The Evolving RT in the Homecare World

In today’s health care world of tracking hospital readmissions — and hospitals being held accountable for those readmission — the RT in the home care field must evolve and be more critical than ever before. Especially since COPD readmissions are one of the big targets. We all know that RT visits in the home are not reimbursable. However, having nurses, LPNs, CMAs and caregivers educate, manage and oversee these COPD patients is not the answer. The past readmission rates prove this.

As a home care RT, my focus has always been on PAP therapy and oxygen. Yet when dealing in these disciplines with a COPD patient, my role has to go further and not become routine. Clinical thinking dictates how to get these patients to use their equipment and to manage both diseases together. It is not just about the pressure and the mask fit with these patients. We have to look outside the box when they are struggling and ask why? Is the head of their bed elevated at least 30 degrees; have they taken their bronchodilators before bed? Are they managing their COPD properly?

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A Need for Patient Education
Working in patients’ homes today, I find it disturbing how many COPD patients are being discharged from the hospital without peak flow meters, spacers, medication education and proper cleaning instructions. Many of my patients have never heard of a peak flow meter let alone know how important this piece of equipment is to managing their disease properly or how to use it. A peak flow should be done every morning before any medications have been taken. This number should be as important to a COPD patient as a weight is to a CHF patient or a blood glucose number is to a diabetic. The problem is lack of education. We teach CHF patients and diabetics how to use these tools and how to manage their diseases. How much do we teach the COPD patient? Yes, we all do smoking cessation with them, but that is just the tip of the iceberg. We must do more.

Hospitals must begin teaching the importance of a peak flow — how to take a peak flow and what the numbers mean. Each COPD patient should be discharged with a peak flow meter and chart to keep track of their daily numbers. They should understand what the red, yellow and green zones are and what to do when they find themselves in each zone. This should be done every morning before that first respiratory treatment is given and charted.

Homecare Collaboration
DME companies need to become focused on supplementing hospitals in the home with a COPD program. This will not be easy due to cost; however, it is what the hospitals need and will be looking for in the future from DME companies. The DME that is hospital-based and can support the hospital with clinical RTs will become the hospital’s first choice. The DME’s program should coordinate with the hospital and home care nursing programs to be sure the same material and instructions are taught across the continuum of care. There needs to be this collaboration of care in order for the readmission of COPD patients to decrease. The DME program will need to have: clinically focused RTs, a COPD education program and protocol that equips each patient with peak flow meters, spacers, respiratory medication education, cleaning regimen for all their equipment and weekly RT follow ups. Coordination with the home care nurses will ensure these patients are well taken care of and educated properly.

The bottom line is we need to become proactive with these patients and realize that the RT is the only one who can teach these skills to the patient properly.

Janet McIntyre, RRT, is clinical respiratory services manager at Healthy@Home.