Oxygen Therapy
Which patients on oxygen must be seen by an RT?
RTs are to set up oxygen therapy and monitor when a patient requires > 0.50
How often do we see patients on the wards who are prescribed nebulized salbutamol?
RTs to assess ALL patients on the wards Q24 who are receiving nebulized treatments until able to successfully switch over to MDI.
Check 12 hours following switchover to MDI
Switchovers are to be done between 0700-1900
Where do you locate information for complex, chronic inpatients and outpatients with tracheostomies? Where can you document this information?
Found under sharepoint, but also in the red binder above the sink in the break room.
For each outpatient visit, you can either document online or on a respiratory therapy progress note that indicates the correct registration date.
All hard-copy paperwork must be returned to health records - outgoing mail.
Who can order a new CPAP start in the hospital?
NEW POLICY - Only respirologists can order a new CPAP start on the wards.
Where do you place a requisition from the printer for a patient who is the ER?
Next to the printer, below the slots for the wards and the PF lab is a folder where requisitions for ER patients are placed when taken off the printer.
Who is able to adjust oxygen on the wards?
RTs and Physicians are all able to adjust oxygen; RNs able to adjust when <0.50 .
PTs do not have this in their scope of practice in the hospital setting.
Where do you locate the MDI switchover forms and who fills them out?
Forms are located in formimprint. RTs can fill them out and place them in the chart.
Who can write a Wean to Decannulate (WTD) order?
Only respirologists, intensivists, cardiac anaesthetists or ENT can write a WTD order.
What needs to be done for a new CPAP start up in hospital?
The respirologist needs to be consulted. An overnight oximetry on room air must be performed and interpreted.
CPAP can be initiated with prescription of pressures, but then needs to be followed up with overnight oximetries to ensure appropriate pressure has been established.
What is the difference between a SVC and an FVC?
SVC is a slow inspiration followed by a slow exhalation in comparison the forced expiration of the FVC. The slower flow has less resistance and results in a higher volume and is a better predictor for muscle weakness.
This can be done on a Wrights respirometer or the regular spirometer.
How often do we see patients who are on high flow oxygen?
Patients who are on oxygen > 0.50 must be monitored Q4H, including vital signs and the delivery device.
Actively dying patients are Q24H to check the aerosol device, but no vital signs unless ordered.
Who cannot be switched from nebulized treatments to MDI?
Patients who are prescribed regular nebulized treatments at home should not be switched over to MDI
What does wean to decannulate (WTD) include?
Daily Cuff deflation trials
Daily Corking/plugging trials
Trach changes/downsizing
*assess 4 hours then 12 hours post
Once successfully corked for 24 hours, a decannulation order can be obtained.
How can we initiate acute care BIPAP on the wards?
BIPAP can be initiated on the wards for impending respiratory failure or actively dying patients as long as ICU/HAU or the EP is consulted for the orders.
An RT must be designated solely for those patients until moved to an acute care/monitored setting.
When would you perform MIP/MEPs and what are the normal values?
NEW POLICY - we no longer perform MIP/MEP on the wards due to a lack of calibrated equipment and inaccuracies in measurements and inappropriate patient selection. This is only done in ICU and for outpatients. SVC is more appropriate for measuring respiratory deterioration and muscle weakness.
MIP= +50-100 MEP=-60-90
SVC< 15 mL/kg can indicate the need for mechanical ventilation.
When you discontinue a patient on high flow oxygen therapy, how often do you monitor them?
When discontinuing high flow oxygen, the patient must initially be monitored at 4 hours and then at 12 hours. Documentation should be done on the RT progress notes as well with these checks.
How do we assess patients on the ward who are prescribed nebulized salbutamol?
RN is to initiate treatments and alert RT of all new aerosol orders on the wards.
Assessment includes: dosage, schedule, appropriateness, respiratory vital, potential to switch to MDI, and coordination with RN to ensure continuity of care.
All this needs to be documented under Respiratory Therapy progress notes.
Who can write a decannulation order on the ward?
On the wards, only Respirologists can write a decannulation order.
*In ICU - Respirologists, intensivists.
In CSICU- Cardiac anaethetist
What constitutes a good quality overnight oximetry test?
4 hours of continuous monitoring of saturations and heart rate is required. Document if patient is on oxygen or CPAP.
DEI > 5 is considered abnormal
Check tracings to make sure artifact is not affecting the results
What is the difference between palliative care and comfort care?
Palliative care is a program for all patients with a life-threatening illness or condition with a life expectancy up to 6 months or wishes for focus of care to be palliative rather than curative. Pts can be better managed with medications for dyspnea that many other physicians are hesitant to prescribe.
Comfort care (and Hospice) is for patients who are actively dying. Most patients are sent to hospice with a projected stay of less than 3 months.
How do you assess and transport a patient on high flow oxygen?
Assessment for a safe transport of a patient on high flow oxygen includes: Sp02, lying patient flat with NRFM or other acceptable option, document how patient tolerated it and then whether you need to accompany the patient on the transport.
Chart after the transport to ensure the patient has been returned to the original oxygen settings.
According to our protocol, who is responsible for giving nebulized salbutamol in the ER?
RTs are to assess/deliver ALL prescribed aerosols in CSICU, ICU, ER and with all patients who require > 0.50 Fi02
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Describe the role of the RT when transporting a tracheostomy patient on the ward with oxygen to a procedure.
RTs are to see the patient for a risk assessment, set up appropriate oxygen equipment, ensure safety bag is present and document.
Assess once back from transport to ensure the oxygen equipment is set up and the safety bag is back and document
Why don't we routinely initiate new CPAP starts in hospital?
There is evidence of poor compliance with patients who have been trialed on CPAP while in hospital due to : poor oximetry testing, acute illness, medications, poor sleep, poor interface/old machinery, lack of humidity.
Also, RTs do not routinely assess and follow CPAP patients on the ward
Who can be referred to COPD self-management education sessions and how do you do this?
All patients who are admitted to hospital with AECOPD and a confirming spirometry can be referred for education without a Dr's order. This can be done via Meditech:
RT - PRREF - pulmonary rehab referral