Presented byAhmed Al Gahtani, BSRC, RRT Associate Director Clinical Education

Chairman, RTS Advisory Committee

Dept. of Respiratory Therapy Program

Inaya Medical College, Riyadh

Optimizing Bronchial Hygiene Therapy

• The current research and clinical trials are not conclusive, and have number of limitations regarding study design, sample number, reported positive outcomes. (LACK OF EVIDENCE VERSUS LACK OF BENEFIT)

• The physician needs the assistance and expertise of trained and motivated respiratory therapists.

• Bronchial Hygiene Therapy is an interactive process.•No single method of airway clearance is better than another.• The therapist needs to work for and with the patient to find the methods most

suitable.• Variety helps, it is useful to be proficient in several methods of airway clearance.

The Conclusion

•Measure 1:▫Therapist-Driven Protocol Program

•Measure 2:▫Patient involvement and selection of BHT technique.

•Measure 3:▫Therapeutic & Clinical Objective

•Measure 4:▫Combination & Variety of techniques

Optimizing Bronchial Hygiene TherapyMeasures to wards the right direction

•Deliver individualized diagnostic and therapeutic respiratory care to patients

•Assist the physician with evaluating patients’ respiratory care needs and to optimize the allocation of respiratory care services

•Determine the indications for respiratory therapy and the appropriate modalities for providing high- quality, cost-effective care that improves patient outcomes and decreases length of stay

•Empower respiratory care practitioners to allocate care using sign- and symptom-based algorithms for respiratory treatment

Measure 1: Therapist-Driven Protocol Program

Copyright © 2016 CLINICAL MANIFESTATIONS AND ASSESSMENT OF RESPIRATORY DISEASE, SEVENTH EDITION

•Give practitioner authority to:▫Gather clinical information related to the patient’s respiratory status▫Make an assessment of the clinical data collected▫Start, increase, decrease, or discontinue certain respiratory therapies on a

moment-to-moment basis•The Innate Beauty of Respiratory TDPs Is That:▫The physician is always in the “information loop” regarding patient care▫Therapy can be quickly modified in response to the specific and immediate

needs of the patient

Therapist-Driven Protocol Program

Copyright © 2016 CLINICAL MANIFESTATIONS AND ASSESSMENT OF RESPIRATORY DISEASE, SEVENTH EDITION

•Respiratory TDPs significantly improve respiratory therapy outcomes, and They do so at appreciably lower therapy costs

Clinical Research Verifies

The implementation of this protocol appears to have improved utilization and reduced airway clearance charges to patients.One limitation of this study is the relatively short period of time the protocol has been in place

Copyright © 2016 CLINICAL MANIFESTATIONS AND ASSESSMENT OF RESPIRATORY DISEASE, SEVENTH EDITION

•Results showed a statistically significant difference with decreased duration of therapy

•The statistically significant decrease is due to the combined effect of therapies discontinued immediately upon assessment as well as an overall shorter therapy duration due to the application of the treatment flowchart/risk tool

•Conclusions: Successful implementation was facilitated by achieving buy-in from the medical director of Respiratory Care Services as well as medical leadership in all areas

1. Importance of communicating with physicians in ICU prior to changing therapy on patients with higher Respiratory Risk scores

2. Vigilant monitoring of staff adherence to protocol requirements (implementation and documentation).

Copyright © 2016 CLINICAL MANIFESTATIONS AND ASSESSMENT OF RESPIRATORY DISEASE, SEVENTH EDITION

No assessment program in place

The promise of a good therapist-driven protocol

Therapist-Driven Protocol Program

Foundations for a strong therapist-driven protocol program.

The Knowledge Base Required for a Successful TDP Program

Copyright © 2016 CLINICAL MANIFESTATIONS AND ASSESSMENT OF RESPIRATORY DISEASE, SEVENTH EDITION

Protocol Copyright © 2016 CLINICAL MANIFESTATIONS AND ASSESSMENT OF RESPIRATORY DISEASE, SEVENTH EDITION

• Availability • Effectiveness • Clinical Status • Lifestyle • Expense 

Measure 2: Patient involvement and selection of BHT technique.Patient Preference is Important

•Why are we doing •What were the indications•Assessment of outcomes

Measure 3: Therapeutic & Clinical Objective

•Combination of techniques to provide Bronchial Hygiene Therapy improves outcomes than single technique approach.

•Variety improves patient adherence

Measure 4: Combination & Variety of techniques

• The current respiratory devices have been designed to enhance patients’ compliance and independence.

• Also they decrease the respiratory complications. Furthermore these devices are easy in use and they reduce cost of therapy

• The number of published reports is limited, though more research is needed to define the effectiveness of the devices of respiratory physiotherapy and their place among the current techniques available

Measure 4: Combination & Variety of techniques