Communicating Is Key
Communication has been an age-old problem in healthcare. Relaying information from shift to shift, practitioner to other staff, and staff to physician has presented us with a challenge. We've chosen three forms of communication:
1) A written shift report sheet that details each patient's therapy, diagnosis, current lab and radiology reports, ventilator and weaning schedules, as well as any special approaches or techniques found successful with that individual's care;
2) A verbal shift report, detailing the day's events for each patient; and
3) A documentation and assessments from each shift on progress and obstacles encountered during the practitioner's shift.
Additionally, being a technologically progressive facility allows Good Shepherd the availability of physician intervention via tele-intensivist, and computer access to lab and radiology results. Each respiratory therapist also carries a cellular phone to provide immediate access to patients.
Consistency Of Care
Good communication has helped Good Shepherd address the issue of consistency of care. Consistency of care and a consistent approach to patients are important in their rehabilitative course. If we aren't consistent, the patient can become a victim of the healthcare system. Improved communication and adherence to protocols allow us to provide care reliably.
Adherence to protocols is an ongoing process, and education is the first step. Management plays a key role in developing this process and continuing to reassess the strengths and weaknesses of the protocol.
Staff members should be aware of existing protocols, have a thorough understanding of their progression and know what to do when a situation falls out of the established guidelines.
However, keeping care consistent while utilizing a per-diem staff can present its own set of hurdles. Each institution has its own unique approach to care and, when working between institutions, the per-diem practitioner may confuse policies. It's preferable to place per-diem practitioners with full-time personnel as a reference for institutional policies and procedures.
Coordination of the healthcare team also is vital to the progression of a patient's rehabilitative course. Each discipline plays a vital role during the rehabilitative hospital stay. The nurse plays the coordinative role, orchestrating the healthcare team during a patient's rehabilitative and medical recovery.
It's important to prioritize care according to the medical and rehabilitative needs of the individual on any particular day. These needs will change as the individual progresses or suffers an exacerbation from other co-morbidities.
The bedside RT is only as good as the rest of his or her team. Well-informed, consistent, and methodical approaches to care will provide favorable outcomes. Developing a working model that incorporates each discipline involved in the patient's care will assure the patient doesn't become a victim of the healthcare system.
Bill Barnes, BA, RN, RRT, is a respiratory therapist at Good Shepherd Specialty Hospital, Bethlehem, PA.
Table: Guidelines for Decannulization
- Negative sputum culture
- Afebrile times 3 days
- Clear or improving chest X-ray
- Intact cough and gag reflex
- No aspiration problem or laryngeal penetration
- No pending procedures that will require intubation
- Peak cough flow more than 165 Lpm to assure adequate cough to mobilize secretions
- Ability to tolerate the use of a speaking valve or capped tracheostomy tube during the day
- Need to be suctioned less than three times per day
- No sleep dysfunction
- O2 saturations are greater than 92 percent on room air or pre-morbid O2 use.