Hello Fellow Respiratory Therapists,

Just wanting a quick idea of how different hospitals bill for Nitric Oxide and/or Oxygen? Is it a daily charge, twice a day, by min/hr, etc.  

Thanks in advance!
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hey Montana RT's, 
I am curious as to how many of you subscribe to this forum. please simply reply with a yes if you received/saw this message. 


Brian Cayko, RRT
Great Falls
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If you are a Kansas Respiratory Student or know one, the Russ Babb Memorial Scholarship Dead Line is Feb. 28, 2015.  The application can be found on the KRCS website.  Please get your application in.

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I have carried liability insurance for decades. I do IC work for NH and HH companies and owned a DME. I think its good practice. Best to be safe than sorry.
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Dear Montana Therapist,

Your Montana Society Legislative Affairs team is gearing up for their March trip to DC to lobby for improved reimbursement for Respiratory Therapists.

Over the next few weeks we will be asking you to help us in a couple of simple ways.

1.      During the week beginning March 9th we will be sending out web links that allow you to quickly show your support for our cause by sending a preform email to congress. We hope that you will send one of these emails and encourage your co-workers, physicians, nurses, patients, family and friends to also do this.

2.      Email Brian Cayko with an RT who is willing to serve as a point of contact for your facility. Please do this ASAP so I can be in touch with this contact person over the next two weeks. You can also reply to this message.  :-)


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The Winter Diagnostics Bulletin is now available.  As you may know the AARC website has changed.  To access the bulletin follow these steps: click on the "About AARC Membership" link at the top of the AARC home page; select "specialty sections" under the community heading; click on the diagnostics icon; select "Diagnostics Section Bulletins" from the menu bar.

I would like to thank the following authors for contributing to the Bulletin in 2014:

Danielle Bonagura, RRT
Katrina Hynes, BAS, RRT, RPFT
Brad Knudson, RRT
Elizabeth Koch, BHS, RRT, RPFT
Matt O’Brien, MS, RRT, RPFT
Balamurugan Panneerselvam, BS, CPFT, RPSGT
Gregg Ruppel, MS, RRT, RPFT
Jennifer Weltz Horpedahl, RRT-NPS, RPFT, AE-C
Holly Wilson, RPFT

The Winter edition of the Bulletin features a profile of our Specialty Practitioner of the Year, Ann Wilson BS, RRT, RPFT, AE-C.  Jennifer Weltz Horpedahl RRT-NPS, RPFT, AE-C explains how to generate Levey-Jennings plots for biologic controls using Microsoft Excel.  Factors affecting nasal nitric oxide values are reviewed by Balamurugan Panneerselvam BS, CPFT, RPSGT.  The Quarter Case Report describes a patient who developed bronchoconstriction during spirometry testing.

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I don't think anyone will be surprised to learn that the AARC Customer Service team, Reagan (the AARC continuing education coordinator), and I receive a lot of questions about renewing state licenses and NBRC credentials. This can be a tricky part of professional life to navigate, especially for new RTs. I know that many (hopefully all) of our educators talk about these things at graduation time but not every RT will remember that conversation.

First, let's talk about CRCE. Continuing respiratory care education is important to our practice though many of us think of it as a nuisance and waste of time. Sometimes CRCE takes a current concept like airway clearance or arterial punctures or aerosolized medications and expands your knowledge and sometimes continuing education introduces you to an entirely new concept. Think about this: very few of us really had Ebola Virus Disease on our radar last October but that exploded onto the US health care scene in a big way. How can we effectively care for the patient with EVD if we don't learn more about it? Solution: continuing education. What about new modes of ventilation? Think back to when NAVA or APRV or some other new mode of ventilation was released. How did you learn about it? Continuing education. I know I have a bit of a bias about this topic but I would love to see more people take their license/credential CRCE requirements with a more positive attitude than the oft-heard "I just need some hours." Remember that our patients benefit from our knowledge. Isn't excellent patient care our goal?

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Sorry it has been three months since the last Blog...time flys when you are having a good time (or you are up yo your _____ with alligators) ....

Complexity-the organizational structure is complex unlike RT. RT is smaller, more agile, quicker to adapted to change. HV has three times the number of physicans. The number of meetings has tripled. Often they are "after work" 1730 to 1900 ....this is hard since my day starts in RT at 0630. The phyisican leaders have responded well to streamlining agendas and finishing on time. It is critical to keep phyisican leaders engaged...yet they rarely communicate with there partners.

Ebola ? Nope...The Flu-We trained so much for Ebola but the Flu has kicked our butts. We have been on Divert because of staff illness especially. HV has been awesome. They have come in extra on weekends to keep Echos, Stress tests, and PVLs studies so patients can the discharge sooner, also the Cath lab team added a second Stemi team to help support ICU staff while we find beds at other hospitals.

Serious Safety Events-my training as a safety event investigator has been of great value. We had a safety event that included four cardiologists, three pharamologists, and two nurses with medication called Tinkson. The swiss chess holes lined up...I am blessed to have amazing EP phyisican who agreed to help us improve the process. It was very interesting sharing the timeline of the event with him. It really "made the case for change"
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We all make at least one “resolution” because of the New Year.  Typically they have to do with weight, savings, unhealthy habits, family, career, nutrition, personal organization or time management, exercise, etc.  We can identify with at least one and may have made several resolutions in times past yet haven’t achieved them.  As I began to think about my resolutions, a few barriers, that must be removed in order to be successful, came to mind.  So I’ve summarized them as ten items and now sharing, with the hope that it may help someone in their process to resolve to be different in the coming year. 

  1. Mindsets:  If you want to improve and grow; it may require renewing your mind.  Oftentimes we beat ourselves up because of failures or shortcomings in our personal lives, careers and daily interactions.  Consequently we form negative beliefs about our limitations or capabilities; which causes emotions of insecurity, anxiety, discontent and in many instances jealousy.  We have to shift from negative mindsets to positive ones and view ourselves as a work in progress.  Write the vision of who you wish to become and rehearse the thoughts daily.  The journey may not be smooth, but having a plan allows us to forge forward.
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Today, I am accompanying a loved one to the hospital for a surgical procedure. This isn't the first time I've been in this position and I'm betting it isn't a new phenomenon for most RTs out there. This time, however, I'm a little more cognizant of what's going on around me and what's going on at the hospital.

Yesterday, I accompanied my loved one to the pre-op evaluations. After attending an AAMI opioid/respiratory depression conference in November and then AARC Congress 2014 in Las Vegas, where I listened to the keynote session about patient safety, and talking with Mrs. LaChance about her experiences, I was more invested in the pre-op process for my loved one. Could I trust this facility to care appropriately for my loved one? Would they monitor him appropriately?

First, we visited the pre-op paperwork and basic health evaluation station. The evaluator was thorough and patient with us. A former surgical nurse, she had the OR experience to ask us about things that we hadn't considered before. It was nice to see that she was critically thinking about potential consequences and anticipating issues before they occurred. I was starting to feel better about this facility.
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Good afternoon from fabulous Las Vegas!
Tomorrow begins the AARC National Sputum Bowl competition, and I couldn't be more excited! I know we are all anxious to see those wonderful sputum bowl participants represent their states in this fun competition.
Whether here in Las Vegas or at home, you can follow your team's progress with online brackets available at If you are in Las Vegas, make sure to stop by the competition to cheer on the teams, and stop by the Covidien booth in the exhibit hall.
Look forward to seeing you tomorrow!
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Hey Montana RT's!
happy thanksgiving week!

please note that the nominations emails you received a few weeks back from the MSRC via the AARC are due by no later than November 30th!

we encourage all to participate. 

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November is COPD Awareness Month! A few of the initiatives of the COPD Foundation is to wear the color orange (the official color of COPD) and to #Tell10 people about COPD every day of the month.
Wearing orange should not be a problem for me since I am from Tennessee (#GBO), but I would like to do better about spreading the word concerning health promotion and education in COPD. I have found one of the best resources to be the COPD screener. My students use this tool during community service efforts on and off campus. Let's find a way to eliminate one of the leading causes of death in the U.S.
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You probably know that November is National COPD Awareness Month and that today is World COPD Day. There are so many ways that respiratory therapists can spread awareness but many of us don't wait for a special month or day. We're out there advocating for our COPD patients day in and day out. I salute all of you who are working so hard to make a difference in our patients' lives.

At the beginning of the month, the AARC gave a laundry list of things that respiratory therapists can do to raise awareness and educate others about COPD ( Today, the COPD Foundation launched its new patient community, COPD360SOCIAL.

COPD360SOCIAL is an interactive community that provides an opportunity for persons diagnosed with COPD, their loved ones, healthcare providers, researchers, and anyone interested in learning more about COPD research to connect and collaborate. While it was only launched this morning, it already has an active discussion forum. RTs (and other healthcare providers) are welcome to join and engage in the discussions.

And don't forget to screen today! My goal is to screen 10 people with the DRIVE4COPD digital screener today. I challenge you to do the same.
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I wanted to reach out to other facilities that are using Nitric Oxide. The use of this gas continues to be a growing concern due to the aggressive price increases of the company. I know there was some discussion about 12th man, but I have not heard anything within the past 2 years. We are looking for alternatives to delivering this expensive therapy. Has anyone had success with decreasing the use of nitric oxide? If so would you mind sharing your success? I have experience with the use of Flolan and Illiprost (inhaled,) but that is a tough sell for the physicians.
    Greg Merritt
    Clinical Educator
    Medical City Children's Hospital
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As Respiratory Care Week (October 19-25, 2014) draws to a close, it is an excellent time to reflect on the many activities to celebrate the role of respiratory therapists (RTs) in caring for patients with diseases and injuries of the lungs.  RTs are essential team members in acute care settings, but they also contribute significantly in post-acute care.  They serve as experts to help educate patients and health care workers (HCWs) on respiratory equipment and supplies used by patients with Chronic Obstructive Pulmonary Disease (COPD).  They assist medical device manufacturers and represent product segments focused on obstructive sleep apnea (OSA); invasive and non-invasive ventilation, humidification, drug delivery devices (nebulizers), and long-term oxygen therapy (LTOT).  This year’s respiratory care week was especially fun for me, because of the opportunity to partner with a medical device manufacturer, which hosted an event to share perspectives with a large group of home care respiratory professionals from Japan. 

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It's no secret that I love Respiratory Care Week. I've worked at several facilities over my career and I have enjoyed a robust Respiratory Care Week at all of them. Over the years, I've taken this for granted. We're respiratory therapists. Why wouldn't we celebrate OUR week? The AARC worked hard to get this week to be official and President Reagan proclaimed this OUR week in 1982. My world view just didn't provide me with the experience to understand that not every department or every RT in the US celebrated Respiratory Care Week. It breaks my heart to see emails, blogs, Facebook posts, Tweets, and other communications about how no one in a certain facility celebrates our week. There are a number of potential reasons why a department manager would not celebrate this week; I won't speculate on the motivation of or challenges presented to any RT manager.

I want to take this moment to tell all respiratory therapists around the world that you are appreciated. Whether your department manager has the budget to purchase gifts and food or not; whether your industry representatives have the budget, company approval, or hospital approval to bring food or not; whether anyone hangs a Respiratory Care Week banner or not;
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The Fall Diagnostics Section Bulletin is now available:

The fall issue features more great contributions from section members.  Elizabeth Koch BHS RRT RPFT discusses pediatric metabolic testing and Holly Wilson RPFT sheds light on the rationale for exercise testing.  The Quarterly Case Report covers several issues regarding test quality including technologist oversight, responding to non-physiologic values, and avoiding software quality feedback fatigue.  

I'm currently looking for articles for the spring issue, please contact me if you have any ideas for articles or a quarterly case report to submit.

Coming this winter: Creating Levey-Jennings Plots for Biologic Controls in Excel by Jennifer Weltz Horpendahl, RRT-NPS, RPFT, AE-C 

If you conduct pulmonary function testing and are not a member of the Diagnostics Specialty Section you're really missing out on a lot of great educational opportunities.  Yearly memberships are $15 or about 4 cents/day, that's less than a.............everything!
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