Birth of a Protocol

I mentioned 2005 AARC Conference  in San Antonio. I think that was some kind of turning point or watershed for me. I was working for Kindred Healthcare as an IT Manager/Superuser/Documentation trainer between 4 hospitals and training regionally while working most weekends in RT for OT at one of the 4 hospitals. I had been doing that for about 2 years having moved from my position as Staff Edcuators in the RT department at the Tarrant County SW Kindred Hospital. The IT position came with a pay increase, but it never fit right. When I went to AARC that year I really missed doing RT FT and had really built up a passion for LTAC critical care and vent weaning.

The conference was in early December of that year. Some time in late summer I was approached by the ICU nurse manager about my thoughts about performing grand rounds in the ICU. I had encountered an article that demonstrated that daily rounds to enforce and instruct on the weaning protocol and to monitor care had a profound effect on clinical results. I developed a tool and with the nurse manager’s help and the blessing of the RT Manager we started in October.

I had been at that facility for quite some time. I believe it was about 7 years at that time. When I was there a couple of years I left and took a position as Clinical Coordinator at a Vent Program at a local nursing home. I had developed some very successful techniques for weaning while working at the LTAC. It was a THC hospital then a Vencor at the time I left back then. My greatest frustration back then was I worked 12s and I would nearly get someone weaned and go off for 3 or 4 days then come back and find them back at square 1. We did not have a protocol at that time and we had nothing to use to keep everyone on the same page. I would try writing detailed weaning orders and getting them signed off by the docs, but others could just as easily get orders to put them on hold. So when I went to the vent program at the nursing home I started by writing in detail what at the time I thought was the considerations and techniques that were making my efforts with the vent patients effective as a sort of protocol and used it at the nursing home. I have to say caring for respiratory patient in a nursing home may be some of the hardest work I have ever done. Many of our patients were neuromuscular patients and we tried to have each of them up and out of bed and outside or in a common area daily. We also made sure every patient with any potential was assessed for weaning potential daily. In a program that accepted unweanable patient from area LTACs we had real success at weaning and decannulation of the patients that came to us without criteria that would exclude them from weaning efforts. That protocol served us well for the year or so that I was there until Medicare quit paying for RT in the nursing facilities and the home essentially eliminated the program.

When I went back to the LTAC to negotiate for my old position I insisted that if I were to come back that we would make the protocol I had written into policy and put it to use in that facility.