Section: Policy #:

Effective Date:

Sponsor: David Kelley D.O.Title: Respiratory/ICU Medical Director

Supersedes:

Author: Darla Harwood RRTTitle: Resp. Manager

Next Review Date:

Frequency Guidelines for ICU Protocol Therapy

APPLIES TO: Clarian Arnett Health or X Clarian Arnett Hospital Clarian Arnett Clinic Clarian Arnett Surgery Center

I. PURPOSE To provide frequency guidelines for the use of ICU protocol driven therapy in a consistent manner based upon evaluations and objective scoring.

II. SCOPE This policy applies to all Respiratory Care Practitioners (RCP’s), physicians, and nursing staff. III. POLICY STATEMENTS

The highest frequency of an order generated by protocol application will generally be Q2 hours around the clock (ATC).

V. PROTOCOL:Adult Treatment Frequency Guidelines

Type of Procedure

Indications Score

Aerosols (incl. MDI, )Q2-Q4, ATC & PRN Severe wheezing, severe dyspnea, unable to sleep 1 & 2Q6 or QID, & PRN at night Moderate wheezing, Hx asthma 3Q6 PRN Intermittent wheezing 4

Bronchopulm HygieneQ4 ATC Copious secretions, dyspnea, unable to sleep, mucus plug 1QID & PRN at night Moderate secretions 2TID Small amts secretions w/poor cough & hx secretions 3Q shift W/A Unable to deep breathe and cough spontaneously 4

Lung Expansion Therapy (incl. EZPAP)Q4 W/A & PRN at night Severe atelectasis, poor oxygenation 1QID High risk for persistent atelectasis, existence of same 2TID At risk for developing atelectasis 3Q shift W/A Prevention of atelectasis 4Instruct, 1 follow-up Patients able to perform well on their own 5

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Some notes and definitions related to Treatment Frequency that apply to Adults AND Pediatrics: PRN is defined as: when patient requires treatment in between regularly scheduled

times, but not more frequently than 2 hrs apart. Patients with aerosols more frequent than Q4 should be discussed with physician. Any

time clinical status deteriorates or adverse event occurs, contact physician. An example of this would be when a patient’s score goes back one step instead of progressing toward less intensive therapy.

Reassessment for patients on protocols will be performed in accordance with the patient’s acuity level as indicated by the total score from the assessment tool. The acuity level may change with each evaluation. The patient will be reassessed with each treatment and therapy will be adjusted as needed.

Reassessment Frequency (may also use for Peds)

Assessment Score

Reassessment Frequency

1 Daily*2 & 3 48 hrs to 72 hrs maximum4 & 5 If 2 consecutive reassessments remain unchanged and treatment is still required (as

opposed to being ready to DC), Reassessment may be extended to 7 days.*If, after 3 days of daily evaluation, a patient with a score of 1 is found to be chronic but stable, Reassessment may be performed Q3 days.

RESPONSIBILITY: Respiratory Care DepartmentAPPROVAL BODYExecutive approval identified here (by Documentum Manager) APPROVAL SIGNATURES

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