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Executive Nurse Leadership Program
Hospital Department Rotations: Respiratory-Essay #3

Equipment and supplies obtained through contract services consist of ventilators, bipap machines and cough assist devices. The hospital has sixteen ventilators on-site which are hospital owed; however there must be two ventilators onsite to serve as back-up. When the need for greater then fourteen ventilators arises, contracted ventilators must be brought in-house. The hospital currently owes one bipap machine, therefore whenever it is use a contracted bipap machine must be brought in. The cough assist device is when patients are unable to produce an effective cough and is rented as needed for patients. Supplies for this contracted equipment may also be obtained on an as needed basis. Staffing is based on respiratory therapy hours per patient day (HPPD) and the acuity level of the respiratory patients in house. Must days there are two respiratory therapists per twelve hour shift and the Director of Respiratory Therapy is counted in staff for day shift. Occasional on weekends an extra respiratory therapist maybe added for an eight hour shift in place of the Director of RT, however this is only when the census is high and the patient acuity is high as well. Patients are weaned from the ventilator according to the established weaning protocol. The pressure support weaning protocol is initiated as ordered by the pulmonologist and will be conducted between 8:00 am and 8:00 pm. Patients are not weaned if their FIO2 need is greater than 60% to maintain a SpO2 greater than 91%. As DRT, interaction with the physicians occurs on a daily basis and the current relationship is one of mutual trust and respect. Challenges faced in this position include meeting staffing budget, getting RT’s to follow the wean protocol as well as other policy and procedures. Staffing is

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