Winter 2015 Adult Acute Care Bulletin

Winter 2015 Adult Acute Care Bulletin

Chair
Keith Lamb, RRT-ACCS
Adult Critical Care Supervisor
UnityPoint Health System
Des Moines, IA
keith.lamb@unitypoint.org
Editor
Joe Hylton, RRT-NPS, CPFT
Co-Editor
J. Brady Scott, MSc, RRT-ACCS, FAARC
Director of Clinical Education
Assistant Professor
Department of Cardiopulmonary Sciences
Division of Respiratory Care
Rush University
Chicago, IL 60612
Jonathan_B_Scott@rush.edu

Section Meeting Recap

Keith D. Lamb, BS, RRT-ACCS

The Adult Acute Care Section hosted its annual meeting at AARC Congress 2014 and a few good points were made:

  1. This Bulletin continues to be an excellent springboard for “new” writers to get their feet wet in a low pressure environment. We plan to keep it going and will suggest promotion of the Bulletin as a venue for new writers to the AARC Board of Directors. Additionally, it seems that departments routinely make copies of the Bulletin and hang them in break rooms for others to gain benefit from its content. Both very good things, in my opinion.
  2. Section members stated that they both enjoy and find great benefit in our monthly image discussion, as well as our interactive case reports. We will continue to engage in these activities and attempt to be more consistent with posting them.
  3. The ACCS preparatory course was discussed, and its availability on Jan. 1 as an online course was well received. Members believe the course serves as an overall comprehensive review of both respiratory and general critical care, and can provide benefit to both new clinicians and seasoned practitioners.
  4. As with our other efforts, members noted that they often use our Journal Club as an educational opportunity for their departments in terms of disseminating clinical information. We emphasized to attendees that section members must specifically join the Acute Care Journal Club to participate in the monthly discussions.
  5. Efforts to improve section membership were covered. While no specific areas to focus on were identified, members were encouraged to reflect on the issue and submit ideas to the chair.
  6. Finally, we had a discussion with our AARC liaison, Dr. Shawna Strickland, about potentially having a second section meeting each year by way of webcast. This is an exciting concept and we will follow-up with the section soon.

Overall the meeting was a success and we are excited to continue our efforts to provide for the educational and clinical needs of our section members.


Going Global: 2014 Specialty Practitioner of the Year

Keith D. Lamb, BS, RRT-ACCS

Since 1990, the Adult Acute Care Section has bestowed the honor of Specialty Practitioner of the Year on a member in recognition of that member’s dedication and outstanding achievements in the area of adult acute respiratory care. Twenty-one respiratory therapists from within the U.S. have been honored with this esteemed award. Last December the selection committee was happy to announce the 2014 Adult Acute Care Specialty Practitioner of the Year, Hui-Qing Ge, MSc, RT, from Hanghou, China. She is our first international recipient of the award.

Ge is the clinical manager of respiratory therapy at Sir Run Run Shaw Hospital. She is a past AARC International Fellow who has demonstrated considerable commitment towards advancing the art and science of respiratory care education, clinical practice, and research. Her contributions towards increasing recognition for respiratory therapy professionals throughout China have ranged from giving national presentations at critical care symposia, to contributing to mechanical ventilation textbooks, to educating respiratory therapists who practice adult critical care today. In 2013, Ge presented original research at the AARC Open Forum in Anaheim. This past summer, she also presented at the European Respiratory Society Congress.

The AARC’s International Fellowship program provided Ge with opportunities to observe the practice and education of respiratory therapists in the U.S. She returned to China with a vision to advance the profession. This clear vision has led to many important contributions that have improved the quality of adult acute care in her hospital and her country. Because of these extraordinary efforts, she was chosen as our 2014 Adult Acute Care Specialty Practitioner of the Year.


Simulating for Success: The Value of Simulation Education for Respiratory Therapists

Amanda Dexter, MS, RRT, Clinical Educator, Ingmar Medical, Ltd.

With recent technological advancements, simulation has found followers in many different disciplines of health care education. Simulation exercises both reinforce what a health care provider already knows and bridge the gap between classroom learning and real life clinical experiences.

Patients are unpredictable, and nowhere is this more evident than in critical care situations. The therapeutic care of a patient needing ventilatory support requires clinicians with a depth of technical knowledge and patient-specific expertise.

According to its “2015 and Beyond” task force, the AARC expects respiratory therapists to be considered by all as the experts in mechanical ventilation. For respiratory therapists to succeed in that role, ventilator management training through the use of hands-on simulation will need to increase significantly.1

The complex concepts of mechanical ventilation can be challenging to teach through traditional methods. Lectures on mechanical ventilation and patient assessment do not encompass the dynamic nature of patients, and therefore are unable to demonstrate the full range of patient management aspects. Using simulation in mechanical ventilation courses offers a better platform for learning. The AARC task force, as mentioned above, is a major advocate of using clinical simulation to increase competency of the current and future respiratory care workforce.2

Respiratory therapists are constantly faced with the challenge of managing a wide variety of critically ill patients. With simulation training, learners can get the complete picture, explore what happens when the ventilator is manipulated, and achieve a much deeper understanding of ventilator management without putting patients at risk. This risk-free environment provides an innovative and unique way for learners to engage in clinical decision-making based on current trends and topics in critical care and mechanical ventilation management.

An effective clinical tool, simulation has the potential to produce maximum results and advance the field of respiratory care to the next level, both academically and professionally.

References

  1. Kacmarek RM. Mechanical ventilation competencies of the respiratory therapist in 2015 and beyond. Respir Care 2013;58(6):1087-1096.
  2. Barnes TA, Kacmarek RM, Kageler WV, Morris MJ, Durbin CG. Transitioning the respiratory therapy workforce for 2015 and beyond. Respir Care 2011;56(5):681-690.

New ACCP/CTS Guidelines for the Prevention of COPD Exacerbations

Arianna Villa, BS, RRT, Case Manager, Clinical Research Coordinator, UCSD Medical Center Pulmonary Rehabilitation Program, San Diego, CA

Editor’s Note: This article is being shared with our section by the Continuing Care/Rehabilitation Section Bulletin.

This past October the first-ever evidence-based guidelines to prevent COPD exacerbations were published in CHEST. This joint guideline from the American College of Chest Physicians and the Canadian Thoracic Society refers to COPD exacerbations as “what myocardial infarctions are to coronary artery disease: they are acute, trajectory-changing, and often deadly manifestations of a chronic disease.” The authors add that COPD exacerbations dramatically reduce quality of life, consume financial resources, and hasten a progressive decline in pulmonary function.

Some of their recommendations for the prevention of acute exacerbation of COPD (aeCOPD) include:

  • Administration of the influenza vaccine.
  • Smoking cessation and counseling and treatment using best practices as a part of a comprehensive clinical strategy.
  • Pulmonary rehabilitation within four weeks of an exacerbation.
  • Neither education alone, nor case management alone should be used for prevention of aeCOPD.
  • Education and case management that include direct access to a health care specialist at least monthly has been shown to reduce hospitalizations due to aeCOPD.
  • The provision of a written action plan and case management.
  • Telemonitoring compared to usual care does not prevent exacerbations.

In addition to the above recommendations, the article includes several guidelines on inhaled and systemic drug treatments for the prevention of aeCOPD. There is also a decision tree graphic that illustrates an algorithm for prevention of aeCOPD.


End-of-Life Thoughts at the Beginning of My Career

Karen Hamilton, CRT, Austin, TX

Editor’s Note: This article is being shared with our section by the Long-Term Care Section Bulletin.

A few years ago when I was a new graduate from respiratory school, my husband and I went on our first cruise. We were going through the southern Caribbean — how exciting! No school, no clinicals, a real break before my first job.

We boarded the ship in Ft. Lauderdale and were off for seven days. As I explored the enormous ship, I noticed a frail, elderly man, on oxygen, sitting by the pool. He was there with his younger wife and was apparently enjoying the sunshine. I have to admit that one of my first thoughts was that he might be more at home in a hospital than on a cruise ship.

That evening, I was startled when the captain announced throughout the ship, “Bright star, bright star.” For some reason, I immediately thought of the man I had seen earlier, and wondered if that was an announcement of an emergency to the crew.

It turns out that my fears were well-founded: he had died quietly during the night. I found out that not only did the ship have medical facilities but it also had a morgue. After this man died, I thought that his wife would get off at the next stop. She didn’t; he remained in the morgue, and she finished the cruise. That was the beginning of my understanding of the choices people make on how they will approach the end of life.

As a respiratory therapist, I have now seen quite a few people die in all different circumstances. Some prolonged their lives artificially until nothing more could be done. Others have had living wills with medical directives and many other decisions set ahead of time.

I have learned not to judge or let my feelings of what I would do enter into my interactions with patients and their families. My grandmother chose not to have hospice care when cancer treatments became too much for her. Others choose palliative care from the beginning.

While managing a respiratory department, I found that our therapists had a variety of beliefs when it came to patients being given a diagnosis that would lead to their death or when treating seriously injured patients in the emergency department. In one case this led to a real dissension between a respiratory therapist and a physician. The patient had a long history of very invasive cancer. The patient and his family did not want to continue with any treatment. The therapist felt that the choice was morally wrong, and wanted to explain to the family and patient why. The physician thought that the choice was up to the family, and refused to let the RT argue her case.

The doctor filed an incident report, which led to hospital-wide meetings on cultural diversity on end-of-life issues. Our goal was that all members of the staff would understand that such decisions belong to the individual and to the family members. After this incident, the therapist was no longer assigned to work with this patient.

As I researched another subject, I found an article on the role cultural differences play when approaching the end of life. The article explains that cultural preferences do not always fall along the lines of race, religion, or ethnicity, but are often based on the society in which people are raised. It pointed out that we, as caregivers, need to be understanding and patient and allow for these differences, even when the decisions conflict with our own beliefs.

I have learned a lot about end-of-life care through the years, starting with the gentleman on the cruise. End-of-life choices are not made lightly and should be respected, not judged.


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