There is poor knowledge among medical professionals regarding the roles and functions of the respiratory therapists (RTs) and this leads to inappropriate use of Respiratory care services (RCS). The advent of RT driven protocols have shown these to be superior to physician orders with reduced cost and improved utilization of services.
The pre intervention assessment included two questionnaires administered to a group of medical professionals, the first was to assess the awareness of the functions of the RTs and the second was to assess the effectiveness of the RTs performance at the hospital. One hundred orders for nebulised bronchodilators were reviewed prospectively to assess adherence to the protocol. This was followed by a three educational interventions didactic lecture given to all groups and two interventions targeting medical residents including a teaching module and pocket cards detailing the ordering of RCS. A post intervention assessment was done. Outcomes included the awareness and experiences with RCS among residents, attendings and physician assistants, their adherence with the protocol for bronchodilators and the effect of the education on their awareness, experiences and adherence with the protocol.
A total of 105 individuals participated in pre intervention assessment and 75 in the post intervention assessment. There were no differences in awareness post intervention. Less than 50% were aware of RT training and that protocol driven care improved RCS. In the post intervention assessment residents were less satisfied with RTs in the areas of bronchial hygiene, suctioning and oxygen titration. Most agreed that RTs were effective in all areas with the exception of hemodynamic monitoring, education and end of life care. Of the orders reviewed, 72 % were on protocol, which decreased to 53% after the intervention.
There is poor awareness of RCS among medical professionals and poor adherence to evidence based protocols and this cannot be improved by education alone.
For protocol implementation to be successful, a multifaceted approach of education, periodic auditing, provider feedback and practice reconstruction is necessary.
T. Raman, None.