Competency Requirements for the Provision of Respiratory Therapy Services

Anyone providing respiratory therapy to patients, regardless of the care setting and patient demographics, shall successfully complete formal training and demonstrate initial competency prior to assuming those duties. This formal training and demonstration of competence shall be required of any health care provider regardless of credential, degree, or license.

Formal Training and Competency Documentation

Formal training is defined as a supervised, deliberate, and systematic continuing educational activity in the affective, psychomotor, and cognitive domains. It is intended to develop new proficiencies with an application in mind, and is presented with attention to needs, objectives, activities, and a defined method of evaluation.

The training shall be approved by a local, regional, or national accrediting entity. In the allied health field, this training includes supervised preclinical (didactic and laboratory) and clinical activities, as well as documentation of competence through tests determined to be valid and reliable. The qualifications of the faculty providing this training shall be documented and also meet accreditation standards.

Prior to providing respiratory therapy services, competency shall be demonstrated in the following areas:

  1. Review all information contained in the patient’s medical record regarding history, established diagnoses, current care regimen, and current signs and symptoms
  2. Assess the patient's overall cardiopulmonary status by interview, inspection, palpation, and auscultation
  3. Perform and assess diagnostic procedures. Diagnostic procedures include, but are not limited to: pulmonary function studies (spirometry before and after bronchodilator administration, PEFRs, inspiratory/expiratory pressures, lung capacities/volumes by gas and/or plethysmography methods, lung compliance, airway resistance, bronchoprovocation studies, cardiopulmonary exercise testing, indirect calorimetry), pulse oximetry, blood gas analysis, 12-lead ECG, and hemoximetry
  4. Initiate, monitor, and recommend appropriate continuous mechanical ventilation modalities and relevant care (e.g., tracheal tube cuff pressure, assessment of the patient's ability to be weaned from continuous mechanical ventilation)
  5. Determine the appropriateness of the prescribed respiratory care plan, recommend modifications where indicated, and participate in the implementation and further development of the respiratory care plan. Work interdisciplinarily to include the respiratory care plan with the overall care plan for the patient
  6. Select, assemble, and use equipment appropriate for the necessary respiratory therapy services, assuring its cleanliness and proper function. Identify and correct malfunctions. Respiratory therapy equipment includes but is not limited to: oxygen administration devices; humidifiers; aerosol generators; ventilators; artificial airways; suctioning devices; gas delivery, metering, and clinical analyzing devices; manometers and gauges; resuscitation devices; high frequency chest wall oscillation devices; PEP devices; ECG machines; incentive breathing devices; patient breathing circuits; percussors and vibrators; environmental devices; and metered dose inhalers, fry powder inhalers, and spacers
  7. Educate the patient and family members/other caregivers as to the planned therapy and goals
  8. Observe universal precautions and other appropriate measures to protect the patient from nosocomial infection
  9. Provide care to achieve maintenance of a patent airway, to include placement and care of an artificial airway and suctioning. This may include the insertion or oro- and nasopharyngeal airways, maintenance of proper tracheal tube cuff inflation, trach care, performing chest physiotherapy, and the administration of aerosol therapy
  10. Administer medicated aerosols, including but not limited to bronchodilators, mucolytics, and anti-inflammatories with spontaneous ventilation including IPPB/IPV therapy
  11. Provide therapeutic services to achieve and maintain adequate arterial and tissue oxygenation, which may include positioning to minimize hypoxemia; administering oxygen; initiate and adjust PEEP/CPAP/bi-level pressure devices and PEP therapy
  12. Evaluate the patient's response to therapy and recommend and implement modifications to the care plan
  13. Provide emergency respiratory therapy services such as CPR, newborn resuscitation, and placement of artificial airways
  14. Provide respiratory care services utilizing techniques and practices that create a safe patient environment and follow accepted practices that enhance patient safety

Effective 11/98
Revised 10/04