To help identify and monitor for respiratory compromise, Canadian Society of Respiratory Therapists has launched a Respiratory Compromise Toolkit.
By Adam Buettner, RRT, FCSRT (President-Elect, Canadian Society of Respiratory Therapists) and Carolyn McCoy, BHS, RRT, FCSRT (Director of Professional Practice, Canadian Society of Respiratory Therapists)
The Canadian Society of Respiratory Therapists (CSRT) recently released a Respiratory Compromise Toolkit to help detect and prevent respiratory compromise.
Respiratory compromise presents significant danger for patients across the continuum of health care. Risk factors are varied, and reach beyond patient-related factors. The nature of the procedures the patient will undergo as well as caregiver and institutional factors also contribute to the likelihood of developing respiratory compromise.
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Recognizing these risk factors on admission and having the proper monitoring in place can be instrumental in identifying and stopping the progression respiratory compromise. The CSRT toolkit includes a printable poster listing these factors. This can be displayed in respiratory therapy departments, nursing stations, report rooms and staff lounges to increase awareness of the risk factors. It can also be used during patient rounds, when developing care plans, when teaching, and as a safety checklist.
The progression of respiratory compromise will vary with the contributing factors. Some patients may initially present with tachypnea due to hypoxemia, others may initially present with bradypnea due to respiratory depression, and still others may present with a pattern of hypoxemia, arousals and eventual arousal failure. Continuous or intermittent monitoring of oxygen saturation alone will not be sufficient to signal a problem.
The toolkit describes how various sites across Canada use continuous and remote monitoring of oxygenation and ventilation to alert caregivers to changes in respiratory status. It also includes relevant evidence-based monitoring guidelines for a variety of clinical scenarios, from a variety of national and provincial organizations. These documents and testimonials can be used by departments to self-assess their current practices, when advocating for a change in practice, and when developing monitoring policies and procedures.
Change management, and methods of implementing change are not generally included in the entry to practice education of respiratory therapists. Yet it is often RTs that note when a change in monitoring practices is required. The toolkit includes resources to direct and support practitioners who wish to implement practice changes in their facilities.
The toolkit launch was supported by two webinars discussing respiratory compromise and monitoring. These webinars review the progression of respiratory compromise, and present the means of implementing monitoring used at three sites in Canada. The presenters discuss the challenges faced and lessons learned when implementing changes. These one-hour presentations can be used as educational tools to support the implementation of appropriate patient monitoring.
For other respiratory resources, please go to the CSRT website.
Adam Buettner is the clinical supervisor for respiratory therapy at St. Paul’s Hospital in Saskatoon, Saskatchewan. He has been practicing as a Registered Respiratory Therapist for 14 years. Adam will become the president for the CSRT in May at the CSRT conference located in Vancouver BC.
Carolyn McCoy is a respiratory therapist from Quispamsis, New Brunswick. She is the Director of Accreditation and Professional Practice Services with the Canadian Society of Respiratory Therapists.