MANAGEMENT AND HEALTHCARE ETHICS

LECTURE 1: QUALITY AND EVIDENCE-BASED RESPIRATORY CARE

PROF: SIR RITCHIE CABURNAY
1ST SEMESTER A.Y. 2022 – 2023
• Education of medical and nursing staffs
QUALITY AND EVIDENCE-BASED RESPIRATORY regarding respiratory therapy
CARE • Participation in the selection and
QUALITY promotion of technical staff
• Characteristic reflecting a high degree • Participation in the preparation of the
of excellence, fineness or grade. department budget
• Ruskin – “Quality is never an accident. It Note:
is always the result of intelligent effort.” • Essential aspect of providing quality
• Specifically, quality, as applied to the respiratory care is to ensure that that
practice of respiratory care, is care being provided is indicated and
multidimensional. that it is delivered competently and
o It encompasses the personnel who appropriately.
perform respiratory care, the • However, such traditional practices have
equipment used, and the method or often been shown to be associated with
manner in which care is provided. misallocation of respiratory care.
ELEMENTS OF A HOSPITAL-BASED RESPIRATORY • Misallocation
CARE PROGRAM: ROLES SUPPORTING QUALITY o Ordering therapy that is not
CARE indicated
o Ordering therapy to be delivered
MEDICAL DIRECTION: MEDICAL DIRECTOR by an inappropriate method
• Professionally responsible for the clinical o Failing to provide therapy that is
function of the department and provides indicated
oversight of the clinical care that is RESPIRATORY THERAPISTS
delivered. • Capable of medical direction and the
• Medical direction is usually provided by application of well-constructed
a pulmonary/critical care physician or respiratory care protocols
an anesthesiologist. • The quality of Respiratory Therapists
• Medical director must possess depends primarily on their training,
administrative and medical skills. education, experience and
Responsibilities of a Medical Director of professionalism
Respiratory Care o Training – teaches students to
• Medical supervision of Respiratory perform tasks at a competent
Therapists in the following areas: level
o General medical, surgical and o Clinical education – provides
respiratory nursing wards students with a knowledge base
o ICU’s they can use in evaluating a
o Ambulatory care (including situation and making appropriate
rehabilitation) decisions
• Pulmonary function laboratory Respiratory Therapist skills required for
• Development and approval of implementing protocols
department clinical policies and • Assess and evaluate patients regarding
procedures indications for therapy and the most
• Supervision of ongoing quality assurance appropriate delivery method
activities • Be cognizant of age-related issues and
Responsibilities of a Medical Director of how they affect the patient’s ability to
Respiratory Care understand and use various treatment
• Medical direction for respiratory care in- modalities
service and training programs • Adapt hospital policies and procedures
to alternative care sites
 MANAGEMENT AND HEALTHCARE ETHICS
LECTURE 1: QUALITY AND EVIDENCE-BASED RESPIRATORY CARE
PROF: SIR RITCHIE CABURNAY
1ST SEMESTER A.Y. 2022 – 2023
• Respiratory Therapist skills required for • Equipment must be safety checked and
implementing protocols specific maintenance procedures must
• Conduct and participate in research be performed on a regular basis
activities to ensure a scientific basis for METHODS FOR ENHANCING QUALITY
advances in respiratory care RESPIRATORY CARE
• Communicate effectively with all • Respiratory Care ProtocolsAre guidelines
members of the health care team, and for delivering appropriate respiratory
contribute to the body of literature care treatments and services
concerning the field of respiratory care • Protocols may be written in outline form
Professional characteristics of a Respiratory or may use algorithms
Therapist Key elements of a Respiratory Care Protocol
• Completes an accredited respiratory Program
therapy program • Strong and committed medical direction
• Obtains professional credentials • Capable RT’s
• Participates in continuing education • Active quality monitoring
activities • Collaborative environment among RT’s,
• Adheres to the code of ethics put forth physicians and nurses
by the institution or state licensing board • Responsiveness of all participants to
or both address and correct problems
• Joins professional organizations Elements of an acceptable Respiratory Care
Professionalism Protocol as describe by the American College
• Calling that requires specialized of Chest Physicians
knowledge and often long and intensive • Clearly stated objectives
academic preparation • Outline that includes an algorithm
• Professional – an individual conforming • Description of alternative choices at
to the technical and ethical standards of decision and action points
a profession • Description of potential complications
• RT’s demonstrate their professionalism by and corrections
o Maintaining the highest practice • Description of end points and decision
standards points at which the physician must be
o Engaging in ongoing learning contacted
o Conducting research to advance • Protocol program
the quality of respiratory care “Highly desired” features of a changed-avid
o Participating in organized Respiratory Therapy Department
activities through professional • Having a close and collegial working
societies relationship between the medical
Technical Direction director and the RT’s
• Is often the responsibility of the manager • Having a strong and supportive
of a respiratory care department champion for change in the hospital
• Must ensure the equipment and the administrative structure (e.g., hospital
associated protocols leaders, medical director)
• Procedures have sufficient quality to • Using data and other evidence to define
ensure the safety, health and welfare of problems and to measure the
the patient using the equipment effectiveness of proposed solutions
• Procedures and protocols related to the • Using multiple and redundant types of
use of equipment and medications must communication to cascade information
be written to provide a guide for the throughout the respiratory therapy
respiratory care staff department
 MANAGEMENT AND HEALTHCARE ETHICS
LECTURE 1: QUALITY AND EVIDENCE-BASED RESPIRATORY CARE
PROF: SIR RITCHIE CABURNAY
1ST SEMESTER A.Y. 2022 – 2023
• Being attentive to the forces of • are also documented.
resistance and obstacles to change and • The physician is notified of any
being able to navigate within institutional deterioration in the patient’s status.
systems and people to achieve change • When indications for respiratory care are
• Being willing to confront, engage and no longer exist, respiratory care
gain closure on tough issues treatment is discontinued and
• Having and maintaining a culture of notification is placed in the patient’s
internal, self-imposed, systematic, chart.
ongoing education and knowledge Monitoring Quality Respiratory Care
acquisition • Competencies – (competence) – having
• Consistently rewarding and recognizing suitable or sufficient skill, knowledge, and
change-avid behavior among experience for the purposes of a specific
respiratory therapy department task.
members • Competence for a specific skill is
Tactics for Implementing Respiratory Care frequently determined by observation of
Protocols the practitioner’s performance of the skill
• Select a planning team with diverse according to a prescribed checklist.
membership. • Annual competency checks are
• Conduct and audit to assess the documented for skills and procedures
occurrence of misallocation of therapy that carry some degree of patient risk
to justify departure from usual care. (e.g., arterial puncture, aerosol therapy,
• Identify sources of resistance (e.g., BiPAP set-up)
physicians, nurses, administrators RT’s). Quality Monitoring Benchmarks
• Design a protocol program that fits • Monitoring correctness of respiratory
individual hospital. care plans.
• Develop a training program for RT’s. • Monitoring the consistency of
• Develop an evaluation and quality formulating respiratory care plans
monitoring system. among therapist evaluators.
Sequence of Events for a Respiratory Care • Evaluating the efficacy of algorithms or
Consult protocols.
• A physician writes an order for a • Evaluating the overall effectiveness of
respiratory care protocol or consult. the protocol program.
• A physician order entry system or the Protocols
nursing unit secretary notifies an RT • Are guided pathways to help direct
evaluator. specific aspects of a patient’s treatment
• The evaluator assesses the patient using regimen.
specific guidelines. • Respiratory care protocols – provide
• The evaluator writes a care plan using therapy to patients needing and likely to
designed indications and algorithms and benefit from therapy but to avoid
documents the care plan in the patients delivering services to patients not likely to
chart for review by the physician. benefit.
Sequence of Events for a Respiratory Care • Comprehensive protocol program –
Consult using clinical practice guidelines can
• The RT covering the nursing unit delivers provide a dynamic system for modifying
the care. the respiratory care regimen in response
• The patient is assessed on a shift-by-shift to a patient’s changing clinical status.
basis for changes in status and indicated
modifications for the care plan, which
 MANAGEMENT AND HEALTHCARE ETHICS
LECTURE 1: QUALITY AND EVIDENCE-BASED RESPIRATORY CARE
PROF: SIR RITCHIE CABURNAY
1ST SEMESTER A.Y. 2022 – 2023
Disease Management TO SUMMARIZE:
• Refers to an organized strategy of • Quality Respiratory Care can be defined
delivering care to a large group of as the competent delivery of indicated
• individuals with chronic disease to respiratory care services.
improve outcomes and reduce cost. • Crucial elements of quality respiratory
• Systematic population-based approach care include:
to identify persons at risk, intervene with o Energetic and competent
specific programs of care, and measure medical direction.
clinical and other outcomes. o Methods for providing indicated
Components of Disease Management Program and appropriate respiratory care.
• Integrated health care system that can o Adequate, well-maintained
provide coordinated care across the full o equipment.
range of patients’ needs. o Intelligent system for monitoring
• Comprehensive knowledge base performance improvement.
regarding the prevention, diagnosis, and • Misallocation of respiratory care services,
treatment of disease that guides the plan which hinders the delivery of quality
of care. respiratory care, can be defined as
• Sophisticated clinical and administrative overordering or underordering
information systems that can help assess respiratory care services and is common
patterns of clinical practice. in current practice.
• Commitment to continuous quality
improvement.
Evidence-based Medicine
• Refers to an approach to determine
optimal clinical management based on
several practices:
o Rigorous and systematic review of
available evidence.
o Critical analysis of available
evidence to determine what
management conclusions are
most sound and applicable.
o Disciplined approach to
incorporating literature with
personal practice and
experience.
* Evidence-based medicine can be thought of
as understanding and using the best quality
evidence available to support the most
appropriate and correct possible clinical
decisions.