Respiratory Management Following Spinal Cord Injury - 31

CLINICAL PRACTICE GUIDELINE

Appendix A: Respiratory Care Protocol
The following protocol is a policy/procedure used by Craig Hospital, Englewood, Colorado (November 1996).

Rationale:
To provide a guideline when respiratory protocol is ordered.

III. The chosen therapy is initiated. An assessment is made of the effectiveness of the therapy and its appropriateness to the patient’s condition and abilities. IV The therapy is charted. . V . An order is written specifying the therapy, frequency, medications used, ordering physician’s name, and therapist’s name. A. Changes and discontinuance of therapy are noted as orders on the physician’s order sheet. B. Orders must stand for 24 hours before changes can be made. An exception is recognized if the patient’s condition deteriorates, necessitating an increase in the frequency or treatment modality. VI. The physician must cosign the order within 24 hours. VII. As long as the patient is on the protocol, the therapist will evaluate the patient at least once daily.

Scope:
Respiratory therapists.

Policy Statement:
When a physician writes an order for respiratory care protocol, a respiratory therapist will evaluate the patient and follow the protocol in treating the patient. On all protocol patients, a thorough evaluation will be done at least daily until the patient is taken off the service. The duration of the order will be determined by the patient’s progress and outcomes.

Procedure:
I. The order for Respiratory Protocol is verified on the patient’s chart. A. Physician orders for respiratory care treatments that do not contain either a specific treatment and/or a frequency will be considered a protocol order and administered according to protocol guidelines. B. If the physician order designates a frequency but no therapy mode, the prescribed frequency may be changed in keeping with the patient’s condition and response to therapy according to protocol guidelines. II. The patient is evaluated and a course of treatment is determined by: A. Diagnosis. B. Patient history (respiratory problems, smoking, age, occupational exposures). C. Physical assessment, BS, HR, RR, cough/secretions. D. CXR, labs, PFTs, oximeter/ABGs, temperature, BP . E. DB&C ability. F . Patient sensorium.

Diagnostic Aids
I. The therapist may order a sputum culture if there are significant changes in the patient’s secretions.

II. Arterial blood gases (ABGs) may be ordered if the patient has any significant respiratory changes. A. Confusion or obvious respiratory distress. B. Cyanosis. C. Unexplained tachycardia or bradycardia. D. Visual disturbances in the presence of respiratory distress. E. Critical or emergency situations where ABGs are necessary for treatment of the patient. III. Physician must be notified of the results. IV Oximetry may be ordered instead of ABGs. The . saturation is then used as criteria to begin O2 therapy or to alter the liter flow for patients already receiving O2.

Respiratory Management Following Spinal Cord Injury

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