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Friday, September 4, 2009

Bronchodilator Reform: Part I

In February of 2009 I was asked by Anonymous RT to write a guest post for his blog respiratorytherapy101. Right away I decided what his readers and mine have in common is the need for bronchodilator reform, which inspired the following post:

Bronchodilator abuse
By Rick Frea, February 24, 2009 @ RespiratoryTherapy101

Many RTs, along with myself, have been on a crusade for bronchodilator reform. It is our humble goal to end bronchodilator abuse. By this we are not referring to asthma and COPD patients abusing their inhalers, but doctors ordering bronchodilator breathing treatments on patients who don’t need them.

Where I work there are no treatment protocols, so the problem is worse than at hospitals with protocols. Yet my RT friends who work at hospitals with protocols still complain to me about useless breathing treatments. Either it’s in the form of doctors overruling the protocol, or senior RTs who like to play it safe.

So it can be stated here that breathing treatment protocols seem to help, but do not end bronchodilator abuse.

Why is this? Because HMOs and THE government require certain procedures be ordered in order to meet criteria. If criteria is not met the hospital does not get paid.

Pneumonia is a great example. Some unwise person who has no clue what a bronchodilator even is decided that to for them to reimburse for the diagnosis of pneumonia, Q4-6 bronchodilator treatments need to be given.

The idea here is that if the patient isn’t sick enough to need a treatment he’s not sick enough to be in the hospital. Well, we humble RTs know this is ridiculous, but that’s the rule we have to live by. And that’s why our pneumonia protocol calls for Q4-6 Ventolin.

And this is why every single pneumonia patient has to be on Q4-6 Ventolin treatments regardless of whether or not they are having bronchospasm. When we are busy to begin with, this can be quality that could be spent with a person who REALLY needs the services of an RT.

Likewise, since 50% of patients admitted to hospitals are diagnosed with pneumonia, and many of them just because of this reimbursement criteria. That’s the only reason I can explain why so many patients diagnosed with pneumonia have clear lung sounds, a normal x-ray and labs.

The first step in ending bronchodilator abuse is educating folks that Ventolin is a bronchodilator and not a cure all for all annoying lung sounds and diseases. The second step is protocols.

The final step may be going beyond doctors and hospital administrators and finding your way to Washington on a quest to get Senators to pass laws (not that I like laws, but it was the government that caused this problem in the first place) banning Insurance companies and government agencies from setting quotas for reimbursement criteria.

Anyone up to the task?

1 comment:

Anonymous said...

It seems to this lowley RT student extern, that where I work - if patients who only NEEDED treatments, got them....the RT staff would only need to be 50% of what it is.

So in a sense while a waste - I suppose it is some form of job security....

My other pet-peave is doc's who have "standing orders" (read: pre-printed word processed med orders) for ALL of their patients. I mean, really? I thought humans were individual beings with individual physiology...but I digress....

The peave is that on first round treatments we have the "standing order" only to have that changed to something else DAW by the next rounding doc only to have the med orders changed back to the standing orders the next day when Original Doc rounds....

What a waste of effort all in the name of Ego - and "I do JUST because I CAN".......

Not even an RRT yet and I have a very low opinion of the docs at my little institution.....much looking forward to my remaining clinicals and hopefully the chance to witness REAL medicine.....not ready made, in a tube, cookie dough medicine.......