Anyone else have trouble with RT's while in hospital

regina65

New member
The last time I was in for a bowel obstruction I had trouble with the respiratory therapist treating me like I was a child. I was nauseated the whole time I was in. It is really hard to do treatments on their schedule when you're puking. She got really hateful with me if I hadn't been so sick at the time she would had heard an earful. With having cepacia and MRSA these treatments are what have kept me alive. I dont skip them.
 

Ratatosk

Administrator
Staff member
It's been awhile since ds was admitted, but last bowel obstruction and subsequent surgery, he was supposed to do cot every 4 hours. Waiting for the rts, was unacceptable, nurses would page and they'd eventually wander in. Fortunately, DH and I would either strap on his vest and or do manual cpt. I'd speak with your doctor and see if he can take care of this issue
 

jaimers

Super Moderator
I'm so sorry Regina! Hope you feel better soon. Feeling nauseated and doing chest PT is such a horrible combination especially with all the coughing involved! I would talk to your doctor as ratatosk suggested and let him/her know what's going on. I know the RTs have a specific schedule they tend to follow daily so they can make the rounds to all their patients, accommodate everyone's schedule, etc. but they need to understand that sometimes your sickness doesn't follow a schedule! Ask if you can be worked into someone else's schedule for the day or if they can get a vest for you (or bring your own) so that you can do that if you're not ready for them when they need to come.
 

Krazy4Katie

New member
Very sorry to hear. Hope you're feeling better soon. Occasionally we get a "new" RT, but then I go in mama bear mode and straighten then out. I would definitely let your doctor/team know. Only problems we've had is that some of our RT's are wearing strong perfume/cologne, which triggers coughing in my daughter and myself (having asthma). I let our nurse know, and they will get a new RT. Good luck and take care.
 

Ratatosk

Administrator
Staff member
I also recall as per suggestions from here to stick a folded up towel under the vest on ds' stomach/incision site to help with vest treatments, he was prescribed an anti-nausea med prior to his surgery and they also had a belt he tried rather than his full vest which was lower pressure and placed at his chest. Last thing we wanted on top of dealing with obstruction was to end up with respiratory issues.
 

imported_Momto2

New member
I havent been in the hospital in decades (I refuse to stay "in-house") but when I was, I remember the RT's often being literally hours late for our scheduled time. Meaning, of course, that the nebbbie had completely worn off. Often after a few complaints to the head nurse and my doc, they either got someone else or a nurse did it. Granted they werent trained, but ON TIME and HARD meant a whole lot more. I also got RT's that acted as though I was a crystal, and simply did not have the strength to do anything useful other than give me a massage. I usually didnt see them again. And sometimes, I would get a GEM- an RT that was on time, knew their job, and could whack the hell outta me. Those folks were worth their weight in gold. But sadly, that was rare. My parents also did about 50% of my PT's when I was hospitalized, since I was getting them every 4 hours (nighttime too!).
 
T

The Dot

Guest
RT's while in hospital

The last time I was in for a bowel obstruction I had trouble with the respiratory therapist treating me like I was a child. I was nauseated the whole time I was in. It is really hard to do treatments on their schedule when you're puking. She got really hateful with me if I hadn't been so sick at the time she would had heard an earful. With having cepacia and MRSA these treatments are what have kept me alive. I dont skip them.
I am an RT and it has been my job to work with the physicians and the staff to begin providing the necessary in-hospital care for the adult CF patients from the adult CF center across the street from us, who have for years used our neighboring hospital. That is why I joined this Blog - to get feed-back from people just like you. First of all, I am sorry :( that the therapist made you feel worse than you already felt. That is not what we are charged to accomplish. What we are trying to do here is to identify the CF patients who cannot adhere to our schedule for whatever reason and ask the physician if they are OK with us allowing the patient to self administer in their own time. If the physician says yes, we deliver at the regularly scheduled time and do an assessment of vital signs and breath sounds. Then, we check back to assure the patient was able to self-administer the medications. This is not what we have always done, so you may have stayed at our hospital and not been offered this option. Be sure and ask if this option is available if needed in the future.

Also, we try to leave the VEST in the room with the patient at all times, so they can do their CPT at any time. We always use the wrap around type VESTs unless the patient brings in their own, which we attach to our unit. I have struggled with chronic migraines which often manifest as nausea without headache, and I cannot imagine how difficult it must be to take a VEST treatment when nauseated. The doctors here offer the patients a choice of airway clearance, including flutter device and IPV. Perhaps, you should ask your doctor if you could use some other form of airway clearance when you are neauseated?

Under no circumstances do we perform hand CPT. (I'm responding to some of the other writers in the Blog.) The way RT Departments are staffed these days, it is really difficult to allocate an RT to perform hand CPT, and I doubt that RT schools are teaching it the way the used to. The VEST is far superior (according to the studies), and flutter or IPV (device you take your medication with that constantly puff-puff-puffs at you), compare favorably to hand percussion.

Again, my sole purpose for being on this site is to learn from you all, so I thank you. I also want to apologize for any bad experiences you may have had (even at the hospital where I work). Every institution is only as strong as it's weakest member. Please, respond with any recommendations you have that would help us to do better.
 

Aboveallislove

Super Moderator
Dot, I am so happy you are here! Having a "voice" really helps! A few thoughts:
The "ideal" as I see it is to let the CF patient know the options (obviously making sure they follow through). I'm coming from the parent perspective where when our son was hospitalized with DIOS/obstruction, I handled all his treatments because he I had to time everything perfectly given the "input" and "output" issues. And we do this day-in-day out anyway so we know what to do and what works (need for breaks, etc.) So with adults, I could see similar desires...to do it on their time and their way. They do it every day already. Now, if the person isn't compliant that's another issue, but my ideal would be when the person checks in to say, these are our options:
1) We do everything and will be here at X,Y,Z, ZZ times.
2) You can do everything and we will bring in the meds. Let us know the times and times for check-ups that works best.
3) Or what option do you prefer.

I can imagine that some can't do anything but having the option for the "tune ups" that are "normal" would be so liberating, I'd think. Also sleep interruption is a huge issue, so that would help with recovery too.

Thank you for your dedication. There are good and bad employees/providers everywhere. And personally, I can't tell you how much it means when we have someone so dedicated...thank you,
 

Aboveallislove

Super Moderator
PS I wonder if it even possible that the clinic provides patients with their options so that they know before going to the hospital and can think through things and be ready when they get there. "Knowing" what to expect really helps me handle the stress of hospitalzations.
PSS I love the idea of being able to use the own equipment and we brought ours in. We're use to it and don't have to worry someone made a mistake in infection control protocals!
 

Ratatosk

Administrator
Staff member
During our last stay, the doctor scheduled vest & neb treatments every 4 hours. We coordinated with the nurse & rt regarding times. First time in the NICU, treatments were coordinated a certain time after meals -- he ate every 3 hours, was supposed to have cpt every 4.

With his obstruction it wasn't an issue as he wasn't allowed to eat. However, We weren't allowed to use our own vest. The hospital policy didn't allow outside equipment, so a vest was provided to us during our stay. There were disposable tubes, a full disposable vest and band. It stayed in the room and wasn't used by other patients (cross contamination issues). The RTs handled inhaled meds, so while we could strap on his vest, we didn't have access to albuterol, atrovent or pulmozyme. Middle of the night treatments, we always did CPT at home as his vest would wake him up. Between his first stay in the NICU and his bowel obstruction (6 years) RTs no longer knew how to do cpt. Which was fine, we could do his CPT. But again, no inhaled meds available if the RTs were running late or a no show.

One thing that had changed in the 6 years since our first stay. There was no longer the community bottle of albuterol. When DS was in the NICU, RTs would go from bassinet to bassinet -- they'd wash hands, but they'd pull tubes of saline and a brown bottle of albuterol out of the pocket of their scrubs. They also would hold the babies up against their chests to do CPT treatments. My MIL, who had been a nurse in a TB ward YEARS before brought up concerns with that, wondered why they didn't gown and glove up...
 
T

The Dot

Guest
Trouble with RT's in hospital

PS I wonder if it even possible that the clinic provides patients with their options so that they know before going to the hospital and can think through things and be ready when they get there. "Knowing" what to expect really helps me handle the stress of hospitalzations.
PSS I love the idea of being able to use the own equipment and we brought ours in. We're use to it and don't have to worry someone made a mistake in infection control protocals!
Aboveallislove - thanks for your input - it is invaluable to me! I think a patient booklet explaining how we do things would be a great thing to hand the patient in the clinic or when they get their first visit from RT in the hospital. I put together a brief booklet, but our plan has been evolving, so it is not all-inclusive. Will continue to work on that.

We are still working on how to sterilize the re-usable nebs that we dispense. We want to use high-quality nebs for Pulmozyme and Inhaled Antibiotics because these meds are so important and so expensive. But, the high-quality nebs are quite expensive. We must either dispose of nebs after use, or sterilize them. So, with the high-quality nebs, we clean and sterilize. We are using cold sterilizing for now, but considering purchasing baby bottle sterilizers for the patient rooms. What are your thoughts on that? I am worried because our rooms tend to heat up in the evening in summer, so I am thinking that having a steam sterilizer will add to the heat in the room. Please, let me know what you think.:eek:
 
T

The Dot

Guest
During our last stay, the doctor scheduled vest & neb treatments every 4 hours. We coordinated with the nurse & rt regarding times. First time in the NICU, treatments were coordinated a certain time after meals -- he ate every 3 hours, was supposed to have cpt every 4.

With his obstruction it wasn't an issue as he wasn't allowed to eat. However, We weren't allowed to use our own vest. The hospital policy didn't allow outside equipment, so a vest was provided to us during our stay. There were disposable tubes, a full disposable vest and band. It stayed in the room and wasn't used by other patients (cross contamination issues). The RTs handled inhaled meds, so while we could strap on his vest, we didn't have access to albuterol, atrovent or pulmozyme. Middle of the night treatments, we always did CPT at home as his vest would wake him up. Between his first stay in the NICU and his bowel obstruction (6 years) RTs no longer knew how to do cpt. Which was fine, we could do his CPT. But again, no inhaled meds available if the RTs were running late or a no show.

One thing that had changed in the 6 years since our first stay. There was no longer the community bottle of albuterol. When DS was in the NICU, RTs would go from bassinet to bassinet -- they'd wash hands, but they'd pull tubes of saline and a brown bottle of albuterol out of the pocket of their scrubs. They also would hold the babies up against their chests to do CPT treatments. My MIL, who had been a nurse in a TB ward YEARS before brought up concerns with that, wondered why they didn't gown and glove up...
Yes - things have changed a bit! Of course, with the CF update last year, even more protective measures. But, pharma companies learned along the way how to dispense in single dose vials and this has made it much safer for us to dispense medications to our patients. Of course, they also had to convince hospitals that it was cheaper to by the vials than pay for a patient who gets sicker because of your care! That has become more important to hospitals with the changes in the way insurance companies pay for care.

Every hospital has it's own infection control policies, but any hospital serving an accredited CF Clinic is held to a higher standard. Even so, it is the doctors and the nurses and the RTs and infection control officers who police all this. While accrediting agencies expect minimum standards, it takes forward thinking clinicians with a heart and mind for excellence to pursue the very best in infection control for any population. So, of course, you will see different standards everywhere you go. I worked at Oakland Children's Hospital in 2006 and I was on immunosuppression for my own chronic disease. So, I quite often wore a mask around coughing children. I cannot tell you how many times I was scolded by nurses for doing so. Yet, you would think they would want the best in infection control for their kiddos???

Working for an adult hospital now, I forget about waking up babies in the middle of the night for treatments. The adult clinic believes in scheduling RT treatments twice daily unless the patient is critically ill. I agree, it would be much easier to do hand percussion on a sleeping child than strapping on a VEST and waking them up.
 

Aboveallislove

Super Moderator
Hey Dot,
Thanks for asking for my thoughts. Bottom line is this: I do not think in the hospital setting you can properly sterilize nebulizer cups for reuse. We use more care at home than the guidelines provide for a hospital and you don't have nearly the issues of MRSA etc. But more importantly is the inability for staff to be compliant. I was curious re our hospital's infection control procedures and googled and found that with c-diff, following the hospital's OWN policies was horrible. Only about 50% of doctors followed, nurses were about 80%. (RTs may be better or worse? Turn over could be an issue as well.) And from the personal experience, we see stupid stuff all the time: for instance staff cleaning my fil button and then opening the door with the same gloves. And what do you think my mil is going to touch leaving the room? Or the CF mom who said how the doctor doing her son's lung transplant scrubed in and then turned the light switch on? And then you have issues of mold growing in the sink (which our clinic rooms do because they have overflow values and the hand soap which bubbles goes through that when draining and is more susceptible to mold. So even if you have the best policy for sterilization/cleaning, I sincerely doubt you will have compliance and asceptic handling of more than 50%. (See the example of the RT who dropped it on the floor and then wanted to reuse.) This is coming from a momma bear who is clearly anxious in the hospital setting, but it is rational when you read the studies of how these horrible CF bacteria are transferred and how much easier it is to transfer than believed. And as you said, it is cheeper to avoid the infection than pay for it when more harm is done.

I am not, though, oblivious to the cost. I have a business background and understand that if you lose money you won't stay in business (or non-profit) to serve anyone. And that insurance companies control reimbursement. However, I also think that there is much more to the cost than the mere cost of the disposable nebulizer. (I also wonder if the studies really show that much is wasted in using disposables???). The cost of RT time in cleaning, baby sterilizers (which would need sterilization after using for one patient--and I wonder how and IF that could even be down), the cost of supplies to clean, and then the training cost and the cost of disposing ones that aren't properly cleaned anyway, and of course the cost of litigation if someone is infected, as well as the loss of reputation if that happens. On the other hand, it might be possible to work with the CF center or the CFF pharmacy to get the disposable at an even better rate than you currently can.

Anyway, that's where I'm coming from. Thanks for listening Dot.
 
T

The Dot

Guest
Hey Dot,
Thanks for asking for my thoughts. Bottom line is this: I do not think in the hospital setting you can properly sterilize nebulizer cups for reuse. We use more care at home than the guidelines provide for a hospital and you don't have nearly the issues of MRSA etc. But more importantly is the inability for staff to be compliant. I was curious re our hospital's infection control procedures and googled and found that with c-diff, following the hospital's OWN policies was horrible. Only about 50% of doctors followed, nurses were about 80%. (RTs may be better or worse? Turn over could be an issue as well.) And from the personal experience, we see stupid stuff all the time: for instance staff cleaning my fil button and then opening the door with the same gloves. And what do you think my mil is going to touch leaving the room? Or the CF mom who said how the doctor doing her son's lung transplant scrubed in and then turned the light switch on? And then you have issues of mold growing in the sink (which our clinic rooms do because they have overflow values and the hand soap which bubbles goes through that when draining and is more susceptible to mold. So even if you have the best policy for sterilization/cleaning, I sincerely doubt you will have compliance and asceptic handling of more than 50%. (See the example of the RT who dropped it on the floor and then wanted to reuse.) This is coming from a momma bear who is clearly anxious in the hospital setting, but it is rational when you read the studies of how these horrible CF bacteria are transferred and how much easier it is to transfer than believed. And as you said, it is cheeper to avoid the infection than pay for it when more harm is done.

I am not, though, oblivious to the cost. I have a business background and understand that if you lose money you won't stay in business (or non-profit) to serve anyone. And that insurance companies control reimbursement. However, I also think that there is much more to the cost than the mere cost of the disposable nebulizer. (I also wonder if the studies really show that much is wasted in using disposables???). The cost of RT time in cleaning, baby sterilizers (which would need sterilization after using for one patient--and I wonder how and IF that could even be down), the cost of supplies to clean, and then the training cost and the cost of disposing ones that aren't properly cleaned anyway, and of course the cost of litigation if someone is infected, as well as the loss of reputation if that happens. On the other hand, it might be possible to work with the CF center or the CFF pharmacy to get the disposable at an even better rate than you currently can.

Anyway, that's where I'm coming from. Thanks for listening Dot.
Thank you! You have given me much food for thought.
 

imported_Momto2

New member
The dot. yes, I agree that the vest is probably superior to manual CPT, but not everyone can use the vest. The times in my life where I have tried, my ribs kept breaking, even with it turned way down. They didnt actually break while using the vest, but vesting really seemed to weaken them somehow. I have no explanation for it, but after 4 breaks, no more vesting. (and subsequently no more breaks!) I guess everyone is different.
 
T

The Dot

Guest
The dot. yes, I agree that the vest is probably superior to manual CPT, but not everyone can use the vest. The times in my life where I have tried, my ribs kept breaking, even with it turned way down. They didnt actually break while using the vest, but vesting really seemed to weaken them somehow. I have no explanation for it, but after 4 breaks, no more vesting. (and subsequently no more breaks!) I guess everyone is different.
Wow! I think I would have an aversion to vesting as well if my ribs kept breaking! I am assuming you have thin bones as a result of using steroids or malabsorption of calcium or both? I find that some therapists do not really know how to make appropriate adjustments on the vests. I do not recommend that you try again, but for other patients who may be reading this, I recommend that you keep the frequency at 10-14 (or more if you tolerate it and it works), but reduce the intensity. The intensity is basically what makes it squeeze tighter. I sometimes see RTs reduce the frequency, which actually makes the vest less bearable (it is more like you are getting a beating than a "clapping"). I ask them to listen to the sound of the frequency, then ask if they would ever percuss a patient at that slow rate. Of course, they would not, and it is not therapeutic.

Thanks for your input!
 

Jennyvb17

New member
My hospital does it that you get cpt once a day, and have to vest the other times.

i have to say I respond much better to cpt.
I need those breaths between the pounding where you breath out and they push on your chest and vibrate their hands. It is actually the only thing that makes me cough.
I can sit in a vest for half an hour without coughing once.
i cough more if I sit and huff without any vest.
 
T

The Dot

Guest
My hospital does it that you get cpt once a day, and have to vest the other times.

i have to say I respond much better to cpt.
I need those breaths between the pounding where you breath out and they push on your chest and vibrate their hands. It is actually the only thing that makes me cough.
I can sit in a vest for half an hour without coughing once.
i cough more if I sit and huff without any vest.
Wow - that's good to know! Both that there are therapists out there that still use that technique and that it is working for you! I'm also glad to hear that you are a master of the Huff cough. Most of us in the RT department where I work needed a reminder of how to teach that technique because we do not use it a lot with our other patients. It is a very valuable tool! Thanks for sharing that info with me.

Have you ever tried setting the VEST up to cycle through several different levels of therapy - and taking a break between cycles for coughing? I've seen other CF patients do this. They end up cycling to a very high frequency on the VEST, and this seems to be effective for them. (Just curious ;))
 
T

The Dot

Guest
Minnesota protocol

Dot do you mean the Minnesota protocol or something else?
I have only recently become familiar with the Minnesota protocol and find it difficult to imagine anyone being able to tolerate it - although CFers are a lot tougher than the average joe! No, I just met a few CF patients who have their own "protocol" (which may have been adapted from the Minnesota protocol). Just out of curiousity, is anyone out there using the Minnesota protocol for chest phyisiotherapy???
 
Top