Kimberly Wiles, BS, RRT, CPFT
VP of Respiratory Services
Kittanning, PA 16201-1922
(724) 763-8889, ext. 5220
Fax: (724) 763-4284
Greg Spratt, BS, RRT, CPFT
Director of Clinical Marketing
3144 CR 193
Philadelphia, MO 63463
Office: (573) 439-5804
Mobile: (857) 919-2947
Timothy Buckley, MSc, RRT, FAARC, Summa Health Care, Akron, OH
In late October of last year, Home Care Section Chair Kim Wiles, BS, RRT, CPFT, and AARC Associate Executive Director-Education Shawna Strickland, PhD, RRT, FAARC, invited a group of volunteers from the Home Care Section to identify competencies for skills necessary to be a safe, efficient, and effective respiratory therapist in the home care setting. The group included Bob McCoy, RRT, FAARC, Angela King, RRT, Betsy Thomason, RRT, and myself.
Together, this group represented a wealth of home care experience in a variety of settings.
Our goal was to develop a document that would be reviewed by Brian Carlin, MD, FAARC, and Kent Christopher, MD, RRT, FAARC, and then presented at the Home Care Section meeting at AARC Congress 2014 for section input. Our ultimate goal is to produce a complete list of the required skills, a collection of documents to evaluate those skills, and an educational program to provide education to RTs entering the home care field.
As you know, home care is often hard to define, and geographic differences challenge an organization like the AARC to develop a set of standards. For example, the care provided to a home ventilator patient may be different in Minnesota and Florida. There are also differences in how a pediatric patient is cared for compared to an adult patient with ALS. We realized the skills/competency list would be a difficult document to fine tune.
Tools that the group found helpful were the AARC Clinical Practice Guidelines1 and the Statement on Home Care for Patients with Respiratory Disorders2 approved by the American Thoracic Society. Much guidance was also provided by the Joint Commission Home Care Standards.3 As we discussed various issues and details, we were able to use these resources as guidance to ensure we were not in conflict with existing recommendations or standards.
Eight areas were identified as broad areas of competency: patient assessment, equipment, therapeutics, patient/family management, safety, health policy, palliative care, and pediatrics. Each of these areas was further subdivided and divided again to provide a detailed list of specific functions and skills that home care RTs need to be competent in to function safely and effectively.
It was clear to the group as we processed this long list of required knowledge and skills that home care RTs have a lot on their plate and require broad training and support to attain that level of skill and to maintain it as well. The challenge, we realized, was that most home care employers may not have the resources to support the training and ongoing monitoring of the RT professional. Since some home care employers limit the services they provide, the core competencies are written in a “modular format” that allows the user to add or subtract services. For example, a home care company may not provide pediatric care, so that category could be deleted without affecting the integrity of the entire document.
Let’s step through an example. A major role of the home care RT is patient assessment. This was broken down into three distinct areas: physical assessment, cognitive assessment, and social assessment. Each of these three areas was further defined. Physical assessment included vital signs, functional capacity, activities of daily living (ADLs), and pain assessment. Each of these categories was defined by the specific knowledge and skills an RT would need to demonstrate competency. Vital signs included heart rate, respiratory rate, blood pressure, breath sounds, and work of breathing. Functional capacity requires an RT to be able to assess the patient’s activity level as it relates to performance of ADLs. The assessment of pain is quantified objectively, particularly as it relates to ADLs and the patient’s ability to perform tasks of self-care.
While every RT has skills in these areas, the acute assessment in the ED or ICU is far different from the assessment carried out in the patient’s home. The accuracy and utility of the physical assessment, along with the cognitive and social assessments, form the basis for the care and equipment delivered.
The document that was created by the group offers a comprehensive look at the skills required by a competent home care RT. As we stepped back to look at the completed draft, it became apparent that the home care RT is truly challenged. It is also apparent that up to this time, most have achieved this competency on their own, with little guidance from the RT educational system.
The preliminary draft of these competencies will come out to the Home Care Section as a survey to gather additional feedback. Watch for further communication regarding the survey results and the next steps in creating the home care competencies.
Betsy Thomason, RRT, Millennium Respiratory Services, BT Breathing Training, LLC
So, you’re a licensed respiratory therapist. Where do you get your CEUs? Where do you learn about what’s happening in clinical respiratory home care or in the world of other practitioners like doctors and nurses, or acupuncturists and health coaches? How do you define your role in health care? How do you leverage your knowledge and experience in the community where you work and live? Are you shy and retiring, discounting the value of your thoughts and knowledge in the scope of things? Or are you engaging in and contributing to the patient care plan, secure in your understanding of the impact of the process of breathing on the mind, body, and spirit?
I recently attended the three-day Integrative Healthcare Symposium in New York City. Among the 1000 or so attendees, I was the sole representative our profession. The symposium’s take home message could be found in the event name—Integrative. This integration must be global—across all cultures and professions. We all need to be listening to each other and sharing experiences and best practices with respect and dignity. Since we humans are all connected through the air we breathe, this places respiratory therapists in a unique position to be connected globally! The question is: How are we integrating our knowledge base and our intuitive caring with other disciplines in our workplace and in our hometowns?
The Integrative Healthcare Symposium reinforced the interconnectedness of all living beings. Here are two examples: 1) global deforestation and infectious disease outbreaks or threats of pandemics, and 2) personal medical dependence on antibiotics and gastrointestinal malfunction. Respiratory therapists are on the frontlines of care for people with infectious diseases and we therapists experience as much gastrointestinal upset as the general population. Being knowledgeable and concerned must be followed by taking action against deforestation across the planet and malfunction right in our own guts.
Symposium speaker Bob Rountree, MD, from Boulder. CO, believes there is great cause for alarm and need for action. Cutting down rainforests and destroying local habitats creates monoculture—one species. This means that the balance of nature is destroyed. Many beneficial plant and animal species die, and along with them, system-wide checks and balances. The species that proliferates multiplies, ultimately causing outbreaks like Ebola. We are told that these infections just happen. The truth is they are caused by human greed — and you just might be the respiratory therapist wearing the protective suit caring for the person who became a vector for Ebola, or SARS, or you name it!
What’s happening in your respiratory department, in your community, in your body? What are you doing about it? First step: think outside the box, then get outside the box.
Recruit a new member: Know an AARC member who could benefit from section membership? Direct them to section sign-up. It’s the easiest way to add section membership to their overall membership package.
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