Transcript Egan’s Fundamentals of Respiratory Care

Chapter 2
Quality and Evidence-Based
Respiratory Care
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Learning Objectives
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Describe the elements that constitute quality
respiratory care.
Explain methods used for monitoring the
quality of respiratory care provided.
Explain how respiratory care protocols
enhance the quality of respiratory care
services.
Define disease management.
Describe evidence-based medicine.
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Elements of a Respiratory Care
Department
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Medical Director
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Responsible for clinical function of department
Usually is pulmonologist or anesthesiologist
Must possess both management & clinical skills
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Elements of a Respiratory Care
Department (cont.)
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Medical Director (cont.)
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Responsibilities of the medical director of Respiratory
Care include all of the following except:
A. educating the medical and nursing staff regarding
respiratory therapy
B. participating in the preparation of the department
budget
C. organizing the weekly work schedule
D. participating in respiratory care in-services and
training programs
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Elements of a Respiratory Care
Department (cont.)
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Respiratory Therapists
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Quality of RT department depends on education,
experience, & professionalism of therapists
RTs are primary source of quality care provided by
department
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Credentialing in Respiratory Care
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Quality RC departments are staffed with RTs
who hold appropriate credentials
To be eligible for credentialing, individuals
must graduate from CoARC-approved
educational programs
Graduates can then sit for certification &
registry exams offered by National Board for
Respiratory Care (NBRC)
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Professionalism
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Technical Direction
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Quality respiratory care depends on strong
leadership
Manager of department usually provides
technical direction
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This person oversees policies, procedures, &
equipment used to provide safe & effective patient
care
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Methods to Enhance Quality
Respiratory Care
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Respiratory Care Protocols
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Put in place to enhance appropriate allocation of
respiratory care services
Represent guidelines to deliver care only when
indicated, by correct method; discontinued when
no longer needed
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Respiratory Care Protocols
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Respiratory Care Protocols
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Respiratory Care Protocols
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Respiratory Care Protocols (cont.)
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According to respiratory care protocols, what is the
minimum frequency for assessing patients for a
change in clinical status?
A.
B.
C.
D.
Every other day
Every 4 hours
Once per shift
Once a day
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Standardized Assessment
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Care Plan
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Monitoring Quality Respiratory Care
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After all elements are in place, quality
respiratory care is maintained by monitoring
One method to monitor quality of care
provided : seek voluntary accreditation
Accreditation by The Joint Commission is
most important
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Monitoring Quality Respiratory Care
(cont.)
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Current Joint Commission standards call for
continuous quality improvement (CQI)
CQI is an ongoing process to detect & correct
factors hindering quality care
AARC has developed 4 goals that should be
included in CQI plan
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Monitoring Quality Respiratory Care
(cont.)
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
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Monitoring Quality Respiratory Care
(cont.)
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Competencies or “checks”: used to test skills
& knowledge through use of clinical
simulations
Used mainly for procedures that carry degree
of patient risk
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Examples: arterial puncture, aerosol therapy,
BiPAP set up, intubation, & ventilator
management
Simulated patient scenarios help determine
consistency among RTs
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Skill Checklist
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Monitoring Quality Respiratory Care
(cont.)
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Peer Review Organizations
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Federal government established elaborate system
of PROs to evaluate quality of care given to
Medicare beneficiaries
Such PROs evaluate care provided to individuals
in real time to ensure compliance with federal
guidelines
Accountable Care Organizations (ACOs):
emerging groups of health care providers
ACO’s work to enhance quality of care, receive
payments, & lower costs
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Care Plan Audit
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Hospital Restructuring & Redesign
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An attempt to do more patient care w/ less
overhead
Common approaches include:
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Cross-training employees
Using unlicensed assistive staff
Decentralizing services (patient-focused care)
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Disease Management
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Refers to organized strategy of delivering
care to large group of individuals w/ chronic
disease to improve outcomes & reduce costs
Disease management programs may be
developed for patients with asthma, diabetes,
chronic obstructive pulmonary disease
(COPD), or congestive heart failure (CHF)
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All of the following are the goals of disease
management ,except:
A.
B.
C.
D.
Reduce costs
Develop new strategies
Keep track of medication usage
Improve outcome of individuals with chronic
diseases.
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Evidence-Based Medicine
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Represents important concept regarding quality
respiratory care
Refers to determining optimal clinical management
based on evidence found in scientific literature
Scientific literature publishes best scientific evidence
available
Best scientific evidence includes rigorous clinical trials
to support most appropriate & correct clinical decisions
Clinical Practice Guidelines (CPGs) developed by
AARC represent recommendations based on expert
review of evidence
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The goal of evidence - based medicine is to:
A. use results from research for clinical practice
B. use literature based research only for new
medications
C. develop new treatments from a single case
report
D. disregard older case studies and only focus on
more current ones
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Evidence Based Medicine (cont.)
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Evidence comes from 4 different types of studies:
1. Single case studies ( simplest, least rigorous)
2. Case series (collection of patients with similar clinical
features)
3. Cohort studies (comparing 2 groups, greater
scientific rigor)
4. Randomized controlled trials (ideal, most rigorous
evidence)
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Through these studies, new treatments, medications,
& new modes of ventilation have been designed
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Evidence Based Medicine (cont.)
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For study to be successful, key outcomes are:
 Survival
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Discharge from ICU
Organ system failures
Meta-Analysis is additional tool of evidencebased medicine:
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Identifies, analyzes, & summarizes body of
literature for specific topic being studied
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Evidence Based Medicine (cont.)
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What type of study holds the most scientific rigor?
A.
B.
C.
D.
single patient studies
cohort studies
case series
randomized controlled trials
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