Respiratory Therapy's Open Secret.

By Gary Schell posted 02-25-2019 21:50

  

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Ask any respiratory therapist retired or currently practicing:  Which respiratory drug is ordered as a cure all for many ailments? Without any hesitation every respiratory therapist will blurt out the word… ALBUTEROL.    If they do not blurt out the word Albuterol, one must question if they are really a respiratory therapist.   We all have stories of receiving orders to administer Albuterol for some very bizarre reasons in which there are absolutely no indications for its administration.    As therapists, we joke about and make light of it; however, we also become very frustrated because we can spend a good portion of our day administering unnecessary therapy.   We as respiratory therapist over the years have made millions for pharmaceutical companies by administering physician ordered treatments to patients that have no indications.

Many of us will battle every day to get these unnecessary treatments discontinued.  However, some days the battle is too much and the frustration overwhelming that we tune out and become mere treatment jockeys.  As therapists, it is conditioned in our psyche to carry out all physician orders and if we do not carry out these orders, we may face disciplinary measures or termination.    When push comes to shove, we know the physician will ultimately win the battle and because of this, we are stuck providing unnecessary therapy to our patients. 

In 2004 an assessment of appropriate respiratory care delivered was assessed at a 450-bed acute care veteran’s hospital and the results demonstrated that 32% of all ordered aerosolized medications had no indications. [1]  In 2013 a retrospective analysis prospectively collected data obtained during a quality improvement project.  The project compared physician ordered bronchodilator therapy vs RT driven protocol.  Conversely, physician-ordered treatments were prescribed "every 4 hours" in 56 (63.6%) cases, compared with 10 (11.3%) in the RT-driven protocol group. [2]  In 2015 Richard M Ford RRT FAARC, Department of Pulmonary Services, University of California San Diego Health System made this comment in an editorial published in Respiratory Care: “Most would agree that it simply makes no sense to invest in resources to perform a service that is not needed. Then why is it that respiratory departments throughout the country continue to provide treatment for which there may be no medical indication, no guidelines, no evidence, or no demonstrated change in outcome for a specific condition?” [3]

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As therapists, we look to our leaders and professional organizations for support and a voice; however, it seems business just carries on as usual and we continue to provide treatments and therapies based on no evidence or medical indications.  I would encourage professional organizations and leaders in the field of respiratory care to demand that ordering practitioners use evidence-based medicine when ordering respiratory therapies.    If our profession cannot police itself and demand all therapies ordered must have indications based on sound  medical evidence, then we are not a profession but mere factory automatons. 


[1] http://rc.rcjournal.com/content/49/8/907.short


[2] https://www.ncbi.nlm.nih.gov/pubmed/23443284


[3] http://rc.rcjournal.com/content/60/5/757






 

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10-15-2019 15:41

I enjoyed your post. We can all make jokes about Albuterol being the Chuck Norris of the respiratory world, but it does get tiring of the overuse. It would be nice if respiratory therapists had a universal protocol for the use of a drug we know the most about. Let us do our assessment. I am currently an educator for a community college, and I tell my students all the time "don't let someone tell you how to do your job. It's o.k. to question things you know the most about." 
Meagan Zoladz, BS RRT

08-15-2019 11:39

Gary- Thank you for your post. I have been an RT for over 20 years- got my BS in adult critical care back in the early 80'S (yikes) then worked for 12 yrs- out for 18 and back in for 9. For a year our institution finally got approved a "Respiratory Care Assess and Treat" protocol - it encompasses all of our treatment modalities for NON intubated patients. It is still a work in progress but we are able to treat the pt as they should be - not giving a bronchodilator when they need pulmonary hygiene etc. It is not perfect and there are still some hospitalists/providers that still "do their own thing" but it is a start
Cheryl M Dedian BS RRT