slideshow widget

Saturday, February 27, 2010

Q4ever treatments are the easy out for some docs

Where I work breathing treatments are ordered Q4ever. Well, not all of them are Q4, but doctors here never write for how long they want the treatment to be given, and most of the time they never write to discontinue therapy regardless of progress of the patient.

Sometimes therapies are discontinued after RT request, but even these requests often go unheeded. Why is this?

According to "Egan's Fundamental's of Respiratory Care," JCAHO standards recommend that all orders must specify the type of medicine, frequency, and duration of treatment."

Where I work JCAHO has been fired, and ISO has been hired. ISO is an organization that allows businesses to write their own rules and regulations, and it makes sure the hospital follows the rules and regulations it sets for itself. I'm sure it's more complicated than that, but that's the jist of it.

I don't know why JCAHO was fired (I call it fired), but from other RTs I have heard a lot of bad things about JCAHO. ISO, however, isn't necessarily any better. Except, from what I see here, it doesn't set regulations such as making it mandatory to write an order for duration of therapy.

The result of this is Q4-ever treatments on everyone.

I know some hospitals I used to work for had a standard protocol to put a sticker on the chart where the RT would recommend the treatment be renewed or that it was no longer needed, and the doctor could respond to this to make sure un-needed procedures were stopped.

Egan's also recommends that the doctor specify the goals and objectives of therapy. I imagine our hospital switched to ISO because the admins here, perhaps, are aware that there really is no purpose to most breathing treatments.

In fact, Egans states, "Unfortunately, adding goals and objectives to the respiratory care order does not assure that the therapy is needed. To be cost effective, all therapy must be justified and discontinued when no longer needed."

For some reason, the admins at Shoreline medical don't care that un-needed therapies are given. This seems to be a trend across the board for RT departments across the nation.

I have a pretty good feeling the reason for this is the desire to keep the procedure count up in our department to justify having RTs here.

If that's not the reason, then I'm am baffled.


Anonymous said...

Based on my clinical observations 80% of treatments are either unindictaed or continue to be given after resolution of symptoms....but, then, that also means RT Departments are over-staffed. RT's need to get their Congress & Senate people to vote for the RT Bills before them in the Congress & Senate now. RT's ALSO need to get friendly doc's on-board and have them send letters of support for the RT Bills as well.

RT's need to make themselves relevant now, because if someone ever figures out how much money is wasted on unindicated breathing treatments, RT's will go the way of the U.S. auto worker.

Soon 2B a New RT...

Rick Frea said...

I agree and disagree with your statement. While it is true 80% of breathing treatments aren't indicated, there is still a need for RTs in the hospital. Our skills and training helps determine who needs respiratory services to get better, and when these services need to be stepped down. This skill is necessarily not just to speed recovery and save lives, but to reduce cost. We are also needed as part of the critical care team, and in the management of critical respiratory equipment and management thereof. I believe simple RT protocols will resolve all the problems currently faced by RTs, and that laws are not needed.

Rick Frea said...

Likewise, I also believe that lack of protocols results in low moral and high levels of apathy in RT departments. With protocols, and improved moral, RTs will be encouraged, and have the time, to seek out patients who could benefit from RT services. Plus RTs will have more time for education, something that is also billable. So, if we did 80% fewer treatments, the # of RTs needed will not diminish.