VentWorld Director
Member
| SC Manger,
each ventilator patient has varying needs for respiratory care. Some are very stable and only require routine and basic care. Some are highly variable and demanding. The determination of the amount of care needed for a group of any type of patient should take into account the cumulative needs of the entire group and appropriate disciplines time should be allotted to the care of the patients in question. I realize there are other models around the world, but in my experience licensed respiratory therapists are the only discipline that should provide for the respiratory needs of any patient. RCPs are the most cost effective and assure the highest level of safety and the shortest time to the best outcomes. Your question about legality is distressing. You can check with your state board of health to determine the "legality". I will assert that if your unit is full, one RCP per shift is probably not safe. I have direct experience in all levels of care. My heart goes out desperately for vent patients. Yes nurses can monitor vents and suction. I often have heard "well we teach the family to care for these patients at home". This is generally a one on one situation where the family is highly focused on the vent dependent person's needs. These individuals are quite stable. Those patients requiring care in a medical facility are not usually the same as those at home. Nursing is generally not adequate to the task particularly if clinical or technical requirements get far from the normal range. When I say not adequate, I mean trained or staffed. Yes, there are exceptions. Your one respiratory therapist if they are actually carrying a 20 ventilator patient load are either running their legs off far to excess, relegating respiratory care tasks to nurses, techs or families or cutting corners and potentially providing unsafe or stagnated care. I have nothing against nursing. Nurses are heroes of the highest order, but they are not usually trained anywhere near to the extent that RTs are on ventilator patient care and assessment of the patient/ventilator system. A specific number of respiratory therapists may not be required legally, but they are required if you are going to put together a quality program. Speak to administration, not about what is legal, but about what is right by those people on the ventilators. Gather a team of experienced, strong RCPs who are dedicated to producing results for your patients. If you do this it might cost a little more to care for these patients, but you will always have full beds because of the reputation your unit will develop. You will also have less potential for spending time in court. Honestly I would not ever be one of your therapists if you require me to cover 20 vent patients. I would be so stressed to the breaking point trying to meet the needs of such a large group of these demanding patients. Yes it can be done. I have heard of similar units, with similar respiratory staffing. Would I want to be a vent dependent resident or patient on one, would anyone? If you take into account the average needs of vent patients for their respiratory therapists it is very difficult to provide any quality level of care at much less than 3 respiratory therapist hours per patient per day. Considering this you are not staffed with RTs for more than 8 vent patients. In the long term acute facility where I work RTs are not to be assigned more than 5 vent patients. It may well take more than 3 hrs per vent patient day depending on the mix, and yes it possibly could be done with less, but if your group is strictly vent patients, safety becomes marginal and outcomes (weaning, minimization of VAP, and prevention of increases in illness severity, etc) nearly impossible with the lesser. Another sad fact I have observed is that these units are often staffed by therapists with minimal levels of experience when they need highly seasoned practitioners to meet their patient's complex needs. In many places what is legal is way off the mark of what is right for these patients. What is right is actually cost effective in the long run even though that is often a hard point to make with the bean counters. I say go for it, legally required or not. |
