What a busy and interesting day! I have had to break this one down into sections and themes.
FIRST STOP RESPIRATORY THERAPISTS:
I spent my morning and the end of the day with the respiratory therapists.
I was shown around their ICU’s and given a crash course in what respiratory therapists do and their current programme at Boston Childrens.
So what did I find out?
The respiratory therapists cover the hospital for a 24 hour period 7 days a week, working 12 hour shifts.
Their roles include all aspects of respiratory management from setting up ventilation circuits and managing airway treatments, to extended roles.
Examples of these roles are:
• Assisting the set up of ECMO and its monitoring.
• Home ventilation programmes
o C.A.P.E programme: http://www.childrenshospital.org/centers-and-services/department-of-critical-care-medicine/programs-_-services/critical-care-anesthesia-perioperative-extension-and-home-ventilation-program
• Patient and family education
• + I’m sure there are more I have missed or didn’t have time to discuss
At Boston Childrens the respiratory therapists are thought of very highly and are consulted on all aspects of respiratory care. They are excepted to, and do, attend all ward rounds.
When a patient is returning from theatre they are with the nursing staff ready to receive that patient back and transfer them to the ventilator, assuring the settings are adequate to achieve the required result for that patient.
We discussed the over lapping of roles between Nurses, Physical Therapists and Respiratory therapists. This is something I also discussed with Dr Roberson in the afternoon.
Please see the Clinical Roles blog for further information.
In the afternoon I was lucky enough to observe some treatments and some family education at the bedside. One patient was going home with a trache on a ventilator. The trache will then be managed in the community by the C.A.P.E team and the home care support in the community.
I watched as the patients parents where encouraged and educated on how to suction and manage there child’s respiratory function. They were educated in basic assessment of their child’s observations and physiotherapy chest clearance techniques including suctioning.
Separate to this education the family are taught how to operate the ventilator and undertake trache changes as necessary.
Before discharge home the parents must show they are capable of caring for all their child’s needs in a 24 hour period in the hospital. They are supervised and supported at this time as necessary.
This programme not only allows for the family to take their child home, in this case for the first time! But gives back the care to the family that they have been denied due to their child’s poor health. It allows them to assume the normal role as their patients main care giver. And although understandably daunting, from my brief experience the family we very happy with this.
Finally, for all of their tracheostomy patients they have a tracheostomy tube profile (sheet). This details all of the tracheostomy dimensions, including the brand of the trache. Using this information a suction distance is calculated and recorded, as well as the catheter size required. On this form it is also documented weather the patient’s airway is patent from above.
This appears a great simple sheet to allows a quick overview of the patient trache and airway status. As well as acting as a reminder to all care givers.
I had a great time shadowing the team who were all so kind and welcoming!
Thank you all so much!!