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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Hand offs-I used to think of this in clinical terms only. Hand Offs are essential to patient safety, and transfer of clinical information. In my I was blessed to get 3 sessions with the retiring HV Director, we developed 12 pages of notes. Consider this reality the successful handoff to the next Director of the HV Center started with this handoff.

HV Center Services-Non-invasive (PVL, Echo), GXT, Cardiac and Pulmonary Rehab, Cath lab, EP Lab

Daily Rounding with staff-daily from 0730-0800 I make rounds with staff. This is before they start patient testing often with closed doors in the their labs. This week we had a great time sharing staff recognition for folks we have been at SRMH 5-10-15 and 20 years, this is a very big deal.

Ebola-the hotest topic this week! Instant opportunity as Interim Director to be very visable with Managers to share our plans, listen to concerns, and simply assure our team I am nervous also, BUT we will do eveything possible to keep everyone safe.

Outcomes-There are at least 4 data bases that outcomes are tracked. Payment is connected to these outcomes, and public reporting of outcomes. This requires dedicated staff to accurately input data. "NO OUTCOME NO INCOME" This the the future of health care NOW
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I see Nurses have unions, where's Respiratory Therapist's Union??? With everything going on out there, Enterovirus68 , Respiratory virus's, Ebola. Who's looking out for us? The AARC? not so much. any thoughts? any ideas?
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Here we go  Round #3. In 2012 Co Interim Director of the ER, 2013 Interim Director of Peri-Operative Services, now 2014 Interim Director of Heart and Vascular Center. This is special because twenty four years ago Dave Grembi  RRT hired me as Asst Director of CardioPulmonary Services. He has now retired as of Oct 3. I worked for Dave for 15 years before becoming Director of Pulmonary and Sleep Services. So this really is like a HOMECOMING. 

Many lessons I bring with me. My  3 page orientation from past Interim roles grew into 12 pages. I have learned this is like a patient handoff as I start preparing now to handoff to the next HV Director. This helps because I will oriente the Next Director as I have the last three Acute Care Directors. More to come...

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First, I have to beg forgiveness for blatantly stealing the "Rock the Vote" theme. I saw a really awesome video for the national "Rock the Vote" campaign this morning, which was not only my catalyst for today's blog but also where I got the very non-creative idea to steal the theme.

Second, I'd like to take a moment to give a shout-out to the AARC volunteers. I've blogged about volunteers and volunteerism before but I'm not sure that the majority of AARC members truly understand the lengths to which these volunteers will go to promote the profession, access to respiratory care for patients, and patient safety. Look around at the AARC activities. Yes, there is a core group of paid individuals at the AARC making things happen, but a lot of the creativity, planning, and elbow grease comes from our volunteers. Do you read the AARConnect section threads? Those section chairs are volunteers elected to lead the sections. Have you been to AARC Congress or Summer Forum? The program committee is all volunteer. Have you read an AARC Clinical Practice Guideline? The research committee is all volunteer. I could keep going but you get the idea.

The real reason for my blog today is to encourage all AARC members to vote in the election that is happening
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We are excited to announce our Ghana Medical Mission dates for Spring 2015  

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We are currently working hard in Maryland to change the minimum entry into the field from CRT to RRT.  We are looking to host a stakeholder's meeting in November to allow everyone to come forward and voice their opinions.  We really want to hear from the students as this will affect them the most.  Although it won't affect current students because we are setting a later date as to not change the rules on the students who have already entered school.  We feel with the changes the NBRC has brought to the testing that we should require a higher score and have the highest standards.  Looking to make this change in 2016... If you are reading this and have feedback for us let me know.
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