The Right People Plus the Right Equipment Equals Better Outcomes
Source: Carol Devecka
In any profession, innovations occasionally come along that make work easier and maximize the practitioner's efforts. For the respiratory therapists at the University of Texas Medical Branch (UTMB) in Galveston, TX, Aerogen's AeroNeb Pro nebulizer has made such a remarkable difference in their work.
"Nebulizers have been in use for so long, it's hard to imagine this as new technology," says Mary West, program manager and senior respiratory therapist for the Department of Respiratory Care Services at UTMB Galveston. "What makes this one so valuable to the therapists and their patients is the design. Being able to order something that has such clear advantages, continues to be in high demand, and gets positive feedback every time makes me feel like I have done what I set out to do -- to empower the clinical respiratory therapists in their work."
According to Aerogen, the AeroNeb Pro, driven by their OnQTM electronic micropump, is the first major technological advance in 20 years specifically designed for patients requiring mechanical ventilation. Aerogen, the maker of the device, is a specialty pharmaceutical company that provides innovative pulmonary drug products to advance the treatment of respiratory disorders in critical care settings. "The product works because of a screen in it that vibrates, causing 95 percent of the droplets of medication to fall within a therapeutic range," explains West. "The uniformity of size allows the patients to respond to less medication, and respond faster. It can be used in any situation where a nebulizer is needed."
While West does not use the nebulizer clinically herself, it is her job to provide her staff with the necessary tools to do their best work. "I handle the departmental budget, capital equipment, ordering of supplies, evaluation of new equipment and supplies," explains West. "In this capacity, the AeroNeb Pro is one of the easiest choices I have to make. There is no question of its value.
"I also supervise employee interviews, training, discipline, evaluations, time and attendance. I work to maintain the departmental policies and procedures and interact with colleagues from other departments on issues of mutual interest," West continues.
Although her work is currently administrative, West has a long career of clinical care behind her, too. Her combined experiences have given her a keen understanding of the changing needs of UTMB. She has been there since 1978.
"This is a large tertiary-care hospital, with 774 inpatient beds, six intensive-care units and an 80-bed emergency room," explains West. "We are a Level I trauma center, a huge telemedicine center and we have a large Texas Department of Corrections facility on campus. We do everything from burns to pulmonary patients and everything in between. I started in the pharmacy as a pharmacy technologist. I filled inpatient medication orders, prepared IVs and assisted when needed with filling outpatient prescriptions."
To her, working as a pharmacy tech was just a stepping stone to help West reach what she then considered her ultimate goal: nursing. "I had chosen LVN, and was looking to become an RN. What I really wanted to do was to help people," she recalls, "and I began to notice some of the other health fields. I was drawn to respiratory therapy, knowing how crucial breathing is to survival and to healing. I felt it was an area that would allow me to have a big impact."
For over 10 years, West enjoyed a rewarding clinical career as a respiratory therapist at UTMB, gaining in knowledge and responsibility over the years. "I provided bedside patient care, including mechanical ventilation, suctioning, resuscitation, pulmonary hygiene and patient training," she explains, "and I worked with the critically ill patient population. I assessed patients to determine needed levels of respiratory care. I monitored existing orders and consulted with the ordering physicians for individual patients. I evaluated and trained and monitored staff, and was a member of Code Team, which answered all patient codes in all UTMB hospitals."
Her extensive clinical experience prepared West to assume the responsibility of enabling her fellow therapists to provide the highest possible level of care. "Even though I love clinical work, I know what I do now has a broader impact clinically than when I was just one therapist doing one therapist's job," West observes. "The decisions I make have a ripple effect, and impact the care each one of the therapists is able to provide."
She began to fully appreciate this fact when she took over the ordering of equipment and supplies for the anesthesia department at UTMB. Working closely with the anesthesiologists, learning what materials were most crucial and seeing the difference they made was gratifying to West.
Accordingly, she does not make product choices lightly. "A lot of knowledge, a lot of thought and a lot of feedback are necessary when making decisions on what equipment to use. If it is good for the patients, it is good for the staff and for the budget, too. I need to find what makes a difference and ignore the rest of the products that don't deliver what they promise."
The AeroNeb Pro consistently earns raves from the staff. "I have been told so many positive things about this product," stresses West. "One therapist told me that the AeroNeb Pro, in her experience, consistently cuts back response time from 20 minutes to five minutes, requires only half the amount of medicine, and leaves no residual [medicine] at the end of a treatment.
"Paula Cowan, RRT (clinical specialist for that area) and others have shared stories of using it in the Infant Special Care Nursery, where those qualities have helped the smallest patients' outcomes," she continues. "We have a large Infant Special Care Nursery, with survivors as small as 370 grams, less than a pound." Given the extreme sensitivity of such fragile preemies, accurate dosing is crucial to good outcomes. The pediatric patients at UTMB who stand to gain the most from the AeroNeb Pro nebulizer often face extensive periods of hospitalization. Anything that improves their outcomes enough to shorten their inpatient stays has a lasting effect on their health, their lives and the lives of those who care for them.
As West knows very well, an effective delivery system can mean as much to a patient as the medication itself. Peggy Bartram, RRT, (clinical specialist for the pedi area) at UTMB recently told West of one patient whose prospects seemed especially grim. The child was five, and had never been in intensive care before, but was not responding to any treatments. Despite the staff's best efforts, the child's flow volume loops refused to open up.
"[They] tried the AeroNeb Pro on this patient, and almost immediately, the situation improved, and the flow volume increased," reports West. "And the funny thing is, we were not changing anything except the introduction method."
The speed and efficacy of delivery is remarkable. "We are always looking to speed up the time it takes to improve breathing in a patient," stresses West. "Not only are we looking for that from products, but from programs and policies as well."
This interest has lead to a long-standing interest in developing a pediatric transport team at the facility. Respiratory therapists at UTMB are part of the core team that is spearheading the effort to implement the pediatric transport team -- and some current staff members already have a background in transport work, easing its implementation. West and her colleagues are hopeful that the program can be put into effect soon.
"Whether it is demographics, or geographical location, or another factor," muses West, "the fact is, we get quite a number of pediatric emergencies involving breathing difficulties. Our team has been interested in getting care to those patients quicker via a transport team with tools like the AeroNeb Pro on hand. Such speed of care would significantly improve outcomes."
West is not only concerned with respiratory therapy as it affects her work at UTMB, but also with how changes affect the profession as a whole. "The field has branched out more since I first started," she states. "Twenty years ago, we were not helping with invasive procedures. Now we are found in the operating room helping the anesthesiologists, and have stations on ICU floors. We are increasingly accepted as an integral part of the medical team."
Having worked on the anesthesia team at UTMB, West knows the difference a respiratory therapist can make in an operating room. "We are able to bring a satellite blood gas lab right there, which speeds up the process and helps patients get off machines quicker. Having a respiratory therapist on hand allows doctors to more effectively treat patients who, for whatever reason, do not tolerate an IV, for example," she illustrates. "We can ventilate patients better with a handbag, like those with extreme lung disease who do better with a therapist who can respond to their specific needs than they do hooked up to a machine."
West is gratified to know that the field she has chosen makes a difference -- and is increasingly valued by the general public. "I never regret the choice I made to change from a direction towards nursing to becoming a respiratory therapist. I am happy to have been in the field long enough to see both advances in technology and expansion in respiratory therapist involvement in patient care. I am proud of what I do, of what our clinical respiratory therapists do and what we accomplish as a team."
Mary West, RRT-NPS, AAS, earned her certificate of licensed vocational nursing in 1978 from Galveston College, Galveston, TX. After completing 12 hours toward an associate of science degree in 1979, she went on to complete a course of study in respiratory therapy, earning her associate of science degree from Galveston College in 1981. By 1991, she graduated from the University of Texas Medical Branch, Galveston, with her bachelor of science degree in health care administration. She is currently completing work towards a master of science degree in health education at UTMB Graduate School of Biomedical Science, also in Galveston. West is also an assistant professor of respiratory care for the School of Allied Health Sciences, Department of Respiratory Care at UTMB.
Carol Devecka is a freelance writer from Baltimore. She is on the editorial staff of NEWS-Line for Respiratory Care Professionals.
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