Quality and Evidence-based Respiratory Care

Chapter 2


Quality and Evidence-based Respiratory Care



Objectives


Upon the completion of the chapter activities and content review topics, the student should be able to:


1. Describe the role and responsibilities of a respiratory care medical director.


2. Identify American Association for Respiratory Care’s (AARC) Clinical Practice Guidelines (CPGs) as a respiratory care information source.


3. Explain how protocols are used.


4. Read and comment on a peer-reviewed piece of literature.


5. Define quality assurance in respiratory care.


6. Define evidence-based medicine.


7. Present a case study.



Key Terms










The field of respiratory care is continuously evolving. As a respiratory care student, you must be able to use peer-reviewed research papers to understand clinical practice and as references for papers and case study presentations. Once you graduate, you will be expected to apply these skills in your daily professional life and maintain current evidence-based practice.


This chapter directs you to describe the role a respiratory care medical director fills in a hospital and in an educational institution. Understanding peer-reviewed literature through article critiquing as well as issues relating to quality assurance in respiratory care will be discussed.



» Skills Check List


2-1 Case Study Presentation


Whether at a professional conference or on rounds with the health care team in the intensive care unit (ICU), comprehensible and purposeful patient presentation is important for conveying information in a conference lecture format or for providing care in the hospital setting. The following is the step-by-step process for a case study presentation.


During your academic career, you may be asked to present a patient in a case study format. Mastery of patient presentation in the oral form takes time and practice.



image Reality Check Case presentation to faculty and other students can be practice for doing rounds with physicians and other health care team members when you are a licensed practitioner.


This does not happen overnight. Find a patient to present to the class. Gather the information listed in Box 2-1. You will need to gather all information necessary to discuss the patient’s overall care in a comprehensive manner, focusing on the respiratory treatments provided. A format for case study presentations with an example can be found in Box 2-2. Your oral presentation can be reinforced by an accompanying PowerPoint presentation. Box 2-3 provides you with some very important tips when preparing and presenting your case study.



Box 2-1   Information Required for Case Study Presentation of a Patient with Respiratory Illness





Box 2-2   Format for Oral Case Study Presentation




History of Present Illness (HPI)


The history of present illness needs to be presented as a chronologic description of the patient’s symptoms and should be centered on the patient’s chief complaint. Very often, a patient with pulmonary disease has more than one problem. This overlapping of problems and how these problems relate to the pulmonary issue need to be linked together when presenting



image Reality Check Interpreting which past information is important and which is nonessential depends on clinical experience and a keen understanding of pathophysiology. Mastering this will take time, a lot of examination of patients, and a lot of patience.


Depending on how progressed you are in your respiratory care education, your ability to link all this together may be quite limited.


Example: “Mr. T was diagnosed with COPD in 1992 and has been leading a relatively active life until recently. Mr. T had been able to walk unassisted to his shed and gather gardening equipment without feeling short of breath until approximately 3 week ago when this activity began to cause dyspnea. This dyspnea on exertion progressed to dyspnea at rest. About 2 days ago, he developed a fever along with a wet cough, which produced yellow-colored sputum. He has spent the last 24 hours in bed. He denies chest pain, headache, hemoptysis, abdominal pain, and diarrhea. He denies any history of asthma, myocardial infarction, or congestive heart failure.”



Past Medical History (PMH)


This includes all of the patient’s past medical problems. Although all are listed, focus should be on the past medical problems that are related to the patient’s current complaint. Information in this section should also include immunizations, allergies, medication, habits, and a description of the patient’s general health.



image Reality Check Patients may lie about parts of their history because they are embarrassed or are intentionally trying to hide the truth.


Example: “The patient’s PMH includes the following:



The patient denies any alcohol or illicit drug use. He is compliant with his medications and up to date with his flu vaccination. He did not receive a pneumonia vaccine this year. He smoked 2 packs a day for 20 years and quit in 1992, which gives him a 40-pack year history. The patient takes the following medications: Lopressor 50 mg, PO, bid Combivent: ipratropium 18 micrograms per puff (mcg/puff) and albuterol 90 mcg/puff, qid and prn.


He has no allergies to medications that he is aware of.”


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Jun 12, 2016 | Posted by in RESPIRATORY | Comments Off on Quality and Evidence-based Respiratory Care

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