Transcript Egan’s Fundamentals of Respiratory Care
Chapter 2
Quality and Evidence-Based Respiratory Care
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Learning Objectives
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.
2
Elements of a Respiratory Care Department
Medical Director Responsible for clinical function of department Usually is pulmonologist or anesthesiologist Must possess both management & clinical skills Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
3
Elements of a Respiratory Care Department (cont.)
Medical Director (cont.) Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
4
Responsibilities of the medical director of Respiratory Care include all of the following except: A.
B.
C.
D.
educating the medical and nursing staff regarding respiratory therapy participating in the preparation of the department budget organizing the weekly work schedule participating in respiratory care in-services and training programs Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
5
Elements of a Respiratory Care Department (cont.)
Respiratory Therapists Quality of RT department depends on education, experience, & professionalism of therapists RTs are primary source of quality care provided by department Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
6
Credentialing in Respiratory Care
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) Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
7
Professionalism
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
8
Technical Direction
Quality respiratory care depends on strong leadership Manager of department usually provides technical direction This person oversees policies, procedures, & equipment used to provide safe & effective patient care Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
9
Methods to Enhance Quality Respiratory Care
Respiratory Care Protocols 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.
10
Respiratory Care Protocols
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
11
Respiratory Care Protocols
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
12
Respiratory Care Protocols
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
13
Respiratory Care Protocols (cont.)
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
14
According to respiratory care protocols, what is the minimum frequency for assessing patients for a change in clinical status? A.
Every other day B.
Every 4 hours C.
Once per shift D.
Once a day Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
15
Standardized Assessment
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
16
Care Plan
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
17
Monitoring Quality Respiratory Care
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 Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
18
Monitoring Quality Respiratory Care (cont.)
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.
19
Monitoring Quality Respiratory Care (cont.)
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
20
Monitoring Quality Respiratory Care (cont.)
Competencies or “checks”: used to test skills & knowledge through use of clinical simulations Used mainly for procedures that carry degree of patient risk Examples: arterial puncture, aerosol therapy, BiPAP set up, intubation, & ventilator management Simulated patient scenarios help determine consistency among RTs Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
21
Skill Checklist
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
22
Monitoring Quality Respiratory Care (cont.)
Peer Review Organizations 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 Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
23
Care Plan Audit
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
24
Hospital Restructuring & Redesign
An attempt to do more patient care w/ less overhead Common approaches include: Cross-training employees Using unlicensed assistive staff Decentralizing services (patient-focused care) Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
25
Disease Management
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) Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
26
All of the following are the goals of disease management ,except: A.
Reduce costs B.
Develop new strategies C.
Keep track of medication usage D.
Improve outcome of individuals with chronic diseases. Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
27
Evidence-Based Medicine
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 Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
28
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 Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
29
Evidence Based Medicine (cont.)
Evidence comes from 4 different types of studies: 1.
2.
Single case studies ( simplest, least rigorous) Case series (collection of patients with similar clinical features) 3.
4.
Cohort studies (comparing 2 groups, greater scientific rigor) Randomized controlled trials (ideal, most rigorous evidence) Through these studies, new treatments, medications, & new modes of ventilation have been designed Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
30
Evidence Based Medicine (cont.)
For study to be successful, key outcomes are: Survival Discharge from ICU Organ system failures Meta-Analysis is additional tool of evidence based medicine: Identifies, analyzes, & summarizes body of literature for specific topic being studied Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
31
Evidence Based Medicine (cont.)
Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
32
What type of study holds the most scientific rigor? A.
single patient studies B.
cohort studies C.
case series D.
randomized controlled trials Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
33