Sal Project Education
19
November

By Adem Lewis / in , , /


the skills and knowledge needed to
perform a job may be gained through education training or experience
competencies are used to assess our skills and knowledge this PowerPoint is
dedicated to offering the respiratory therapist a resource for information
about annual competency evaluations in the workplace I have included links to
videos images and research papers and other pertinent websites as educational
references for review the competencies listed on this PowerPoint are basically
for an Adult Care Hospital. Competency evaluation tools and hospital policies AIDET AIDET is a communication framework for
healthcare professionals to communicate with patients and each other in a way
that decreases patient anxiety increases patient compliance and improves clinical
outcomes the acronym AIDET it stands for five communication behaviors
acknowledged introduced duration explanation and thank you created by
Studor group as a foundational tactic for effective patient communication AIDET is
used by nurses physicians respiratory therapists technicians food service
administrators and all staff involved in patient and family encounters at the
bedside and across a continuum of care while key words are important in AIDET
it is not a script it is a simple consistent way to
incorporate fundamental patient communication elements into every
patient or customer interaction using AIDET and healthcare facility examples
of AIDET would be acknowledge greet the patient by name make eye contact smile
and acknowledge family or friends in the room introduce introduce yourself with
your name skillset professional certification and experience duration
given an accurate time expectation for test physician arrival and then identified
the next steps when this is not possible give a time in which you will be able to
update the patient on the progress explanation explain step by step what to
expect next answer questions and let the patient know how to contact you such as
the nurse call button and finally thank you.thank the patient and/or family you
might express gratitude to them for choosing your hospital or for their
communication and cooperation thank family members for being there to
support the patient using a consistent conversation framework helps physicians
and staff anticipate the needs of patients and their families so that they
can meet and exceed the level of patience expect after more than 15 years
of practice at hospitals health systems and medical practices AIDET has
proven to improve patient and customer perception of care or service decrease
anxiety for staff and patients and increase compliance resulting in better
clinical outcomes filled patient and customer loyalty and ensure service
providers deliver consistent measures of empathy concern and appreciation
associate health measurable behaviors employees should be able to verbalize
understanding of annual PPD testing policy for tuberculosis verbalized
policy and procedure for needle sticks and exposure to communicable infections and
or diseases demonstrates understanding and usage of standard universal
precautions and verbalizes policy and procedure for employee Falls or injuries
for more information regarding needle sticks employee falls hour
injuries or tuberculin skin testing please click on the following links
below clinical documentation employees should be able to identify different
electronic and paper documentation procedures throughout the hospital
identify departmental documentation forms when electronic documents are
unable understand that all paper documentation forms must have patient
labels understand documentation requirements throughout the hospital
identifies appropriate locations with an EMR for documentation purposes and
understands ventilator documentation requirements at this point you’re
probably asking yourself has an accurate documentation always been important the
answer is invariably yes however in the last few years some major changes in how
hospitals are billed have pushed clinical documentation to the forefront
of health care conversations here are just a few reasons why clinical
documentation has been in the spotlight overpayments and underpayments
are a huge problem the recovery audit program resulted in
more than nine hundred and ninety million in overpayments being returned
to Medicare trust fund and almost 38 million in under payments returned to
health care providers in just three years according to the US Centers for
Medicare and Medicaid Services from 2005 to 2008 due to these astounding
discrepancies Congress instituted a permanent nationwide recovery audit
program clinical documentation affects the hospital’s bottom line health care
is rapidly transforming from a fee-for-service to a pay-for-performance
payment system that relies heavily on clinical documentation to support
payment whereas in the past providers were predominantly reimbursed based on
volume of services now the focus is on the quality of services provided patient
bills are also affected by correct documentation correct documentation is
not only important for hospital reimbursement but also for ensuring that
patient bills are accurate as well clinical documentation improvement and
billing specialists help ensure hospitals physician practices and
patients are correctly billed for the care provided nothing is more
frustrating than getting home from the grocery store to discover your receipt
says you were incorrectly billed for something you purchase now imagine that
frustration amplified to a level where hundreds if not thousands of dollars are
at stake patients deserve to be billed correctly for the services and
procedures they receive just as providers and facilities deserve to be
paid correctly for their hard work clinical documentation helps promote
accuracy which is important for patient care the need to have complete accurate
documentation is significant to a patient for continuing care patient
safety especially poor documentation that is completed in a hurried fashion
will not lend itself to continuing care by other providers imagine if that
patient goes on vacation and acquires a traumatic injury
in such an event the hospital attending to this patient will need accurate
complete documentation about the patient’s history pacemaker and more in
order to proceed in a safe and beneficial manner cultural confidence
caring for a culturally diverse population has become common throughout
the world if we are going to decrease healthcare disparities we need to pay
attention to cultural values beliefs and practices if we do not adopt our health
care delivery system to include these diverse practices the results are the
compromise of patient care poorer health outcomes and an increase in the cost of
health care many resources skills and knowledge are needed to effectively care
for the diverse populations throughout the world
our biggest goal and understanding the need for cultural competency is
improving patient satisfaction and outcomes healthcare disparities across
ethnic social and the economic groups are evidence enough for the need of
healthcare providers to be attentive to cultural diversity and cultural
competency training helps us better understand and become competent and
caring for different populations for more information on cultural competence
please click on the following links below HIPAA and your privacy at Mercy
Health your privacy and confidentiality are taken very seriously the Health
Insurance Portability and Accountability Act safeguards your private information
and protects you and your family as a patient of our Hospital Hospital
compliance with HIPAA is not optional penalties for failing to comply with
regulatory requirements or for the wrong for disclosure of protected health
information can be severe with fines and prison sentences resulting from the most
serious violations compliance with HIPAA guidelines also provides health care
institutions with improved administrative efficiencies reduce
paperwork by promotion of electronic standards
reduce cost and more assurance that health care reform a
remains available confidential and safeguarded patients who require
isolation during their hospital stay may become depressed and agitated which can
adversely affect the recovery not to mention patient satisfaction
scores but with the right communication tools this problem can be avoided
isolation keeps the spread of contagious illnesses down in hospitals the word
isolation can conjure up images of solitary confinement it may hurt
patients morale which can hinder their recovery and lead to poor outcomes so
it’s key to get this impression out of patients Minds first off it’s important
to explain the differences between the types of isolation to patients and their
families that way they won’t get upset when a doctor comes in wearing a mask or
they are placed on a separate floor after giving patients and their families
this basic information about the type of isolation they will be experiencing it’s
important to address their fears and concerns all hospitals in this state
used the same procedures for isolation stock can give patients and their
families color coded FAQ sheets about each type of isolation information on
these sheets includes a basic rundown of the type of isolation the reasons why
it’s necessary and what patients and their families need to do to prevent
germs from spreading throughout the hospital stay the state also has come up
with a list of frequently asked questions clinical staff can distribute
as well being proactive when it comes to letting patients know about isolation
procedures rather than just putting them in place with no explanation can work
wonders with making patients feel more at ease while the procedures may be
familiar to workers who use them regularly most patients don’t have the
same perspective so taking the time to let them know why isolation is a must
with their illness can be critical to their well-being while in the hospital
which can have ripple effects down the line for more information on isolation
policies and measurable behaviors please click on the following link below
patient identification measurable behaviors employees will utilize AIDET
upon entering the room wash and sanitize hands demonstrate proper knowledge of
HIPAA and patient privacy demonstrate use of two unique patient identifiers
and demonstrate proper knowledge of scanning patient armband and medications
prior to administration when applicable checking for patient identification and
sometimes frighten the patient already fearful from having to seek medical
attention it’s important to offer reassurance that by checking their
identification you are looking out for their safety this can be done by
verbalizing intent for example Mrs. Jones I am checking your armband for
safety this simple statement verifying an action that has done multiple times a
day communicates that she is being properly cared for Mercy Health
employees employee should act with professionalism dressed in a way that
inspires trust and confidence and patients and Families be courteous
helpful and professional when using the telephone respond to the requests of
others as quickly as possible and protect the confidentiality of
professional and personal information Mercy Health employees should also
promote teamwork offer help to others participate in group decisions and be
positive about the work and the work environment Mercy Health employees
should be courteous treat others with kindness and respect regardless of how
others behave give others an opportunity to speak and listen to what they have to
say be polite and demonstrate awareness of how his or her words and actions
affect the feelings of others be patient and forgiving when things go wrong and
support and value a multicultural environment communication is key when
working in health care you should always greet others in the manner that helps
them feel welcome take the time to explain things clearly and completely
and for others the opportunity to ask
questions and respond using words that they can understand substance abuse and
fitness for duty while working at Mercy Health understand that the following
activities are prohibited while an applicant or employee is on the facility
promises are otherwise engaged in facility business the manufacturer
possession use or sale distribution dispensing receipt or transportation of
any drug other than as required of an employee to complete job related duties
or the consumption of alcohol except moderate consumption and facilities
sponsored events were authorized understand that testing for alcohol
illegal drugs and controlled substances is an important part of a safe facility
environment understand that in addition to pre-employment drug screening the
facility may also conduct substance screens under any of the following
circumstances subject to applicable laws randomly on the job inquiry when a
controlled substance is missing when an employee is suspected as being unfit for
duty or when an employee returns from a leave of absence of 90 days or more
understand that compliance with this policy is a condition of employment
failure or refusal to cooperate fully submit to any inspection or testing or
follow any prescribed course of substance abuse treatment will be
grounds for discipline up to and including immediate termination aerosol
nebulizer breathing treatments an employee should be able to demonstrate
proper preparation and assembly of equipment apply knowledge understanding
and troubleshooting skills – aerosol systems for adult pediatric and neonatal
patients check order and retrieve appropriate medication and verify
patient and explain the procedure to the patient or family acknowledging length
of treatment and instruct and proper technique properly assess the patient
checking for heart rate respiratory rate and breath sounds before during and
after the treatment is needed documents therapy
appropriately the link below is a short video on how to perform a treatment
correctly arterial blood gases ABG’s an employee should be able to
verify order and patient gather supplies patient label and number explain the
procedure to patient utilize standard universal precautions palpate radial
pulse as first site of choice and perform Allen’s tests or modified Allen’s
tests obtain specimen using proper technique and preparation for radial
brachial and femoral punctures apply firm digital pressure to the puncture
site for five minutes or ten minutes of patient is receiving treatment with
anticoagulants label specimen and patients presence with date and time
obtained puncture site amount of oxygen patient is receiving if applicable and
initials of therapists and be able to enter all required data into the blood
gas analyzer prior to instilling blood report panic critical values to
appropriate personnel properly enter results into the electronic medical
record document procedure appropriately follow the links below to practice ABG
interpretation and brush up on your technique
BiPAP bi-level positive airway pressure employees should be able to verify order
and patient gather necessary equipment and utilize standard universal
precautions explain the procedure to the patient and family demonstrate knowledge
of the appropriate settings and controls for IPAP, EPAP, AVAPS, rate fio2 and
rise time be able to perform a machine parameter check and assessment for
redness on patient’s nose or face assemble and attach patient circuit and
filter apply in position headgear with Minimal leal perform a machine parameter check
and assessment for redness on patient’s nose or face using liquicell, mepilex
or duoderm and use of smart phrase to document demonstrate steps to adjust and
verify alarm settings and parameters document therapy appropriately including
but not limited to patient tolerance breath sounds, pressure, flow, Fio2 heart
rate respiratory rate and oxygen saturation CPAP continuous positive
airway pressure be able to set up CPAP machine mask nasal prong or pillows and
or headgear identify indications and contraindications for CPAP perform a
machine parameter check and assessment for redness on patient’s nose or face
using the liquicell the mepilex, or duo derm and use of smart phrase verify and
set alarm parameters and document appropriately including tolerance
pressure flow fio2 heart rate respiratory rate and oxygen saturation
follow the links below for more information regarding education on BiPAP
CPAP and modes chest physiotherapy employees should be able to verify
orders patient and check chest x-ray explained procedure to the patient and
family demonstrate knowledge of the various patient positioning for therapy
demonstrate knowledge of proper hand percussion, percussor and palm cup used
and placement for lung percussion demonstrates proper duration of therapy
and documents therapy appropriately chest physiotherapy vest employees will
be able to check orders in patients chest x-ray verify patient explained
procedure to patient and family choose appropriate sized vest for the patient
position them correctly and demonstrate correct hookup of
equipment and supplies demonstrate proper duration of therapy and document
therapy properly the following is an educational video on using vest therapy
by Hill room I have no affiliation with Hill ROM this is for educational
purposes only code blue code pink and rapid response team employees will be
able to demonstrate knowledge of BLS ACLS PALS and/or NRP
verbalize the appropriate indications for calling a code blue code pink and/or
rrt appropriately activates a code or RRT and delegates care of other assigned
patients as appropriate during the code or RRT they’re sure that all emergency
equipment is available at the bedside and initiates life-saving interventions
as a team responds provide brief report to the responding team and allow
responding team members to us us and make recommendations for direct care
coordinate efforts with responding team and document care given during code or
RRT appropriately for more information on code blue code pink and rapid response
follow the following links below for BLS ACLS PALS and NRP and RRT. End-tidal co2
employees will be able to identify indications for procedure demonstrate
ability to play sampling line between ventilation device and every device if
intubated or using LMA or cough tracheotomy to ventilate resuscitate the
patient demonstrate ability to place sampling line on spontaneously breathing
patients and demonstrate ability to hook up all sampling devices to the cardiac
capnography monitor and turn on the feature as well as sudden the alarm
limits demonstrate understanding of waveforms knowledge of normal and tidal
co2 ranges understanding that during ventilation of a patient perfusion a
rise in co2 indicates to slow ventilation and understand that during
ventilation of a patient with perfusion a decrease in co2 indicates too fast
ventilation demonstrates understanding that during ventilation of a patient
without poor perfusion is suddenly high co2 reading may indicate a return of
spontaneous circulation and understand that during ventilation of a patient
without poor perfusion a chronically low co2 is expected and prolonged situations
may indicate cardiac arrest or poor cuff seal demonstrate understanding that
during co2 monitoring of a spontaneously breathing patient a low co2 reading
indicated hyperventilation or shallow ventilation understand the difference
between tachypneic and hyperventilation as well as Bradypnea and hypoventilation
document appropriately and if you would like more information follow the link
below for this End-tidal video. Incentive spirometry an employee will be able to
verify order and patient explained procedure to patient and family set
incentive goal based on patient sex age and height instruct patient in the
proper usage of the incentive spirometer instruct patient on proper coughing
technique and documents therapy appropriately follow the following links
for a video and research paper regarding Incentive spirometry intubation and airways
an employee will be able to appropriately select proper oral and
nasal airways and verbalize proper technique and insertion for each
demonstrate proper technique for head tilt and chin lift airway opening
maneuvers able to appropriately select proper size of ET tube and demonstrate
ability to gather and assemble equipment and supplies for endotracheal intubation
demonstrate and verbalize knowledge of landmarks and proper technique for
correct tube insertion and placement monitor patient during and after the
procedure perform or assist in and endotracheal intubation understand readings for end tidal co2 detection devices and document procedure appropriately when
using Airways be able to appropriately select proper oral
nasal and Endotracheal Airways verbalize proper technique for insertion of oral
nasal and and endotracheal airways monitor patient during and after the
procedure gather and assemble equipment and supplies for endotracheal intubation
and assist in endotracheal airways and document insertion placed a
procedure for various Airways follow the following links for more information
regarding intubations and Airways metered dose inhalers MDI administration
via common canister employees will be able to check orders and retrieve
appropriate medication via metered dose inhaler from the automated dispensing
cabinet or Pyxis retrieve a one-way valve holding chamber or spacer to
administer MDI to patient cleans the MDI mouthpiece and canister with an alcohol
wipe prior to attaching the spacer attach the MDI to the spacer once it has
been cleaned with alcohol explained procedure and instruct proper technique
including patient exhalation prior to MDI administration breath-hold after MDI
administration and mouth rinsing as needed post MDI
administration check for heart rate respiratory rate and breath sounds
before during and after the treatment is needed
remove the MDI from spacer and clean the mouthpiece and canister with an alcohol
wipe understand that dry powdered inhalers and nasal inhalers are not used
with spacers and are excluded from the common canister policy understand that
patients under isolation precautions are also excluded from the common canister
policy for more information regarding metered dose inhalers administration via
common canisters please follow the following links below
oxygen therapy an employee will be able to verify order and patient explained
therapy to the patient and family retrieve and assemble all necessary
supplies and equipment apply knowledge understanding and troubleshooting skills
to gas delivery systems for adult pediatric and neonatal patients
demonstrate understanding of various oxygen administration devices low medium
or high flow and the appropriate uses and setup for each one such as nasal
cannulas’, simple face mask, reservoir mask and air entrainment mask
demonstrates knowledge of when humidity or heat should be added to therapy
explain benefits and hazards of therapy to the patient initiates titration and
weaning according to protocol and policy understands documentation requirements
throughout the hospital and documents in the EMR appropriately notice
documentation charging is to be completed within the assigned shift for
more information regarding oxygen therapy please follow the following link
for a YouTube video. PAP, PEP, Easy PAP and Accupap therapy employees will be able
to demonstrate proper preparation and assembly of equipment explain the
procedure to the patient and instruct and proper technique assess the patient
document therapy appropriately adjust device to achieve desired pressure level
and demonstrate knowledge of basic and advanced concepts of therapy Thera-Pep therapy
employees will be able to demonstrate proper preparation and
assembly of equipment devices used are the acappella and TheraPep explain the
procedure to the patient and instruct and proper technique assess the patient
document appropriately adjust device to achieve desired pressure demonstrate
knowledge of basic and advanced concept of therapy follow the links below for
more information of PAP, PEP therapy, Easy PAP and Accupap
therapy patient assessment employees will be able to verify orders and
patient review history and physical information review of relevant
medications lab studies and diagnostic tests identify abnormal findings and
current therapy verbalize understanding of arterial blood gas interpretation
identify indications for therapy and position patient correctly inspect chest
and note breathing patterns auscultate each lobe of both lungs measure pulse
rate and respiratory rate determine presence or absence of signs of
respiratory distress and recognize warning signs that require notification
of nursing staff and/or physician changing therapy and/or medication
specifies process for discontinuation of therapy if patient meets therapy goals
and/or no longer meets criteria for therapy obtain a pulse oximetry
measurement and record findings and the medical record for more information on
patient assessment please follow the following link for the YouTube video on
patient assessment peak flow meter employees will be able to demonstrate
proper understanding a peak flow meter usage and application explain the
procedure to the patient instructs patient on proper technique including
sit stand up straight breathe in as much as possible close lips tightly around
the mouthpiece blowout as fast and hard as possible and determine patient’s
predicted peak flow measurement by measuring the patient’s height and age
using the peak flow guide follow the youtube link below to learn more about
how to use a peak flow meter pulmonary function test employees will be able to
verify order and patient perform calibrations explain the procedure to
the patient family and instruct patient on proper technique acquire a good
history acquire patient height and weight and communicate well with the
patient demonstrate knowledge of equipment usage and setup determine if
post spirometry is indicated perform basic spirometry including pre and post
bronchodilator with or without body box performed DLCO
and/or FRC lung volumes perform a methacholine challenge test and printout
report be able to distinguish a physician’s order to determine what type
of study is needed document a summary of the procedure and for charging purposes
demonstrate understanding of the filing process once the test is read by a
physician the following 5 YouTube videos are links for education regarding PFTs
pulse oximetry the employee will be able to demonstrate understanding of
equipment usage demonstrate proper analysis of oximetry values demonstrate
knowledge of various sensor placement sites for the patient understands the
difference between reusable and disposable sensors and the proper uses
for each documents appropriately for more information regarding pulse
oximetry please follow the following youtube link below
respiratory medications employees will be able to verify order and patient
identify indications for anticholinergics corticosteroids
mucolytics vasoconstrictors anti asthmatics and anti effective agents
therapists must be able to identify adverse drug reactions for respiratory
medications document medication delivery within the patient’s medical record
document patient response to the medication or treatment and notified the
physician when necessary if you would like more information regarding aerosol
therapy please click on the link below for a guide on aerosol therapy sputum
collection a therapist must be able to gather
equipment and supplies demonstrate proper equipment setup in usage explain
the procedure to the patient and family position the patient correctly and
understand the usage of aerosol treatments and CPT to induce a sputum
specimen label specimen and the patient’s presence with date and time
obtained and initials of collecting individual as well as a patient label
handles hazardous sputum specimens correctly and transports to the
laboratory appropriately documents procedures appropriately for more
information regarding sputum collection please follow the following youtube link
below suctioning a therapist will be able to gather equipment and supplies
assess airway and demonstrate understanding of indications explain
procedure to the patient and family and demonstrate proper equipment setup
explain the procedure to the patient family of applicable adjust suction
pressure to appropriate level for adults position patient correctly hyper
oxygenate patient if on a ventilator demonstrates sterile technique used
normal saline when necessary oxygenates patient and uses standard precautions to
dispose of equipment and supplies verbalize time limit per suction events
know the side effects and contraindications of suctioning and
document appropriately for more information regarding suctioning follow
the following youtube link below tracheostomy care a therapist will be
able to demonstrate knowledge of tracheostomy cleaning and care
demonstrate proper trach removal and reinsertion during the changing process
demonstrate knowledge on inner cannula placement and removal and demonstrate
understanding a tracheostomy button or valve for more information regarding
tracheostomy care please follow the following youtube link below ventilator
initiation and therapy a therapist will be able to complete proper system set-up
with or without external heater perform appropriate self tests prior to patient
use explained function of all settings and displays on the selected ventilator
explain all hazards and complications associated with mechanical ventilation
and assure correct ventilator assembly and setup initiate appropriate
ventilator settings as ordered or per protocol place patient on ventilator and
assure immediate and appropriate volume and pressure return set appropriate
alarm values and tests for maximum audibility adjust peak flow for patient
comfort in order to keep peak inspiratory pressures less than 35
centimeters of water and I:E of more than one to two unless otherwise ordered by
physician perform complete ventilator check according to policy both on paper
and in the EMR ventilator protocols and we need therapists will be able to
verify orders and patient identify responsibilities of respiratory care
regarding the patient’s ventilation status state the criteria necessary to
implement ventilator management protocols identify the appropriate
protocol form according to the diagnosis and set initial event parameters
according to the patient’s condition states the amount of time needed to
assess the patient’s response to the ventilator settings to obtain ABG’S
identifies the patient assessment criteria according to the diagnosis
understands the interventions necessary to correct parameters that fall outside
normal ranges and identifies the protocol ranges in which ventilator
changes will be made according to the diagnosis identifies and understands the
clinical integration or decision tree and applies it when problems with
patient comfort hemodynamics lung mechanics oxygenation and ventilation
exists states were all ventilated changes will be documented and
understands that the ventilator management protocol will be followed at
all times unless Physician raise a specific order for
intervention or end to the protocol for more information on ventilator protocols
and weaning please follow the following YouTube video below as well as to
journal articles this concludes my PowerPoint presentation I hope you
enjoyed it as much as I did creating it you are never too old to set another
goal or to dream a new dream I hope you have a great day!


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