Sage Journals: Discover world-class research

Abstract

BACKGROUND: Although therapist-driven protocols (TDPs) are becoming increasingly popular, successful implementation requires confidence in assessment skills and in implementing treatment algorithms. METHODS & MATERIALS: To assess the level of respiratory care practitioners’ (RCP) preparedness for evaluate-and-treat programs, we undertook a survey in which 6 case studies of non-ICU, non-mechanically ventilated patients were mailed to 1,237 RCPs (960 students, 137 staff RCPs, 140 RCP instructors) in 62 schools and 10 hospitals. Using treatment algorithms from the Cleveland Clinic Foundation Respiratory Therapy Consult Service, respondents were asked to generate a care plan for each case study. ‘Correct’ answers were identified beforehand by expert consensus. The answers of individual respondents were graded against correct answers. RESULTS: Mean response rate was 47.8% (students 50.8%, staff 50.0%, instructors 24.2%). Mean (SD) rate of correct responses overall was 49.0 (18.6)%. Comparison of response rates by training level showed that instructors performed better than staff RCPs who performed better than students [64.1 (15.5)% vs 54.8 (18.2)% vs 47.5 (18.3)%, p < 0.05]. In contrast, rates of correct responses were no higher among students completing 4-year vs 2-year vs 1-year (technician) programs [44.9 (20.2)% vs 47.8 (18.4)% vs 47.8% (16.4)%, p > 0.05]. However, students training at clinical sites using TDPs scored better than their counterparts at hospitals not using TDPs. Although 73% of 434 responding students reported being comfortable with protocols, the correct response rate was also low, 47.0 (18.4)%. CONCLUSIONS: (1) Overall, the rate of correct responses was low in this study. (2) Among respondents, instructors demonstrated the highest frequency of correct responses, exceeding staff therapists and students. (3) No effect of length of training program was apparent, although overall student performance was low. (4) Among students, training at clinical sites using TDPs was associated with better performance in the case-study exercises. [Respir Care 1996;41(7):595-600]

Get full access to this article

View all access options for this article.

References

Browning

, Kaiser

, Durbin

. The effect of guidelines on appropriate use of arterial blood gas analysis in the intensive care unit. Respir Care 1989;34(4):269–276.

Hart

, Dubbs

, Gil

, Myers-Judy

The effects of therapist-evaluation of orders and interaction with physicians on the appro-priateness of respiratory care. Respir Care 1989;34(3):185–190.

Stoller

, Haney

, Burkhart

, Fergus

, Giles

, Hoisington

, Kester

, Komara

Jr , McCarthy

, McCann

, Meredith

, Orens

, and the Section of Respiratory Therapy. Physician-ordered res-piratory care vs physician-ordered use of a Respiratory Therapy Con-sult Service: Early experience at the Cleveland Clinic Foundation. Respir Care 1993;38(11):1143–1154.

Weber

, Milligan

Therapist-driven protocols: state-of-the-art. Respir Care 1994;39(7):746–756.

Jacobs

How are we doing with operational restructuring and ther-apist-driven protocols? (AARC poll). AARC Times 1994;18:66–69.

Burton

, Tietsort

. Therapist-driven respiratory care: a prac-titioner's guide. Academy Medical Systems Inc, 1994:47–49.

Respiratory Therapy Educational Programs, Fall 1991. The Com-mittee on Allied Health Education and Accreditation of the Amer-ican Medical Association in collaboration with the Joint Review Com-mittee for Respiratory Therapy Education publishers.

American Association for Respiratory Care. Clinical practice guide-lines: incentive spirometry, pulse oximetry, oxygen therapy in theacute care hospital, spirometry, and postural drainage therapy. RespirCare 1991;36(12):1398–1426.

American Association for Respiratory Care. Clinical practice guide-lines: patient-ventilatory system checks, humidification during mechan-ical ventilation, selection of aerosol delivery device to the lower air-ways, nasotracheal suctioning, bronchial provocation, exercise testingfor evaluation of hypoxemia and/or desaturation, sampling for arte-rial blood gas analysis, and oxygen therapy in the home or extendedcare facility. Respir Care 1992;27(8):882–922.

10.

American Association for Respiratory Care. Clinical practice guide-lines: directed cough, in-vitro pH and blood gas analysis andhemoximetry, single-breath carbon monoxide diffusing capacity, anduse of positive airway pressure adjuncts to bronchial hygiene ther-apy. Respir Care 1993;38(5):494–521.

11.

American Association for Respiratory Care. Clinical practice guide-lines: transport of the mechanically ventilated patient, fiberoptic bron-choscopy assisting, resuscitation in acute care hospitals, intermittentpositive pressure breathing, and bland aerosol administration. RespirCare 1993;38(11):1169–1200.

12.

American Association for Respiratory Care. Clinical practice guide-lines: ventilator circuit changes, static lung volumes, delivery ofaerosols to the upper airway, neonatal assisted ventilation, appli-cation of CPAP to neonates via nasal prongs or NP tubes, and sur-factant replacement therapy. Respir Care 1994;39(8):817–836.

13.

Beard

. Outline of Piaget's developmental psychology for stu-dents and teachers. New York: Basic Books Inc, 1969.

14.

Mishoe

. Critical thinking, educational preparation and developmentof respiratory care practitioners. Distinguished Papers Monograph. Dallas: Daedalus Publishers, Spring 1993;2(1):29–43.

15.

Langley

, Tritchler

, Llewellyn-Thomas

, Till

. Use ofwritten cases to study factors associated with regional variations inreferral rates. J Clin Epidem 1991;44:391–402.

Proficiency among Respiratory Therapy Educators,Staff,and Students in Using Algorithms for Therapist-Driven Protocols

Abstract

Get full access to this article

References