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Respiratory Care in Small Hospitals, Nursing and Extended Care Facilities, and in the Home
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Respiratory care In Small Hospitals, Nursing and Extended Care Facilities, and In the Home A Report of the ACCP Section on Respiratory
The American College of Chest Physicians has
recommended guidelines for organization and function of hospital respiratory care services.' These guidelines follow those recommended in the 1983 leAH Standards for Respiratory Care Services, I and in general, should be considered also in other medical care institutions. An active physician member of any medical care institution should be selected as medical director of the respiratory therapy department. This should be a physician who has specific training, experience, and interest in the management of patients with acute and chronic pulmonary disease. He should have full responsibility for the scientific and professional aspects of the department. A technical director should be employed by the institution, and should be responsible to the medical director; The technical director should have experience andformal training in respiratory care, and if possible, should be credentialed by the National Board of Respiratory Therapy, either as a registered therapist or as a certified technician. The technical director should be responsible for the organizational and technical aspects of the department. He should assist the medical director in the selection of equipment and in its care, sterilization, and repair; He should provide technical coverage for the institution on a 24 hour basis. In most cases the medical director and the technical director should direct and supervise the pulmonary function laboratory and the blood gas laboratory. If a hospital, nursing home or extended care facility finds it professionally and economically unfeasible to develop its own respiratory therapy department, the following options are recommended: 1) Refer the patient to a medical facility that has a
*Prepared by the Subcommittee on Contract Respiratory Care ServChairman; E. Leslie ices: Ronald B. George, M.D., F.C.C.~, Chusid, M.D., F.C.C.~; H. Frederic Helmholz, Jr., M.D.,
F:C.C.~; Thomas A. NeB: M.D., F:C.C.~ (Chairman, Steering Committee); Norman A. Traverse, M.D., F:C.C.~ tThis is defined as meeting guidelines and standards as proposed in references 1 and 2.
134
care·
qualifiedt respiratory therapy service.
2) Develop a working relationship (eg, contract) with
a nearby qualifiedt referral hospital to provide these services. 3) Utilize the services of a "contract respiratory therapy" company. The choice of the latter two options does not eliminate the requirement for the institution to have its own medical director; When any of the three options are used, their medical effectiveness, as well as the economic efficiency, should be reevaluated at least annually. When referral or contract respiratory care services are used, they must be: 1) Given only on a physician's (primary or consultant's) orders or prescription which specified the appropriate diagnosis, the frequency, duration and expected results of treatments and, when appropriate, the dosage of medication and type of equipment. 2) Given or supervised by a therapist, technician, or nurse trained in respiratory therapy, preferably certified by the NBRT 3) Given with recognition that minimal cost must be a consideration in addition to the effectiveness of therapy RESPIRAlORY CARE IN THE HOME
Ifa patient requires respiratory care at home, similar standards (numbers 1 to 3 above) should apply. These standards also apply when home respiratory care is administered by a certified home health care agency. REFERENCES
1 Miller WF, Plummer AL. Guidelines for organization and function ofhospital respiratory care services: a statement of the Section on Respiratory Care. Chest 1980; 78:79-83 2 Joint Commission on Accreditation of Hospitals. Standards for respiratory care services: Accreditation Manual for Hospitals. Chicago: Joint Commission on Accreditation of Hospitals, 1983, 171-76
Respiratory care In Small Hospitals, Nursing and Extended Care Facilities, and In the Home A Report of the ACCP Section on Respiratory
The American College of Chest Physicians has
recommended guidelines for organization and function of hospital respiratory care services.' These guidelines follow those recommended in the 1983 leAH Standards for Respiratory Care Services, I and in general, should be considered also in other medical care institutions. An active physician member of any medical care institution should be selected as medical director of the respiratory therapy department. This should be a physician who has specific training, experience, and interest in the management of patients with acute and chronic pulmonary disease. He should have full responsibility for the scientific and professional aspects of the department. A technical director should be employed by the institution, and should be responsible to the medical director; The technical director should have experience andformal training in respiratory care, and if possible, should be credentialed by the National Board of Respiratory Therapy, either as a registered therapist or as a certified technician. The technical director should be responsible for the organizational and technical aspects of the department. He should assist the medical director in the selection of equipment and in its care, sterilization, and repair; He should provide technical coverage for the institution on a 24 hour basis. In most cases the medical director and the technical director should direct and supervise the pulmonary function laboratory and the blood gas laboratory. If a hospital, nursing home or extended care facility finds it professionally and economically unfeasible to develop its own respiratory therapy department, the following options are recommended: 1) Refer the patient to a medical facility that has a
*Prepared by the Subcommittee on Contract Respiratory Care ServChairman; E. Leslie ices: Ronald B. George, M.D., F.C.C.~, Chusid, M.D., F.C.C.~; H. Frederic Helmholz, Jr., M.D.,
F:C.C.~; Thomas A. NeB: M.D., F:C.C.~ (Chairman, Steering Committee); Norman A. Traverse, M.D., F:C.C.~ tThis is defined as meeting guidelines and standards as proposed in references 1 and 2.
134
care·
qualifiedt respiratory therapy service.
2) Develop a working relationship (eg, contract) with
a nearby qualifiedt referral hospital to provide these services. 3) Utilize the services of a "contract respiratory therapy" company. The choice of the latter two options does not eliminate the requirement for the institution to have its own medical director; When any of the three options are used, their medical effectiveness, as well as the economic efficiency, should be reevaluated at least annually. When referral or contract respiratory care services are used, they must be: 1) Given only on a physician's (primary or consultant's) orders or prescription which specified the appropriate diagnosis, the frequency, duration and expected results of treatments and, when appropriate, the dosage of medication and type of equipment. 2) Given or supervised by a therapist, technician, or nurse trained in respiratory therapy, preferably certified by the NBRT 3) Given with recognition that minimal cost must be a consideration in addition to the effectiveness of therapy RESPIRAlORY CARE IN THE HOME
Ifa patient requires respiratory care at home, similar standards (numbers 1 to 3 above) should apply. These standards also apply when home respiratory care is administered by a certified home health care agency. REFERENCES
1 Miller WF, Plummer AL. Guidelines for organization and function ofhospital respiratory care services: a statement of the Section on Respiratory Care. Chest 1980; 78:79-83 2 Joint Commission on Accreditation of Hospitals. Standards for respiratory care services: Accreditation Manual for Hospitals. Chicago: Joint Commission on Accreditation of Hospitals, 1983, 171-76