical masks. That's just the beginning.
A typical day for me begins by arriving at our department and punching in. The phone I carry to help me communicate while I am mobile at work begins to buzz with messages. A text shows I am needed in the emergency department. I arrive to find that a patient is short of breath. Before COVID-19, I would enter the room without hesitation and begin talking to the patient to determine how they are feeling and do an assessment of what is needed. Today, I operate with the assumption that everyone has COVID-19. That allows me to keep safe and it allows me to ensure my patients are safe. I pause before I go into the room to replace my surgical mask with an N95 mask or what is called a PAPR, a device that allows your breath to be s.
Before COVID-19, we gave lots of breathing treatments. These allow people with asthma, Chronic Obstructive Pulmonary Disease (COPD), and other conditions that make breathing more difficult to breathe easier using inhaled respiratory medicine. This medicine helps open up airways. COVID-19 has changed our practice regarding nebulized breathing treatments. Breathing treatments aerosolize medicine. They can also aerosolize germs like COVID-19. So now, until a patient is proven COVID-19 negative, we give inhalers instead. Like nebulizers, inhalers allow patients to inhale respiratory medicine. But they do not aerosolize germs into the room. So, anyone suspected of or diagnosed with COVID-19 now receives an inhaler instead of a nebulized breathing treatment.
For this particular patient in the emergency department, I first put on a PAPR device before going into the room. I assess how he is doing and begin the process of administering his treatment. The patient will be observed in the emergency department to see how he progresses and based on that, he may be released home or may be admitted. If he is admitted and continues to need assistance with his breathing, the respiratory therapist team will assist with his care throughout the time he is a patient.
Before the COVID-19 pandemic, respiratory therapists provided care for some of our patients in critical condition, but many of these patients were transported to Grand Rapids so they could be under the care of specialty physicians such as pulmonologists. Throughout the pandemic, some of the larger hospitals were filled to capacity, and some of our patients were too ill to be transported. We kept many more patients at the Ludington and other regional hospitals but were able to use telemedicine to ensure the same specialty physicians were involved in each patient’s care.
Telemedicine is a technology Spectrum Health has used for years, but during the pandemic, its use for critical patients became very important. With a monitor wheeled into the patient’s room in Ludington, a pulmonologist in Grand Rapids can see the patient via a camera and talk to the hospitalist on duty about the patient’s condition and care. The specialist can work directly with our local hospitalists to confer on patient care and offer insight on the best course of treatment for each patient. It’s a valuable tool for both physicians, patients, and families.
*This article was edited and published in the Ludington Daily News on March 11, 2021, as an aside to the article: "Fighting COVID 19:
Healthcare workers share stories from frontlines; talk protocol changes, safety, mental health,"
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