Contact Your Washington Congressional Delegation
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AARC Home Care Section Call to Arms July 9th 2008 posted:
Dear Home Care Therapists,
We have been officially notified by the AARC that we will lose our seat at the Board of Directors if our membership is not at 1000 by August 31, 2007. As of today we are not at 1000 home care section members.
I have the gift of procrastination too, so I understand how we might have “forgotten” to renew. Please challenge your colleagues to join or renew to the home care section today. If every state got one or two members to join the home care section, we will hold the board position.
Access is the key to changing the direction home respiratory services appears to be going. We need to have a seat at the board to identify issues. We need to represent our professional organization at political and clinical forums to help identify problems and provide solutions. Now is the time to become passionate about your profession as others are trying to control and limit the quality care that respiratory therapists are known for.
Joan and I are working all options to keep this board position. We both appreciate your help.
Bob
Bob McCoy
Valley Inspired Products
15112 Galaxie Avenue
Apple Valley, MN 55124
Ph: 952-891-2330
Fax: 952-891-4625
www.inspiredrc.com
Update on the DOH has opened the Hospital Licensing Regulations & “Sec (88) “Protocols” and “standing order”. posted 6/24/07
Bob Bonner and myself represented RCSW and Overlake Hospital at the DOH hearing/s for revising the Washington State Hospital Licensing Regulations. Gary Wickman submitted written input opposing suggested changes and offer modification to the language (also spoke at the first meeting along with Donavan Knight). This was done at several meetings with verbal testimony and discussion several times at public hearings with the DOH. “Sec (88) “Protocols” and “standing order”. I believe we will have impact on the final writing of the bill. At the end hearing we had the census vote of the group to remove the langue I / we were concerned.
Will have to see final writing at the end of the year, however results of last meeting report looks like the questionable language is being removed. However this is what published after this meeting in regards to this section.
Level of Support: Supported with Modification
Modified proposal as follows: Revise text as follows:
(88) “Protocols” and “standing order” mean written or electronically recorded descriptions of actions and interventions
for the
implementation by designated hospital personnel under defined circumstances
and authenticated by a legally
authorized
person under hospital policy and
procedure.
Implementation of
a protocol or a standing order requires authentication. an order from a
licensed independent
practitioner
and when used must be recorded in the patient record. Certain orders imply
that related protocols be
activated when
that order is initiated and signed by an LIP, for example but not limited
to:
1. When an LIP
writes an order to initiate Mechanical Ventilation, the Protocol for “Daily
Spontaneous Breathing
Trials” is also
initiated.
Meeting discussion: No additional discussion noted. See substantiation.
ORIGINAL proposed language we were concerned about.
The proposed (in red) language change to State of Washington DOH Hospital Licensing Regulations could have very negative impact on how we do care here at Overlake in general and other hospitals, however I will be referring to just Respiratory Care. This is the change:
(88) "Protocols" and "standing order" mean written or electronically recorded descriptions of actions and interventions for implementation by designated hospital personnel under defined circumstances and authenticated by a legally authorized person under hospital policy and procedure.
Implementation of a protocol requires an order from a licensed independent practitioner and when used must be recorded in the patient record.
A standing order is for an emergency situation, including but not limited to cardio-pulmonary resuscitation or anaphylactic shock and does not require an order from a licensed independent practitioner prior to implementation.
Original posting on the site on the issue:
Sent to RCSW officers and friends Jan. 31, 06
I feel this is very important for SOME of the RC protocols SOME RC departments currently are using. Please read.
The DOH has opened the Hospital Licensing Regulations according to a letter dated December 19, 2005. Their intent is to provide opportunities for simplifying language to increase clarity; updates reflecting 2005 legislative changes; and provide open public options for receiving comments in order to develop recommendations for changes to existing regulations. The following are the most important changes DOH is considering myself and my medical director are most concerned about that would impact how RCPs work with patients and physicians. I know it applies to our department since we do not have 100% written physician orders on ALL patients receiving RC protocols (Protocols were previously approved by physicians). Under this proposed change we would have to stop many of them / call, delay and convince a physician to write a order each time. Also we could create standing order sheets for ventilator patients covering the weaning protocol, which only works for that one protocol since the other protocol are used house wide and we find physicians would rather we did our protocols without all the calls / delays).
The red below is the proposed changes.
There will be public forum meetings held once the new rules are drafted and we want to provide input and attend. They have a form to fill out and submit (attached) if you have a concern, yes they are asking for input. This would be best from the RC director and Manager / Medical Director of your department if you see this as an issue for NOW IS THE TIME TO SPEAK UP with the form first and consider speaking at the hearing (medical director would best, my medical director is fired up and going attend with myself I believe.)
The proposed (in red) language change to State of Washington DOH Hospital Licensing Regulations could have very negative impact on how we do care here at Overlake in general and other hospitals, however I will be referring to just Respiratory Care. This is the change:
(88) "Protocols" and "standing order" mean written or electronically recorded descriptions of actions and interventions for implementation by designated hospital personnel under defined circumstances and authenticated by a legally authorized person under hospital policy and procedure.
Implementation of a protocol requires an order from a licensed independent practitioner and when used must be recorded in the patient record.
A standing order is for an emergency situation, including but not limited to cardio-pulmonary resuscitation or anaphylactic shock and does not require an order from a licensed independent practitioner prior to implementation.
Our RC protocols (may be other standing orders at risk since all are not "an emergency situation" are at grave risk if this protocol is implemented under this suggested changes sense we / some other hospitals do not have physician orders in each patients chart for all of their protocols.
We may no longer be able to provide any protocols without a direct written physician order in each chart.
This is a call to input on these proposed changes. Now we have a brief window to in put to the state as outlined below.
I think immediate input would be good (if others also see it as a issue and I am not just over reacting a bit, I know it is real by my hospital), otherwise wise we may go behind 10 -15 years in my humble opinion for how we are doing our jobs to improve patient care.
What do you think?
First milestone is due February 28, 2006 . This is an important and very proactive step. You can go online and and review what is being considered (blue text) or you can provide input into changing any of the standards. I have attached an electronic copy of the form if you want to submit changes. This is a great opportunity to review any standard you believe should be deleted, clarified or added.
Link how to contact etc. http://www.doh.wa.gov/hsqa/fsl/ruledevelop/rule_development.htm
Link to proposed Hospital License Rules change (do a search for 88 in the document to find the protocol issue:
http://www.doh.wa.gov/hsqa/fsl/ruledevelop/pdf/WAC246-320_CodeRevisorAugust2005-Draft1Language.pdf
Example of a few Overlake RC would be at risk for it implemented:
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Emergent ABG Collection and Analysis Protocol (done to report ABG values with other information at the time the call is made to the physician, this would be a problem............. delay Tx / intervention time for the patient. |
Smith, Terry |
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He/O2 (Heliox) Therapy for Indicated / Selected Status Asthmaticus, COPD and Upper Airway Obstruction Patients (could work with this one since are in ER and physicians are can be access easy) |
Smith, Terry |
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Management of Patient Receiving Bronchodilator Therapy (PDP) Would be our bronchodilator protocol (other hospitals have these as well). The conversion to MIDs automatically (with notification to physicians of course, and of course the can over ride at anytime). This protocol and others have allowed the most appropriate bronchodilator delivery to the patients based criteria (evidence based) so the patients can be trained with feed back on the proper usage of the MDI prior to going home with that device to insure better patient usage at home. This protocol also decreases work loads and expense for more labor intensive / expensive hand held nebulizer (HHN) bronchodilator treatments which are proven to not be more effective in the large sub group of patient that we ID in our protocol. Thus this change would require more RCPs be hired to do the additional HHN without benefit to patient care but drive up cost and have RCPs less available for more beneficial care to the patients than doing routine unnecessary care. This is one more example of the negative impact I would foresee with this change. (This is another evidence based protocol for best practice) We will be losing ground on improve care while becoming less efficiency. These protocols help the patients, physicians, and allowing us to use our limited recourses the most effective way. We have not had problems / negative outcomes using any of these protocols in RC to date. We have been building these for x 15 years now (system) it would be a great loss to see a change that would negatively impact these. These cover a very wide range of types of patients thus standing orders sheet not effective since it can be needed on ANY patient in house that fits the indication and does not have a counter indication (stand orders usually are focused on a sub group of patients only, example by DX could work on ventilated patients so).
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Smith, Terry |
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OXYGEN THERAPY PROTOCOL FOR ADULT & PEDIATRICS. Excluding Neonatal (Patient Driven Protocol) |
Smith, Terry |
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Would impacted patients by slowing the correct O2 delivery levels / devices for those patients not covered by titration / orders or open orders for device written in the chart. |
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Oxygen Therapy Rounds Procedure & Protocol for Discontinuation of Oxygen Therapy |
Smith, Terry |
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Patients on oxygen / higher level for longer than they need. |
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Ventilator Patient Weaning Therapist Driven Protocol (TDP) Currently would stop us until get a physician order which does NOT work well by experience. Thus drive up length of stay on a vent, ICU, and VAP rate. In the long run we could push for a standing order printed on a ventilator standing order sheet that would be signed. However we do not have thus that would someday if we convince others. This is evidence based at this point in history. |
Smith, Terry
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These are a few of our concerns. I challenge you to do quick review of your current and future desired protocols and ask yourself would this change have a negative impact on your department's ability to care for your patients and provide the best services to your physicians? If it would please review with your medical director and consider input / action (fill out the form and submit it and or speak at the hearing on this issue).
VERY TIME SENSITIVE ISSUE if you agree we have a problem please forward and share with other hospitals and RCPs.
Thanks Terry
==================================
Terry Smith BSHAS RRT
Director of Respiratory Care Services & Eastside Sleep Disorders Center
Overlake Hospital MC
1035 116th Ave. NE
Bellevue, WA 98004-4617
Phone#
425-688-5169 Office
Fax # 425-467-3392
mailto:terry.smith@overlakehospital.org
Web Master for the RCSW Page
http://www.rcsw.org
==================================
Sent: Tue 12/20/2005 14:58
To: aarcmember@mail.aarc.org
Subject: Contact Congress Now - Help O2 Patients!
PLEASE CONTACT YOUR SENATORS NOW!!
ISSUE:
Included as a provision of the 2007 federal budget bill is a provision that
would require Medicare patients after 36 months of use on home oxygen
therapy to purchase their oxygen equipment, rather then continue renting the
equipment.
This is a major and detrimental change in the provision of home oxygen
service from what has always been available to the Medicare patient. If
enacted this would place the on the shoulders of the patient the
responsibility and the cost of both servicing and maintaining their oxygen
equipment. This is a patient safety issue, and as respiratory therapists we
ask you to let your Senators know you oppose this provision.
We believe the genesis of provision, has been that some oxygen suppliers
have inconsistently been providing the service and maintenance component for
Medicare covered oxygen equipment. While this servicing and maintenance
concern, combined with the savings to the Medicare program this provision
may create may be why Congress is attempting to enact this provision, the
solution to the problem of inconsistent servicing and maintenance should not
lie on the backs of the Medicare home oxygen patient.
The budget provisions with this O2 language has passed the House of
Representatives and is on its way to the Senate for approval. Therefore, it
is critical for you to contact your Senators as soon as possible to oppose
the O2 provision.
Ask your Senator to kill the bill (S. 1932) by voting NO on the budget
bill. The bill is expected to be debated today on the Senate floor and a
vote is likely to also occur today.
Call your Senators and ask them to vote NO on the budget reconciliation act.
The U.S. Capital switchboard telephone number is 202-224-3121.
Or find your Senators phone number and email address by going to the AARC’s
Capitol Connection, and enter your zip code. http://capwiz.com/aarc/home/
Here is a summary of key provisions of this bill – S. 1932 that will affect
home care patients:
Subtitle B – Provisions Relating to Part B (S. 1932)
(1) Change Capped rental policy for DME
Beneficiary ownership of certain items of DME begins after the 13th month of
rental (for items for which rental begins after January 1, 2006.)
BENEFICIARY OWNERSHIP OF OXYGEN EQUIPMENT BEGINS AFTER 36TH MONTH OF RENTAL.
Eliminates the service and maintenance fee for capped rental DME.
Please contact your Senators now, for the sake of the home oxygen patient.
Thank you for your help.
AARC
POSTED 12-20-05
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