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Thread: Anyone else have trouble with RT's while in hospital

  1. #11
    The Dot
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    Trouble with RT's in hospital

    Quote Originally Posted by Aboveallislove View Post
    PS I wonder if it even possible that the clinic provides patients with their options so that they know before going to the hospital and can think through things and be ready when they get there. "Knowing" what to expect really helps me handle the stress of hospitalzations.
    PSS I love the idea of being able to use the own equipment and we brought ours in. We're use to it and don't have to worry someone made a mistake in infection control protocals!
    Aboveallislove - thanks for your input - it is invaluable to me! I think a patient booklet explaining how we do things would be a great thing to hand the patient in the clinic or when they get their first visit from RT in the hospital. I put together a brief booklet, but our plan has been evolving, so it is not all-inclusive. Will continue to work on that.

    We are still working on how to sterilize the re-usable nebs that we dispense. We want to use high-quality nebs for Pulmozyme and Inhaled Antibiotics because these meds are so important and so expensive. But, the high-quality nebs are quite expensive. We must either dispose of nebs after use, or sterilize them. So, with the high-quality nebs, we clean and sterilize. We are using cold sterilizing for now, but considering purchasing baby bottle sterilizers for the patient rooms. What are your thoughts on that? I am worried because our rooms tend to heat up in the evening in summer, so I am thinking that having a steam sterilizer will add to the heat in the room. Please, let me know what you think.

  2. #12
    The Dot
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    Quote Originally Posted by Ratatosk View Post
    During our last stay, the doctor scheduled vest & neb treatments every 4 hours. We coordinated with the nurse & rt regarding times. First time in the NICU, treatments were coordinated a certain time after meals -- he ate every 3 hours, was supposed to have cpt every 4.

    With his obstruction it wasn't an issue as he wasn't allowed to eat. However, We weren't allowed to use our own vest. The hospital policy didn't allow outside equipment, so a vest was provided to us during our stay. There were disposable tubes, a full disposable vest and band. It stayed in the room and wasn't used by other patients (cross contamination issues). The RTs handled inhaled meds, so while we could strap on his vest, we didn't have access to albuterol, atrovent or pulmozyme. Middle of the night treatments, we always did CPT at home as his vest would wake him up. Between his first stay in the NICU and his bowel obstruction (6 years) RTs no longer knew how to do cpt. Which was fine, we could do his CPT. But again, no inhaled meds available if the RTs were running late or a no show.

    One thing that had changed in the 6 years since our first stay. There was no longer the community bottle of albuterol. When DS was in the NICU, RTs would go from bassinet to bassinet -- they'd wash hands, but they'd pull tubes of saline and a brown bottle of albuterol out of the pocket of their scrubs. They also would hold the babies up against their chests to do CPT treatments. My MIL, who had been a nurse in a TB ward YEARS before brought up concerns with that, wondered why they didn't gown and glove up...
    Yes - things have changed a bit! Of course, with the CF update last year, even more protective measures. But, pharma companies learned along the way how to dispense in single dose vials and this has made it much safer for us to dispense medications to our patients. Of course, they also had to convince hospitals that it was cheaper to by the vials than pay for a patient who gets sicker because of your care! That has become more important to hospitals with the changes in the way insurance companies pay for care.

    Every hospital has it's own infection control policies, but any hospital serving an accredited CF Clinic is held to a higher standard. Even so, it is the doctors and the nurses and the RTs and infection control officers who police all this. While accrediting agencies expect minimum standards, it takes forward thinking clinicians with a heart and mind for excellence to pursue the very best in infection control for any population. So, of course, you will see different standards everywhere you go. I worked at Oakland Children's Hospital in 2006 and I was on immunosuppression for my own chronic disease. So, I quite often wore a mask around coughing children. I cannot tell you how many times I was scolded by nurses for doing so. Yet, you would think they would want the best in infection control for their kiddos???

    Working for an adult hospital now, I forget about waking up babies in the middle of the night for treatments. The adult clinic believes in scheduling RT treatments twice daily unless the patient is critically ill. I agree, it would be much easier to do hand percussion on a sleeping child than strapping on a VEST and waking them up.

  3. #13
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    Hey Dot,
    Thanks for asking for my thoughts. Bottom line is this: I do not think in the hospital setting you can properly sterilize nebulizer cups for reuse. We use more care at home than the guidelines provide for a hospital and you don't have nearly the issues of MRSA etc. But more importantly is the inability for staff to be compliant. I was curious re our hospital's infection control procedures and googled and found that with c-diff, following the hospital's OWN policies was horrible. Only about 50% of doctors followed, nurses were about 80%. (RTs may be better or worse? Turn over could be an issue as well.) And from the personal experience, we see stupid stuff all the time: for instance staff cleaning my fil button and then opening the door with the same gloves. And what do you think my mil is going to touch leaving the room? Or the CF mom who said how the doctor doing her son's lung transplant scrubed in and then turned the light switch on? And then you have issues of mold growing in the sink (which our clinic rooms do because they have overflow values and the hand soap which bubbles goes through that when draining and is more susceptible to mold. So even if you have the best policy for sterilization/cleaning, I sincerely doubt you will have compliance and asceptic handling of more than 50%. (See the example of the RT who dropped it on the floor and then wanted to reuse.) This is coming from a momma bear who is clearly anxious in the hospital setting, but it is rational when you read the studies of how these horrible CF bacteria are transferred and how much easier it is to transfer than believed. And as you said, it is cheeper to avoid the infection than pay for it when more harm is done.

    I am not, though, oblivious to the cost. I have a business background and understand that if you lose money you won't stay in business (or non-profit) to serve anyone. And that insurance companies control reimbursement. However, I also think that there is much more to the cost than the mere cost of the disposable nebulizer. (I also wonder if the studies really show that much is wasted in using disposables???). The cost of RT time in cleaning, baby sterilizers (which would need sterilization after using for one patient--and I wonder how and IF that could even be down), the cost of supplies to clean, and then the training cost and the cost of disposing ones that aren't properly cleaned anyway, and of course the cost of litigation if someone is infected, as well as the loss of reputation if that happens. On the other hand, it might be possible to work with the CF center or the CFF pharmacy to get the disposable at an even better rate than you currently can.

    Anyway, that's where I'm coming from. Thanks for listening Dot.

  4. #14
    The Dot
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    Quote Originally Posted by Aboveallislove View Post
    Hey Dot,
    Thanks for asking for my thoughts. Bottom line is this: I do not think in the hospital setting you can properly sterilize nebulizer cups for reuse. We use more care at home than the guidelines provide for a hospital and you don't have nearly the issues of MRSA etc. But more importantly is the inability for staff to be compliant. I was curious re our hospital's infection control procedures and googled and found that with c-diff, following the hospital's OWN policies was horrible. Only about 50% of doctors followed, nurses were about 80%. (RTs may be better or worse? Turn over could be an issue as well.) And from the personal experience, we see stupid stuff all the time: for instance staff cleaning my fil button and then opening the door with the same gloves. And what do you think my mil is going to touch leaving the room? Or the CF mom who said how the doctor doing her son's lung transplant scrubed in and then turned the light switch on? And then you have issues of mold growing in the sink (which our clinic rooms do because they have overflow values and the hand soap which bubbles goes through that when draining and is more susceptible to mold. So even if you have the best policy for sterilization/cleaning, I sincerely doubt you will have compliance and asceptic handling of more than 50%. (See the example of the RT who dropped it on the floor and then wanted to reuse.) This is coming from a momma bear who is clearly anxious in the hospital setting, but it is rational when you read the studies of how these horrible CF bacteria are transferred and how much easier it is to transfer than believed. And as you said, it is cheeper to avoid the infection than pay for it when more harm is done.

    I am not, though, oblivious to the cost. I have a business background and understand that if you lose money you won't stay in business (or non-profit) to serve anyone. And that insurance companies control reimbursement. However, I also think that there is much more to the cost than the mere cost of the disposable nebulizer. (I also wonder if the studies really show that much is wasted in using disposables???). The cost of RT time in cleaning, baby sterilizers (which would need sterilization after using for one patient--and I wonder how and IF that could even be down), the cost of supplies to clean, and then the training cost and the cost of disposing ones that aren't properly cleaned anyway, and of course the cost of litigation if someone is infected, as well as the loss of reputation if that happens. On the other hand, it might be possible to work with the CF center or the CFF pharmacy to get the disposable at an even better rate than you currently can.

    Anyway, that's where I'm coming from. Thanks for listening Dot.
    Thank you! You have given me much food for thought.

  5. #15
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    The dot. yes, I agree that the vest is probably superior to manual CPT, but not everyone can use the vest. The times in my life where I have tried, my ribs kept breaking, even with it turned way down. They didnt actually break while using the vest, but vesting really seemed to weaken them somehow. I have no explanation for it, but after 4 breaks, no more vesting. (and subsequently no more breaks!) I guess everyone is different.

  6. #16
    The Dot
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    Quote Originally Posted by imported_Momto2 View Post
    The dot. yes, I agree that the vest is probably superior to manual CPT, but not everyone can use the vest. The times in my life where I have tried, my ribs kept breaking, even with it turned way down. They didnt actually break while using the vest, but vesting really seemed to weaken them somehow. I have no explanation for it, but after 4 breaks, no more vesting. (and subsequently no more breaks!) I guess everyone is different.
    Wow! I think I would have an aversion to vesting as well if my ribs kept breaking! I am assuming you have thin bones as a result of using steroids or malabsorption of calcium or both? I find that some therapists do not really know how to make appropriate adjustments on the vests. I do not recommend that you try again, but for other patients who may be reading this, I recommend that you keep the frequency at 10-14 (or more if you tolerate it and it works), but reduce the intensity. The intensity is basically what makes it squeeze tighter. I sometimes see RTs reduce the frequency, which actually makes the vest less bearable (it is more like you are getting a beating than a "clapping"). I ask them to listen to the sound of the frequency, then ask if they would ever percuss a patient at that slow rate. Of course, they would not, and it is not therapeutic.

    Thanks for your input!

  7. #17
    Senior Member
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    My hospital does it that you get cpt once a day, and have to vest the other times.

    i have to say I respond much better to cpt.
    I need those breaths between the pounding where you breath out and they push on your chest and vibrate their hands. It is actually the only thing that makes me cough.
    I can sit in a vest for half an hour without coughing once.
    i cough more if I sit and huff without any vest.
    32 year old, female, matching pair of Delta F508
    FEV1 ~45%
    Currently see Dr. Simon @ U of M hospital, he is the best!

  8. #18
    The Dot
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    Quote Originally Posted by Jennyvb17 View Post
    My hospital does it that you get cpt once a day, and have to vest the other times.

    i have to say I respond much better to cpt.
    I need those breaths between the pounding where you breath out and they push on your chest and vibrate their hands. It is actually the only thing that makes me cough.
    I can sit in a vest for half an hour without coughing once.
    i cough more if I sit and huff without any vest.
    Wow - that's good to know! Both that there are therapists out there that still use that technique and that it is working for you! I'm also glad to hear that you are a master of the Huff cough. Most of us in the RT department where I work needed a reminder of how to teach that technique because we do not use it a lot with our other patients. It is a very valuable tool! Thanks for sharing that info with me.

    Have you ever tried setting the VEST up to cycle through several different levels of therapy - and taking a break between cycles for coughing? I've seen other CF patients do this. They end up cycling to a very high frequency on the VEST, and this seems to be effective for them. (Just curious )

  9. #19
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    Dot do you mean the Minnesota protocol or something else?

  10. #20
    The Dot
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    Minnesota protocol

    Quote Originally Posted by Aboveallislove View Post
    Dot do you mean the Minnesota protocol or something else?
    I have only recently become familiar with the Minnesota protocol and find it difficult to imagine anyone being able to tolerate it - although CFers are a lot tougher than the average joe! No, I just met a few CF patients who have their own "protocol" (which may have been adapted from the Minnesota protocol). Just out of curiousity, is anyone out there using the Minnesota protocol for chest phyisiotherapy???

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