Respiratory Therapy 101: Just Keep Breathing

I am excited for the new computer system at work. You see, we’re implementing a whole new billing and charting system in the RT department. I suspect that over time it will improve the consistency of our documentation, the adequacy of our care (arguable), and our charge capture. But the big reason I’m excited boils down to one thing: flowsheets.

You see, in most hospitals I have worked in us RT’s get our own flowsheets in the ICU. We document ventilator settings, respiratory and mechanical measurements, and treatments or interventions on them, and typically we leave them attached to a clipboard attached to the ventilator in the patient’s room. We do this for a number of reasons: a physician or nurse who wants to see what we’re doing can easily access the flowsheet, and we don’t have to chase papers when we’re doing our rounds.

But at Sunny Flats, we share our flowsheets with nursing. The ICU nurses have a trifold flowsheet that documents everything they do, and fully 1/3 of their trifold is dedicated to us RTs. The problem is that those flowsheets are in high demand. In addition to all the charting that the RN has to do on it, physicians are using them, risk managers and utilization reviewers are looking at them, the HUC needs them to enter orders and do mystical chart things, and pretty much everyone but the janitor needs the sheet for some reason.

What does this mean? It means that I spend probably a good two hours every day tracking down or waiting for flowsheets, which I then use for about two minutes of good solid documentation. This seems inefficient, at best.

But with the advent of our Computers On Wheels (COWs, complete with names like “Bessie” or “Moo-lan” or “Moo-nshine” or any other cow pun you can imagine) and our new mediserve charting system, documentation will be a cinch. I’ll simply wheel my computer up to the ventilator, click the patient’s name on my worklist, and fill out our vent form. If I do a treatment or any interventions I simply enter them under the appropriate spot in the system. In the event of a patient on isolation for infectious organisms, I’ll do a variation on what we do now, which is to write everything in Sharpie on a paper towel and tape it to the door of the room, to be transcribed once I am in a clean zone again.

This whole new computer system will streamline our processes and make life easier…once the implementation is finished. The implementation will be fun because many of my fellow RTs fear computers like dogs fear vacuums, and also because people tend to fear and resist change. But I suspect that things will get better once the griping dies down.

I, for one, am looking forward to it. Minor changes like this can make enormous differences in quality of care. I’ll keep you posted.