Therapist-Driven Protocols Might Improve with New Name

Therapist-Driven Protocols Might Improve with New Name

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Therapist-Driven Protocols Might Improve with New Name

By Paul Mathews, PhD, RRT, FCCM, FCCP

Patient-Driven Protocols (PDPs) or Therapist-Driven Protocols (TDPs)? That was the topic on RC World regarding the proper term to call treatment protocols familiar to many therapists.

PAUL MATHEWS “We decided to call our protocols PDPs instead of TDPs, because we feel it is the patients and their conditions that drive the protocols, not the therapists,” argued Karen J. Stewart, MS, RRT, director of Respiratory Care and Sleep Disorders at Charleston Area Medical Center, Charleston, W.V.

Many departments have changed the term from therapist driven protocols to patient driven protocols, it turns out. There are various reasons for the transition.

In some parts of the country, physicians were not as accepting of protocols if they were led to believe decisions surrounding patient care were made by therapists without their input.

“If you think about what we are tying to do, we are progressing care of a patient based on the outcome achieved by the patient, thus the term patient driven protocol,” Stewart explained. She makes some valid points. Consider the following line of thought:

If your 8-year-old child needs to go someplace, is your car kid-driven or adult-driven, based on their requirements? It is the same principle. The driver performing the activity is not necessarily the same one needing the activity.


Perhaps what we really do are Physician-Initiated, Patient-Directed, Therapist-Driven (and to appease management) Fiscally Conserving Protocols. (PIPDTDFCPs). OK, that’s a bit much, but you get the idea.

It is issues like this that cause confusion and indecision. We standardize terminology to clarify concepts and communications, not to please a given segment of the population.

Recently I did an editorial review of an article submitted to a journal. In the article, the author introduced the abbreviation “SOA” to mean “shortness of air.” Nearly every reference to this phenomenon elsewhere uses “SOB” for “shortness of breath.”

Should I have let the author’s abbreviation stand as written? Of course not! There is a clear and universally accepted usage for the SOB concept.

Similarly, what if I decided to start referring to arterial blood gas values in units of micro-tonnes (mT) rather than mmHg, torr units or kilipascals. Aren’t the latter three confusing enough? How receptive do you think editors would be to my innovative use of terminology? Not very, I would guess.

One argument that “physicians were not as accepting of protocols if they were led to believe decisions surrounding patient care were done by therapists without the physician’s input” is valid. But it points to miscommunication rather than fact. Under protocols, the physician writes the order initiating a protocol that has been previously approved. The doctor also has options of not ordering, revoking or modifying protocols at any point of the process. From a historical perspective, the initial concept and drive for TDPs came from physicians, not therapists.


Another issue I would like to discuss is the concept of self-administration of respiratory meds for hospitalized patients. Tracey Farrell, MS, RRT, raised this issue with a question on RC World. “Does anyone have a protocol for self-administration of medicated aerosols to share?”

Jim Cowan, RRT, ventilator care coordinator at St. John’s Health Systems, Springfield, Mo., replied,Patient administration of medications is a bad idea…It’s “TDP.” The patient doesn’t drive the protocol, we do.”

Kevin Coates, RRT, commented: “this protocol would be for patients who normally give themselves aerosol treatments at home and are still capable of doing so. The mind set is this would free up respiratory resources while allowing those patients to receive their therapy when needed, without having to wait for an RT who may be busy elsewhere.

Sorry. I am with Jim on this one. We have beaten this horse until it is dog food. Why should RC-administered drugs be treated differently than drugs administered by nurses? Does this imply there are two standards of care related to medication delivery and control in your institutions?


When I have been hospitalized, I have not been allowed to self-administer my own insulin, antibiotics, or cardiac meds. Pain medications via PCA pumps are dose- and interval-controlled by the nursing staff. They are not really self-administered. The potential for error is large, as is the possibility of over or under use, drug interactions and mis-recording of drug use. At the very minimum, I would check with your institution’s risk management and legal counsel prior to implementing this procedure.

Allowing self-administration of drugs also seems to set us in a position that we can be perceived as being less professional than other licensed caregivers. Perhaps it is because like O2, respiratory care drugs aren’t real drugs. Don’t you think it is less than professional to go along with policies and procedures that diminish your professional control and position? The argument has been made that RCPs often miss treatments and that nursing staff will get them done. When nurses miss treatments, they are required to file incident reports.


Sometimes in the daily challenges that life gives us, we miss what is really important. We may fail to say hello, please, or thank you, congratulate others on something wonderful that has happened to them, give a compliment, or just do something nice for no reason. If we forget, we are not living up to our potential.

Isn’t that what we are all about as RCPs, to better the lives of others? *

Paul Mathews is an associate professor of respiratory care education at the School of Allied Health, University of Kansas Medical Center, Kansas City.