WEST VIRGINIA NORTHERN COMMUNITY COLLEGE by liaoqinmei

VIEWS: 9 PAGES: 62

									WEST VIRGINIA NORTHERN
 COMMUNITY COLLEGE



   RESPIRATORY CARE
Associate of Applied Science
     Degree Program



   STUDENT HANDBOOK
         2008
                         West Virginia Northern Community College
                                     1704 Market Street
                                    Wheeling, WV 26003
                                       (304) 233 - 5900
                                      www.wvncc.edu
                                 Student Information

If found please return to:


Name _______________________________________________________________________

Address _____________________________________________________________________

City/State/Zip_________________________________________________________________

Home Phone ___________________________ Cell Phone ____         ____________________

E - Mail _____________________________________________________________________

Start Date ________________________         Completion Date _______________________


In case of emergency contact:

Name _                          ________________________________________________

Address_____________________________________________________________________

City/State/Zip_________________________________________________________________

Home Phone __________________________       Cell Phone __       ___________________

Family Physician________________________ Phone Number        _________   ___________




                                   College Contacts


Ralph Lucki                                 (304) 214-8878
Lisa Ingram                                 (304) 214-8874
Debbie Yadrick                              (304) 723-7536
Cindy Ritchie                               (304) 214-8834
                                                  TABLE OF CONTENTS

SAFE AND ETHICAL CLINICAL ........................................................................................................ Page 1

CLINICAL/LAB POLICIES .................................................................................................................. Page 3
      Clinical/Lab Attendance .......................................................................................................... Page 3
      Call - Off Procedure ................................................................................................................ Page 3
      Weather Related Call -Off ....................................................................................................... Page 3
      Smoking .................................................................................................................................. Page 3
      Meals....................................................................................................................................... Page 3
      Communication Equipment ..................................................................................................... Page 3
      Emergency Treatment During Clinical Rotations .................................................................... Page 3
      Liability Insurance ................................................................................................................... Page 3
      Parking .................................................................................................................................... Page 3
      Learning Resources ................................................................................................................ Page 4
      Internet Resources.................................................................................................................. Page 4
      Uniforms/Supplies ................................................................................................................... Page 4
      Professional Appearance ........................................................................................................ Page 4

HEALTH CARE SYSTEMS ................................................................................................................. Page 6
     Information Management ........................................................................................................ Page 6
     Patient/Institutional Confidentiality .......................................................................................... Page 6
     Patient Rights and Organization Ethics .................................................................................. Page 7
     Patient Rights and Responsibilities ........................................................................................ Page 7
     Patient Assessment ................................................................................................................ Page 7
     Patient Education .................................................................................................................... Page 8
     Advanced Directives ............................................................................................................... Page 8
     Positive Communication Tips ................................................................................................. Page 8

ENVIRONMENTAL MANAGEMENT .................................................................................................. Page 9
      Risk Management ................................................................................................................... Page 9
      Orientation, Training and Continuing Education ..................................................................... Page 9
      Incident Report ...................................................................................................................... Page 10
      Fire Safety ............................................................................................................................. Page 10
      Medical Equipment ............................................................................................................... Page 10
      Medical Gas System Failure ................................................................................................. Page 10
      Electrical Safety ................................................................................................................... Page 11
      Electrical Interruption ............................................................................................................ Page 11
      Allergies ................................................................................................................................ Page 11
           Security ................................................................................................................................. Page 12
           Infection Control .................................................................................................................... Page 12
           Exposure to Bloodborne Pathogens ..................................................................................... Page 12
           Exposure to Airborne Pathogens .......................................................................................... Page 12
           Patient Lifting and Moving .................................................................................................... Page 13
           Emergency Preparedness .................................................................................................... Page 13
           Emergency Codes ................................................................................................................ Page 13
           Hazard Communication ........................................................................................................ Page 14
           Material Safety Data Sheets (MSDS) ................................................................................... Page 14
           Hazardous Material Inventory ............................................................................................... Page 14
           Hazardous Waste Spill.......................................................................................................... Page 14

AGE SPECIFIC CARE ...................................................................................................................... Page 15
      Neonate (Birth - 28 days) ..................................................................................................... Page 15
      Infant (29 days - 1 year) ....................................................................................................... Page 15
      Toddler (1 - 3 years) ............................................................................................................ Page 15
      Preschooler (3 - 5 years) ..................................................................................................... Page 16
      School Age (6 - 12 years) ..................................................................................................... Page 16
      Adolescent (13 - 18 years) ................................................................................................... Page 16
      Young Adult (19 - 44 years) ................................................................................................. Page 17
      Adult/Middle Age (45 - 65 years) ......................................................................................... Page 17
      Late Adult (65 years +) ......................................................................................................... Page 18

CLINICAL AFFILIATE CONTACTS .................................................................................................. Page 20

CLINICAL RECORDS MANAGEMENT ............................................................................................ Page 21

COMPETENCY CHECKLIST ............................................................................................................ Page 22

PROGRAM LEARNING OUTCOMES .............................................................................................. Page 23

BASIC COMPETENCY VERIFICATION .......................................................................................... Page 36

CLINICAL/LAB RECORDS ............................................................................................................... Page 39




                                                                                                                                                 9
                                  RESPIRATORY CARE
                               Description of the Profession
Respiratory care is a life-supporting, life-enhancing health care profession practiced under qualified
medical direction. Respiratory care services provided to patients with disorders of the
cardiopulmonary system include: diagnostic testing, therapeutics, monitoring, and rehabilitation.
Patient, family, and public education are central to the mission of the profession. Respiratory care
services are provided in all health care facilities and in the home.

The knowledge and skills of the Respiratory Therapist are acquired through formal programs of
didactic, laboratory, and clinical preparation. Therapists may assume clinical responsibility for
specified respiratory care modalities involving the application of well defined therapeutic techniques
under the supervision of a physician.
A.       Review clinical data, history, and respiratory therapy orders.
B.       Collect clinical data by interview and examination of the patient. This will include portions
         of the data by inspection, palpation, percussion, and auscultation of the patient.
C.       Recommend and/or perform and review additional bedside procedures, and laboratory
         tests.
D.       Evaluate data to determine the appropriateness of the prescribed respiratory care.
E.       Assemble and maintain equipment used in respiratory care.
F.       Assure cleanliness and sterility by the selection and/or performance of appropriate
         disinfecting techniques and monitoring their effectiveness.
G.       Initiate, conduct, and modify prescribed therapeutic procedures to achieve one or more of
         the following specific objectives:

In addition to general respiratory care the respiratory therapist applies scientific knowledge and
theory to practical clinical problems of respiratory care. The respiratory therapist is qualified to
assume primary responsibility for all respiratory care modalities, including the supervision of
respiratory therapy technician functions. Under the supervision of a physician, the respiratory
therapist may be required to exercise considerable independent, clinical judgment in the respiratory
care of patients.
A.       Review, collect, and recommend obtaining additional data. The therapist evaluates all data
         to determine the appropriateness of the prescribed respiratory care, and participates in the
         development of the respiratory care plan.
B.       Select, assemble, and check all equipment used in providing respiratory care.
C.       Initiate and conduct therapeutic procedures to achieve one or more specific objectives.
D.       Maintain patient records and communicate relevant information to other members of the
         health care team.
E.       Assist the physician in performing special procedures in a clinical laboratory, procedures
         room, or operating room.




                                                                                                   10
                          Student Statement of Responsibility
 Instructions: Please read carefully and decide if you can commit to these requirements. Your signature on
 this document indicates that you have received and read the West Virginia Northern Community College
 Respiratory Care Student Handbook and accept the conditions of the agreement.

I am aware that the following characteristics are necessary to complete the Respiratory Care
Program.

1.      I must be able to:
        a.      perform medium to heavy work (lift 50 lbs);
        b.      walk and stand on hard surfaces for prolonged periods of time;
        c.      climb stairs, stoop, kneel, crouch, reach, stretch, feel, lift, push, and pull;
        d.      hear acutely for auscultation of vital sign measurement or have appropriate
                corrective device;
        e.      see acutely close-up and at a distance; have depth perception, discriminate colors,
                or have appropriate correction;
        f.      communicate both verbally and in writing - grammar, punctuation, and spelling are
                critical;
        g.      function in stressful situations;
        h.      demonstrate integrity, honesty, and reliability.

2.      It is my responsibility to read and adhere to all policies and procedures of West Virginia
        Northern Community College as defined in the College Catalog, Student Handbook and
        Respiratory Care Student Handbook.

3.      It is my responsibility to complete an annual physical exam form, with appropriate
        laboratory studies, immunization records and that any major change in health status must
        be reported to the program director. Note:        All student records are provided to
        clinical affiliates as requested.

4.      It is my responsibility to complete the required background check and drug screening test
        and that any change in my status must be reported to the program director.

5.      I am subject to random drug screening at my expense. Unauthorized use of controlled
        substances will be cause for dismissal from the Respiratory Care program

6.      I am expected to attend all Respiratory Care classes and clinical experiences. Travel is
        and it is my responsibility to have safe and reliable transportation.

7.      I am responsible for any expense incurred as a result of illness or accident while in the
        Respiratory Care program. West Virginia Northern Community College does not provide
        individual health and accident insurance.


8.      I understand that if I leave the Respiratory Care program for any reason I must apply for
        readmission for the following academic year. Readmission is not automatic and I must
        meet specific requirements.

9.      I am aware that I may not be allowed to take the licensing exam for Respiratory Therapists
        if I have been convicted of a felony. I further understand that I must submit any information
        regarding a conviction for felony or misdemeanor to the Director of Respiratory Care upon
        admission to the program. Failure to provide the above information or any falsification of
        records will result in immediate dismissal from the program.


                                                                                                     11
10.    I understand that I am required to participate in a variety experiences including
       Professional Development, Community Service, Program Activities, College Activities as
       part of the overall learning experience at West Virginia Northern Community College.

11.    I acknowledge my responsibility under federal applicable law and the Affiliation Agreement
       to keep confidential any information regarding facility patients/clients or staff, as all
       confidential information of the Facility, Corporation/Organization and College. I agree,
       under penalty of law, not to reveal to any person or persons, except authorized clinical staff
       and associated personnel, any specific information regarding any patient or staff, and
       further agree not to reveal to any third party any confidential information of the Facility,
       Corporation/Organization and College. Any Breech of Confidentiality will result in
       immediate dismissal from the Health Sciences Program in which I am enrolled.




                                                         ______________________________
Student Signature                                        Date



_________________________________________
Print Student Name




                                                                                                  12
                   Equal Opportunity and Affirmative Action Policy

West Virginia Northern Community College is morally and legally committed to a policy of
equal opportunity and prohibits discrimination with respect to race, sexual orientation,
gender, age, color, religion, disability, veteran status and national origin for all employees,
students prospective students and applicants for employment. West Virginia Northern
Community College neither affiliates with nor grants recognition to any individual, group or
organization having such discriminatory policies or practices.

This policy extends to all West Virginia Northern Community college activities related to the
management of its educational, employment, financial, business and other affairs. It
applies to all personnel management practice including, but not limited to, recruiting, hiring,
transfer, promotion, training, compensation, benefits, layoff and termination. West Virginia
Northern Community College is committed to maintaining an atmosphere that is free of
discrimination and harassment in any form.

West Virginia Northern Community College will continue to take affirmative action
measures to ensure the entry of qualified minorities, women, veterans and the disabled as
defined by law into the faculty, staff and student bodies. In education, equal opportunity on
a merit basis is fundamental to equality in all other forms of human behavior; therefore,
commitment to this goal is required of every College employee.

Any infractions of this policy will be subject to disciplinary actions as deemed appropriate
and defined by College policy. Such infractions should be reported to the Human
Resources Office, Room 108, B & O Building.



                       Academic Policy Excerpts
(Refer to the Student Catalog for Complete Policies)

Academic Integrity
The College’s academic program requirements are determined according to standards of each
field, as recommended by qualified faculty in consultation with professionals in the field. Academic
programs are approved by the WVNCC Board of Governors. All academic programs undergo a
periodic program review involving professionals in the field and other educators with reports
reviewed by the Board of Governors and Higher Education Policy Commission.

Accredited programs undergo additional review and meet specific requirements for the professional
accreditation. In addition to the specific academic course and program requirements, academic
policies assure the integrity of the academic experience and degree.


Assessment of student academic achievement
An important aspect of assuring achievement of state and national academic standards. This
process includes the administration of standardized assessment measures which determine the
achievement level of students at West Virginia Northern in specific areas and levels as compared
with other students in similar levels and specialties across the country. These assessments are
required of students; however, individual scores are not used as part of students’ grades. Instead, it
is information which permits the College to assess its strengths and needs to assure academic
integrity in academic programs. Currently, Academic Profile by Educational Testing Services
assesses general education attainment. WorkKeys by ACT is administered to students completing
A.A.S. degrees to assess job-related skills as compared to specific occupational standards. These
assessments are scheduled at times to make it convenient for students to participate. Failure to

                                                                                                   13
comply with completion of these required assessments can result in a “hold” on student records
until completed.


Academic Program Completion Timeline Requirements
Students are expected to complete program requirements listed in the catalog in effect at the time
of entry into the program provided graduation requirements are completed within five years and the
student does not “stop out” of college for two consecutive years. Students may elect to meet
program requirements listed in a later catalog, provided all requirements of the later catalog are
met. Students who do not take courses for more than two consecutive years must complete a new
application for admission and undergo review with an academic advisor in the program to
determine applicability of prior courses which may result in a revised plan for completion of degree
requirements. Students who do not complete degree requirements within five years must have a
new plan for completion approved to assure the degree reflects current program competencies.


Class Attendance and Participation
Although classes vary with regard to requirements, activities, and instructional methods,
attendance and active participation are the responsibility of students who wish to succeed.
Students are expected to make progress and meet course expectations in time frames outlined by
the instructor. During the first week of classes, students receive instructor expectations and should
clarify any questions regarding these requirements. Instructors are eager to assist students toward
success. It is the student’s responsibility to consult with the instructor regarding attendance or
participation problems to determine if alternative arrangements can be made. Failure to attend or
actively participate can result in administrative withdrawal
by the instructor.


Academic Honesty and Support of a Learning Environment
All students are responsible for their own academic work and behavior which supports a learning
environment. Dishonesty results in disciplinary action such as lower grade, failing grade or
administrative withdrawal, program probation, suspension or dismissal. Behavior which interferes
with the rights or learning environment of others can result in administrative withdrawal,
suspension, or dismissal. Students have rights to appeal such decisions consistent with policy. See
Student Rights and Responsibilities in this catalog.


Plagiarism
Includes using someone else’s ideas without giving credit to that person in an appropriate citation
or using someone else’s words without placing them in quotation marks and/or without identifying
that person in an appropriate citation.

Cheating includes such practices as receiving test answers from or giving test answers to another
student, submitting another student’s work as one’s own work (unless permitted to do so as a result
of a joint assignment), stealing tests or test items, or using notes when not permitted.

Student Rights and Responsibilities
The submission of an application for admission to the College represents an optional and voluntary
decision on the part of the prospective student to partake of the program and privileges offered by
the College pursuant to the policies, rules, and regulations of the Board of Governors and the
College. Institutional approval of that application, in turn, represents the extension of a right or
privilege to join the College community and to remain a part of it so long as the student fulfills the
academic and the behavioral expectations that are set forth in the policies, rules, and regulations of
the College. A complete copy of academic rights and responsibilities as well as student conduct
policies, rules, regulations, disciplinary action, and appeals procedures is available at the campus
service center and the College’s Web page.

                                                                                                   14
Student Academic Rights
Each student shall have the following academic rights:
1.     The right to be graded or have his/her performance evaluated solely upon performance in
       the coursework as measured against academic standards. The student shall not be
       evaluated prejudicially, capriciously, or arbitrarily. The student shall not be graded nor shall
       his/her performance be evaluated on the basis of his/her race, color, creed, sex or national
       origin.
2.     The right to have any academic penalty reviewed.
3.     The right to have access to a copy of the college catalog or program brochure in which
       current academic program requirements are described (e.g., required courses, total credit
       requirements, minimum grade point average, probation standards, professional standards,
       etc.). Students have the right to receive from the instructor written descriptions of content
       and requirements for any course in which they are enrolled (e.g., attendance expectations,
       special requirements, laboratory requirements including time, field trips and costs, grading
       standards and procedures, professional standards, etc.). The instructor of each course is
       responsible for assigning grades to students enrolled in the course, consistent with the
       student’s academic rights.


Student Rights Related to Records
Admissions records, grade reports, financial aid records and reports of disciplinary action are
official student records which are maintained by the College’s records office and financial aid office.
Consistent with the Family Educational Rights and Privacy Act of 1974, as amended, students are
ensured the right to view the information in their own file as outlined in the law and to dispute any
items which are believed not to be appropriate for the file. Copies of most items may be obtained
by the student, except copies of documents provided by a third party, such as high school and
other college transcripts and immunization records. A fee is assessed to cover costs.

Access to record by academic advisors, counselors, and other West Virginia Northern personnel
who have a need to know specific information to provide advice, counseling, and appropriate
services is provided. Access to and copies of student records, such as transcripts, will not be
provided to others unless specifically requested in writing by the student.

A “hold” on students’ records will be placed if a student’s obligations to the College are
outstanding. Copies of transcripts will not be provided if a “hold” is placed on records until
satisfactory arrangements for meeting those obligations are met.


Rights Related to Membership in College Community
Enrolled students are extended rights and privileges as part of the College community so long as
the student fulfills the academic and behavioral expectations that are set forth in the College’s
policies, rules, and regulations. These rights include essential freedoms of scholarship and inquiry
central to all institutions of higher education, access to campus resources and facilities, freedoms
of expression, association, rights to privacy and confidentiality of academic and disciplinary
records, and rights of due process as are applicable to them.


Standards of Conduct
All students are subject to, and are required to comply with, observe, and obey the laws of the
United States and the State of West Virginia; ordinances of local city, county, and municipal
governing bodies; policies, rules, and regulations of the College, its governing board and the
Higher Education Policy Commission; and the directions and orders of the officers, faculty, and
staff of the institution who are charged with the administration of institutional affairs.

Failure to meet standards of conduct can lead to disciplinary action with sanctions including
probation, suspension, or expulsion. Failure to meet standards of conduct will be evidenced by, but

                                                                                                    15
not limited to, failure to comply to laws, ordinances, policies, and appropriate institutional
instructions; disorderly conduct; theft or damage to property; disruption or interference with the
rights of others; disruption or interference with an institutional activity, program, meeting,
classroom, clinic, or laboratory activity, or other operation; hazing; firearms policy, or participation
in discrimination activities.

Disciplinary action is taken consistent with the seriousness of the alleged offense and with due
process consistent with Higher Education Policy Commission guidelines and as outlined in the
College’s procedures. Disciplinary sanctions of suspension or expulsion imposed by any public
state college or university in West Virginia apply to the person sanctioned not only at the institution
where the sanction was imposed, but shall also be effective at all institutions in the public higher
education system.


Academic Responsibilities
Students are expected to adhere to academic standards in all academic settings, classrooms,
laboratories, clinics, and any other activities which are part of academic requirements. Normally,
students may finish a program of study according to the requirements under which they were
admitted to the program. However, requirements are subject to change at any time, with
reasonable notice provided to the students.

Failure to meet academic requirements, including those for academic honesty, may be subject
to one or more of the following penalties:
1.       A lower grade or failure of the course or exclusion from further participation in the class
        (including laboratories or clinical experiences), all of which may be imposed by the
        instructor.
2.      Academic probation as determined and defined by the College.
3.      Academic suspension as determined and defined by the College.

Academic dismissal is defined as termination of student status, including any right or privilege to
receive some benefit or recognition or certification. A student may be academically dismissed from
a limited enrollment program and remain eligible to enroll in courses in other programs at the
College, or a student may be academically dismissed from the College and not remain eligible to
enroll in other courses or programs at the College.


Academic Appeals
Appeals of academic penalties shall be governed by due process and shall include:
1.     Written notice to the student of failure to meet or maintain an academic standard, of the
       methods, if any, by which the student may correct the failure, and of the penalty which may
       be imposed.
2.     An opportunity for the student to meet with the faculty member or other individual(s) who
       have judged his/her performance to be deficient, to discuss with these faculty member(s)
       or other individual(s) the information forming the basis of the judgment or opinion of his/her
       performance, to present information or evidence on his/her behalf, and to be accompanied
       at any such meeting by an advisor of his/ her choice from the institution.
3.     An opportunity for the student to appeal the decision or judgment of faculty members
       through the established institutional appeals procedure within thirty (30) calendar days
       after written notice of the decision or judgment.
4.     An opportunity to appeal to the President of the College or his/her designee within thirty
       (30) calendar days after the receipt of written notice of the decision or judgment.
5.     The decision of the President or his/her designee regarding an academic appeal is final.



Standards of Academic Progress

                                                                                                       16
Any student whose declared goal is to earn a degree or certificate and who does not meet the
Standards of Academic Progress after one semester will be placed on Academic Probation. While
on Academic Probation, the student’s progress will be monitored by the Committee for Standards
of Academic Progress and the Records Office.

The criteria for Standards of Academic Progress are:
• A cumulative grade point average (GPA) of at least 2.0 at the end of each semester; and
• Successful completion of at least 75% of credit hours attempted each semester including
developmental courses. Evidence that mitigating circumstances beyond the control of the student,
other than lack of satisfactory academic progress in the course, led to withdrawal may result in a
waiver of this standard.



Sexual Harassment/Discrimination Policy
Students at West Virginia Northern Community College are entitled to an educational environment
free from all forms of sexual harassment. No member of the College community may engage in
sexual harassment or discrimination against another or conduct herself/himself in a manner which
creates a hostile or offensive learning environment. It is the responsibility of any student who
knows about sexual harassment or discriminatory conduct to bring it to the attention of a College
official.

Sexual harassment includes any unwelcome sexual advances, requests for sexual favors or other
verbal or physical conduct of a sexual nature. It is a form of sex discrimination that is both
reprehensible and unlawful. Students should feel free to make complaints concerning allegations of
sexual harassment. To the extent possible, strict confidentiality will be maintained in all
investigative procedures. Students who believe that they have been the subject of sexual
harassment or discrimination should contact the Campus Counselor or Campus Executive Director
for guidance and clarification of complaint procedures. If a student charges sexual harassment, the
Student Appeals for Non-Academic Matters Policy or Academic Sanctions and Appeals Policy
applies. Policy Manuals are available in the offices of the President, Campus Executive Directors
and in the Learning Resource Centers on all three campuses. Resource materials regarding sexual
harassment are available in the campus Learning Resource Centers.



Firearms Policy
Firearms, explosives, weapons of deadly force, or other weapons of mass destruction are not
allowed on the property except for legally authorized law enforcement officials.


Drug-Free Schools and Communities Information
The purpose of this information is to comply with the Drug-Free Schools and Communities Act of
1989 and the Drug- Free Work Place Act of 1988. This information applies to the entire College
community, including students, faculty, staff and visitors to any of the campuses or classroom
buildings.


Standards of Conduct
The unlawful manufacture, distribution, dispensing, possession or use of illicit drugs and alcohol on
West Virginia Northern Community College property or as a part of any College activity is
prohibited. It is prohibited to 174 - Policies come to work, class or any College-sponsored function
under the influence of alcohol or illicit drugs.

Disciplinary Sanctions


                                                                                                  17
Consistent with College, local, State and Federal laws, the College will impose disciplinary
sanctions for violation of the standards of conduct outlined above and prohibited in the Drug-Free
Schools and Communities laws. Violations could result in expulsion from school, termination of
employment and/or referral to law enforcement agencies as is consistent with College policies.
Federal trafficking penalties include substantial fines and imprisonment up to life. West Virginia
Law provides for penalties dependent on the classification of the substance, the activity involved
and other convictions. The most severe penalties are for possession with intent to sell. Convictions
may provide for fines and/or imprisonment with the amount and time dependent upon other factors.

College sanctions will be consistent with procedures used in other disciplinary actions as described
in the Student Code of Conduct and Governing Board policy. For employees, sanctions may
include oral warning, written reprimand, suspension, termination and referral to law enforcement
agencies. Disciplinary sanctions for students may include reprimand, probation, suspension,
expulsion and referral to law enforcement agencies. Action for visitors may include referral to law
enforcement agencies.


Health Risks
There are many known health risks linked to the use of alcohol and illicit drug use. Preventable
illness, disabilities and deaths are estimated to affect 25.5 million Americans.


Alcohol and Drugs
Alcohol abuse is often characterized by one of three different patterns: (1) regular and daily use, (2)
drinking large amounts of alcohol (binging) at specific or irregular times, or (3) periods of sobriety
interspersed by periods of heavy drinking and intoxication. The disorder is progressive and can be
fatal. If you recognize any tendencies toward alcohol abuse in yourself, your friends or loved ones,
please seek help as outlined below.


Health risks of other drugs include:
Narcotics (including opium, morphine, codeine, heroin and others): Physical addiction, loss of
awareness, respiratory restriction and possible death.
Depressants (including barbiturates, Quaaludes and others): Slurred speech, disorientation,
shallow respiration, coma likely with overdose.
Stimulants (including cocaine, amphetamines and others): Increased heart rate and blood
pressure, possibly leading to death; increased excitation; loss of appetite.
Hallucinogens (including LSD, “mushrooms,” PCP, mescaline and others): Illusions and
hallucinations; poor perception of time and distance; psychotic and unpredictable behavior, often
leading to injury and arrest. Symptoms may reappear (flashback) some time after use.
Cannabis (marijuana, hashish, THC and others): Unrealistic euphoria, diminished inhibitions,
disoriented behavior, diminished motivation, increased pulse.

Additional information is available in the Student Handbook and College Catalog.




                                                                                                    18
                      American Association for Respiratory Care
                             Policy Statement Excerpts

Cultural Diversity
The AARC is committed to the advancement of cultural diversity among our members, as well as in
our leadership. This commitment entails: being sensitive to the professional needs of all our
members, promoting appreciation for, communication between, and understanding among people
with different beliefs, colors, genders, and backgrounds, and recruiting strong leadership
candidates from under-represented groups for leadership and mentoring programs.

Competency Requirements for the Provision of Respiratory Therapy Services
Anyone providing respiratory therapy to patients, regardless of the care setting and patient
demographics, shall successfully complete formal training and demonstrate initial competency prior
to assuming those duties. This formal training and demonstration of competence shall be required
of any health care provider regardless of credential, degree, or license.


Respiratory Care Scope of Practice
The practice of respiratory care encompasses activities in: diagnostic evaluation, therapy, and
education of the patient, family and public. These activities are supported by education, research
and administration. Diagnostic activities include but are not limited to: (1) obtaining and analyzing
physiological specimens; (2) interpreting physiological data; (3) performing tests and studies of the
cardiopulmonary system; (4) performing neurophysiological studies; and (5) performing sleep
disorder studies.

Therapy includes but is not limited to application and monitoring of: (1) medical gases (excluding
anesthetic gases) and environmental control systems; (2) mechanical ventilator support; (3)
artificial airway care; (4) bronchopulmonary hygiene; (5) pharmacological agents related to
respiratory care procedures; (6) cardiopulmonary rehabilitation; and (7) hemodynamic
cardiovascular support.

The focus of patient and family education activities is to promote knowledge of disease process,
medical therapy and self help. Public education activities focus on the promotion of
cardiopulmonary wellness.


Health Promotion and Disease Prevention
Education and training of the respiratory care practitioner is the best method by which to instill
awareness for the opportunity to improve the patient's quality and longevity of life, and that such
information should be included in their formal education and training.

The respiratory care practitioner's responsibility to participate in pulmonary disease teaching,
smoking cessation programs, pulmonary function studies for the public, air pollution alerts, allergy
warnings, and sulfite warnings in restaurants, as well as research in those and other areas where
efforts could promote improved health and disease prevention. Furthermore, the respiratory care
practitioner is in a unique position to provide leadership in determining health promotion and
disease prevention activities for students, faculty, practitioners, patients, and the general public.

The need to provide and promote consumer education related to the prevention and control of
pulmonary disease to establish a strong working relationship with other health agencies,
educational institutions, Federal and state government, businesses and other community
organizations and to monitor such.




                                                                                                      19
Role Model Statement
As health care professionals engaged in the performance of cardiopulmonary care, the
practitioners of this profession must strive to maintain the highest personal and professional
standards. A most important standard in the profession is for that practitioner to serve as a role
model in matters concerning health. In addition to upholding the code of ethics of this profession by
continually striving to render the highest quality of patient care possible, the respiratory care
practitioner shall serve as a leader and advocate of public respiratory health.

The respiratory care practitioner shall:
1)     participate in activities leading to awareness of the causes and prevention of pulmonary
       disease and the problems associated with the cardiopulmonary system.
 2)    support the development and promotion of pulmonary disease awareness programs, to
       include smoking cessation programs, pulmonary function screenings, air pollution
       monitoring, allergy warnings, and other public education programs.
3)     support research in all areas where efforts could promote improved health and could
       prevent disease.
4)     provide leadership in determining health promotion and disease prevention activities for
       students, faculty, practitioners, patients, and the general public.
5)     serve as a physical example of cardiopulmonary health by abstaining from tobacco use
       and shall make a special personal effort to eliminate smoking and the use of other tobacco
       products from the home and work environment.
6)     strive to be a model for all members of the health care team by demonstrating
       responsibility and cooperating with other health care professionals to meet the health
       needs of the public.


Practice Settings
Elements of the scope of practice of respiratory care are performed in acute care hospitals and
alternative sites where patient care is provided. Alternative sites include, but are not limited to,
patients' homes, convalescent centers, skilled nursing facilities, and retirement centers.

The complexities of respiratory care are such that the public is at risk of injury and health care
institutions are at risk of liability when respiratory care is provided by inadequately educated and
unqualified health care providers rather than by practitioners with appropriate training and
education.


Practitioner Qualifications
Practitioners who provide respiratory care services shall demonstrate their ability to meet the
educational and experience requirements for the safe delivery of respiratory care services through
competency validation mechanisms established by either legislative or regulatory acts of their
respective states or commonwealth, or through a validated voluntary credentialing mechanism
endorsed by the National Commission for Health Certifying Agencies.


Statement of Principles
The American Association for Respiratory Care (AARC), a national society of health care
professionals, is sponsored by the American College of Chest Physicians, the American Society of
Anesthesiologists, and the American Thoracic Society. The Association is dedicated to maintaining
the highest standards of practice in respiratory care. Respiratory care is defined as a health care
specialty under medical direction in the assessment, treatment, management, control, diagnostic
evaluation, and care of patients with deficiencies and abnormalities of the cardiopulmonary system.

Respiratory care shall mean the diagnostic and therapeutic use of the following: medical gases and
administration apparatus, environmental control systems, humidification, aerosols, medications,


                                                                                                       20
ventilatory support, bronchopulmonary drainage, pulmonary rehabilitation, cardiopulmonary
resuscitation and airway management.

Specific testing techniques are employed in respiratory care to assist in diagnosis, monitoring,
treatment, and research of cardiopulmonary pathology. This shall be understood to include
measurement of ventilatory volumes, airway pressures, gas flows, blood gas analysis and other
related physiologic monitoring.

Respiratory therapists are integral members of the hospital based health care team working under
the supervision and guidance of a physician. They shall work together to determine appropriate
diagnoses and administer appropriate treatment for acute and chronic pulmonary and
cardiovascular disorders.

The AARC recognizes the need to assure high quality patient care at affordable cost. To that end,
we believe a combination of specialized formal education and clinical training is the best method to
develop highly skilled respiratory care personnel. The AARC endorses the standards of practice
adopted by the Joint Commission on Accreditation of Healthcare Organizations as an additional
quality assurance mechanism and sees uniform credentialing as another positive step toward
assuring high quality health care.


Validate the science of Respiratory Care
Validate the value of the Respiratory Therapist (RT) in providing respiratory care by supporting,
conducting, and publishing research information. The focus of this research should be to compare
the value of the RT to others who may provide respiratory care services. The information generated
should consider the information needs of employers, legislators, regulators, other health
professionals, and patients. These research efforts will, when appropriate and possible, be
conducted in collaboration with other health care stakeholders.
1)      Financially support research which seeks to advance the art and science of
        respiratory care in all care sites
2)      Conduct scientific conferences to advance the art and science of respiratory care
3)      Publish scientific information which advances the art and science of respiratory care
4)      Work collaboratively with other health professions to conduct research to validate the role
        of allied health professionals
5)      Refine the focus of the role of the RT in health promotion and disease prevention
6)      Develop and revise Clinical Practice Guidelines to reflect the science of the proper role of
        the RT

Promoting Respiratory Therapists as the best providers of Respiratory Care
Assure that the science that clarifies the value and role of the RT is provided to those stakeholders
whose decisions and actions need to be guided by that information.
1)      Collect and disseminate information that documents the costs in dollars, length of stay, and
        lives of respiratory care being provided by persons other than RTs
2)      Assist RTs to eliminate the provision of inappropriate respiratory care
3)      Focus the attention of RTs on providing respiratory care at the lowest cost
4)      Increase the access of under served populations to the services of RTs
5)      Promote positive models of excellence in respiratory care
6)      Develop model position descriptions for RTs in various roles which emphasize quality,
        access, and cost control




                                                                                                   21
                          Safe and Ethical Clinical Experiences

Policy
A student whose pattern of behavior is found to be unsafe may be terminated from the program for
reasons of unsafe practices at any time during the semester and receive a non-passing grade for
the course. A student who is terminated from the program must apply for readmission to the
Respiratory Care Program for the following year. Consideration for readmission is based on the
nature of the dismissal at the discretion of the Program Director. There are no implied guarantees
that readmission will be granted.

Definition
Students will demonstrate patterns of professional behaviors which follow the legal and ethical
codes of Respiratory Care practices; promote the well being of clients, health care workers, and
self in the biological, psychological, sociological, and cultural realm. Within the scope of our
practice students demonstrate accountability in preparation, documentation, and continuity of care;
and show respect for the human rights of individuals.


Guidelines for Evaluating Safe Practice
Regulatory Considerations
       Students practice within the boundaries of the AARC and WVSRC. Examples of unsafe
       practices may include, but are not limited to:
       1)      Attending a clinical rotation under the influence of drugs and/or alcohol
       2)      Refusing a patient assignment based on client's race, culture, or religious or sexual
               preference
       3)      Inappropriate practice in any assigned activity related to clinical practice
       4)      Refusal to provide comprehensive respiratory care on any assigned client.

Biopsychosocial Considerations
       Student practice attempts to meet the needs of the human system from a biological,
       psychological, sociological, and cultural standpoint as it pertains to Respiratory Care.
       Examples of unsafe practice may include, but are not limited to:
       1)      Failure to display stable mental, physical or emotional behavior(s) which may
               affect others' well being
       2)      Failure to follow through on referrals or interventions to correct deficit areas which
               may result in harm to the others (deficit areas defined above)
       3)      Acts of omission/commission in the care of clients, such
               as: physical abuse, and circumstance, mental or emotional
               abuse, and multiple medication errors
       4)      Interpersonal relationships with agent staff, coworkers, peers, faculty resulting in
               miscommunications, disruption of client care and/or unit functioning
       5)      Lack of physical coordination necessary for carrying out safe respiratory
               procedures

Ethical Considerations
        Student practice demonstrates accountability for preparation, documentation, and
        promotion of continuity in the care of client. Examples of unsafe practice may include, but
        are not limited to:
        1)      Attempting activities without adequate orientation, theoretical preparation or
                appropriate assistance
        2)      Dishonesty




                                                                                                   22
Accountability Considerations
Student conduct shows respect for the client, family, health team member, faculty, and self
including but not limited to the innate, legal, ethical, and cultural realms. Examples of unsafe
practice may include, but are not limited to:
        1)       Failure to maintain confidentiality of interactions
        2)       Failure to maintain confidentiality of records
        3)       Dishonesty in relationships

Procedure
A student whose pattern of behavior endangers anyone will be given a verbal and written warning
by the clinical instructor. If the student's pattern of behavior is repeated the clinical instructor will
request a meeting with the Program Director. Documented evidence from the student, faculty,
and/or staff will be considered in the decision to terminate a student from program. Upon a decision
by the Program Director that, the student's conduct in unsafe, the student may be terminated from
the program and will receive and "F:" for the clinical course. Failing any clinical courses results in
immediate dismissal from the program. All students have the right to appeal the decision and
should refer to the student handbook.




                                                                                                      23
A student whose pattern of behavior is found to be unsafe may be terminated from the program for
easons of unsafe practices at any time during the semester and receive a non-passing grade forthe
ourse. A student who is terminated from the program must apply for readmission to the
Respiratory Care Program for the following year. Consideration for readmission is based on the
nature of the dismissal at the discretion of the Program Director.

Clinical/Lab AttendanceClinical/Lab Attendance
Each clinical affiliate provide unique and limited learning experiences. Due to time constraints and
commitments to patients, staff and other students, attendance at the scheduled time and location is
mandatory.

It is the responsibility of the student to get approval from the clinical site coordinator to schedule
makeup time before the end of each semester. Due to unique opportunities at certain clinical
affiliates, make-up time must be arranged at the schedules site. The Director of Clinical Education
must be notified of all arrangements with the clinical site coordinator, followed by documentation on
the Daily Performance Record.

A physician's release to return to the clinical area is required when three consecutive days are
missed. Excessive absenteeism/tardiness will result in dismissal from the program.

Call - Off ProcedureCall - Off Procedure
Students are required to calling off for all clinical/lab absence or for tardiness. You must notify the
clinical affiliate and Director of Clinical Education at least one hour prior to the scheduled clinical
time. Failure to follow these policies will result in administrative withdrawal from the course.

Weather Related Call -OffWeather Related Call -Off
When classes at the college are canceled due to inclement weather before the scheduled clinical
time, the student must follow the above call-off procedure. The decision to attend a clinical rotation
during inclement weather remains with the student. The student is encouraged to attend if possible,
remember hospitals do not close during inclement weather.

SmokingSmoking
Smoking is NOT permitted prior to or during any clinical experience. Smoke lingers on your clothes,
hair and breath. It is your responsibility as a Health Care Professional to promote good health
habits through client education and personal example.

Meals
Hospital cafeterias are available to students at regular cost, or you may bring your own meal. You
are NOT permitted to leave the clinical site for meals.

Communication Equipment
Use of cellular phones and pagers are NOT permitted at the clinical site.

Emergency Treatment During Clinical Rotations
Emergency care is provided at all hospitals in case of an accident. However, thee student is
responsible for costs incurred. ALL accidents must be reported to your clinical instructor as per
clinical site policy.

Liability Insurance
Students not employed as a health practitioners are covered by West Virginia State Liability
Insurance.




                                                                                                     24
Parking

        Wheeling Hospital                Designated Student Parking Area Only
        Ruby Memorial Hospital           Designated Student Parking Area Only
        UPMC                             Designated Student Parking Area Only
        OVMC                             Parking Garage (fee), Streets, School Parking Lot
                                        Please do not attempt to have your ticket stamped by
                                        OVMC
        Bellaire                         Streets by hospital
        All Others                       Employee Parking Lot


Learning Resources
Students have access to services provided by the Learning Resources Center, Respiratory Care
Departments, Hospital Medical Libraries and Public Libraries following appropriate procedures.
Note: Some medical libraries may not permit students to “check out” materials.


Internet Resources
Students have Internet access in the Learning Resources Center, Computer Labs and Respiratory
Care Lab. Refer to the college policy in the student handbook on Internet Use.


Uniforms/Supplies
Uniforms are purchased through WVNCC Bookstore
Stethoscope with bell and diaphragm
Watch with seconds reading capabilities (analog or digital)
Pocket notebook
White leather tennis shoes
White socks
WVNCC Photo ID Badge


Professional Appearance
Students must maintain a professional appearance when participating in any clinical related
experience. This includes arriving at a site before changing into scrubs, community service events,
and clinical rotations that do not require specified uniforms. Adhering to the following general rules
will keep you in compliance with policies of each clinical affiliate:
1        Good personal hygiene
2.       Hair must be clean, neat, and kept clear of the face
3.       Mustaches and beards are must be clean and neatly trimmed
4.       One set of small, non-dangling earrings may be worn (Earrings are not permitted for
         males)
5.       No other visible body piercing or tattoos are permitted
6.       Two small rings may be worn, but must be removed during scrubbing
7.       Fingernails must be cut to a reasonable length and only clear, unchipped polish is allowed
8.       No chains, bracelets, or large jewelry is to be worn
9.       Wear appropriate protective attire (masks, gloves, jackets etc.)
10.      Designated uniforms with name tag are to be worn during clinical experiences and NOT to
         be worn in public.
11.      Shoes must white, leather with clean shoestrings. No open-toed or canvas shoes.
12.      White socks or hose must be worn
13.      Revealing or offensive clothing is NOT permitted
14.      Excessive perfume or aftershave is NOT permitted
15.      Clothing must be fit well, not be distracting or unprofessional in appearance and in good
         repair.

                                                                                                   25
REMEMBER
Each clinical site has specific requirements regarding the above. You are required to follow the
policies of each clinical site.

Clinical instructors have the right to dismiss any student from a
clinical experience if your appearance is deemed inappropriate.

You have chosen to become a Professional Respiratory Therapist. As respected
A member of the healthcare team, you will be working with professionals from
many discipline as well as patients and family members. You are evaluated daily
on your professional behavior which includes your attitude, attendance and
appearance. It is your responsibility to represent your college, your profession and
most importantly, yourself as a potential, future employee.




                                                                                                   26
                                         Health Care Systems


Information Management
Management Information Systems depend on much information to provide patient care including
writing in a patients charts, billing, record keeping, reports of meetings, etc. Students must be
familiar with how the hospital manages this information. Information must be:
         1.       quick and easy for appropriate personnel to access
         2.       correct
         3.       kept private and safe, through the use of passwords and limited access
         4.       used to improve the work efficiency
         5.       shared between departments in order to improve patient care
         6.       kept on every person treated
         7.       protected against being lost or destroyed
         8.       protected from people who do not have a reason to see it or use it


Patient/Institutional Confidentiality
Everyone must protect the confidentiality of patient information. Patient information may be shared
or discussed only with other healthcare workers who have a legitimate need to know. Students and
staff who do not need to know patient information have a responsibility to consciously avoid it.

If you are ever unsure whether you should or should not report private patient information, don't
report it and consult your instructor as to the appropriate course of action. Anyone who violates the
confidentiality of patient information is subject to disciplinary action.

As students in Health Care, you have access to patient and institutional information. All information
concerning patients is considered strictly confidential. Written, verbal or computer accessed
information is to be protected and used only as needed for purposes of patient care. Disclosure of
confidential patient information breaches the patient's right to privacy and can lead to suspension
from the program and legal litigation.

Students must acknowledge responsibility under federal law and the Affiliation Agreement to keep
confidential, any information regarding patients, and all confidential information of the Facility and
Corporation Organization. Students agree, under penalty of law, not to reveal to any person or
persons except authorized clinical staff and associated personnel any specific information
regarding any patient, and further agrees not to reveal any information regarding the facility and
corporate organization.


Patient Rights and Organization Ethics
Patient Rights and Organization Ethics improves patient outcomes by respecting individual patient
rights and conducting business relationships with patients and community in an ethical manner.

Students must understand and respect the rights and values of patients in meeting their needs and
preferences. How students respond to patients has a significant impact on the patient's experience
and care. Students must:
        - Promote consideration of patient values and preferences
        - Recognize the hospital's legal responsibilities
        - Inform patients of their responsibilities in care they receive
        - Manage the hospital's relationships with patients and community in an ethical manner




                                                                                                    27
Patient Rights and Responsibilities
Individual rights and dignity are always important and must be protected. During illness and
hospitalization the assertion of these rights becomes important in assuring patient recovery and
well being.

Patients have the Right to:
        Be treated with dignity and respect
        Know the names and professional status of people serving them
        Privacy
        Confidentiality of their records
        Receive accurate information about health related concerns
        Know the effectiveness, possible side effects and problems of all forms of treatment
        Participate in choosing a form of treatment
        Have an advance directives, healthcare proxy or durable power of attorney
        Receive education and counseling
        Consent to or refuse any care or treatment
        Select and/or change their healthcare provider
        Review their medical records with a clinician
        Information about services and related costs

Patients have the Responsibility to:
        Seek medical attention promptly
        Be honest about their medical history
        Ask about anything they do not understand
        Follow health advice and medical instructions
        Report any significant changes in symptoms or failure to improve
        Respect hospital policies
        Respect the property of the hospital and the property of others in the hospital
        Assure that financial obligation be paid promptly
        Notify the hospital of any change of name, address or telephone number.


Patient Assessment
Patient assessment determines the kind of care required to meet a patient's needs.. To provide
patients with the right care at the right time, qualified individuals assess patient needs throughout
the patient's contact with the medical facility.

Hospital Accreditation Standards (JCAHO) address the following processes and activities:
1)      Data Collection - The hospital collects data about each patient's physical and psychosocial
        status and health history.
2)      Data Analysis - The hospital analyzes data to produce information about each patient's
        care needs, and to identify any additional information required.
3)      Decision Making - The hospital bases care decisions on information developed about each
        patient's needs.


Patient Education
In an effort to provide quality health care, patients, families and significant others have a right to
education as it applies to understanding health issues, the recovery process, maximizing function
and related information which may lead to the highest level of wellness. It is important to educate
patients and their families in order to:
         - Understanding the patient's health status
         - Increase compliance with the health care plan
         - Actively participate in the decision making process concerning health care options
         - Increase the family care skills and coping mechanisms
         - Promote an overall health patient lifestyle

                                                                                                     28
         - Understand the financial implications for treatment and other health care choices.

Students must document education provided and related information as per hospital and
department policies and procedures. The only way to prove that the patient has been educated is
to document.


Advanced Directives
An Advanced Directive is a document in which a person states choices for medical treatment or
designates who should make treatment choices if the patient should lose the capacity to make or
communicate healthcare decisions.

At the time of the patient's admission, each patient is asked if he/she has a healthcare proxy. If a
proxy exists, a copy of the form is placed in the medical record. If a patient does not have a
healthcare proxy, education materials are given to the patient.


Positive Communication Tips
Change This                                          To This
"I don't know."                                      "I'll find out" or "Let's find out
"We can't do that."                                  "Here's what we can do for you"
"That's not my job."                                 Offering to find someone to help or make it your
                                              job.
"You'll have to..."                               "Here's what you need to do." or "That's a good
                                              question.
"Just a second. Can you wait a minute?"           Give an accurate time frame, explain if you can.
"No"                                              Think for a minute what you can do or what you
                                              have that may help.




                                                                                                        29
                                 Environmental Management

Management of the Environment refers to three components: buildings, equipment, and people.
The primary goals are to:
        Reduce and control environmental hazards and risks
        Prevent accidents and injuries
        Maintain safe conditions for patients, visitors and staff

Seven areas are referred to as a part of environmental management plan:
       1 . Safety                                5. Hazardous Materials and Waste
       2. Security                               6. Life Safety
       3. Medical Equipment                      7. Utility Systems
       4. Emergency Preparedness

Policies and procedures are located in each Department on each of these plans. Everyone is
responsible for making the environment safe and effective.


^Risk Management
The goal of Risk Management is to:
       Reduce the risk of injury and loss to patients, visitors, personnel and the hospital.
       Promote awareness of risk through identification of potential hazards, evaluation of
       situations that represent risk.


Responsibility
      Students are responsible for risk prevention by active intervention and by immediate
      notification of responsible authorities.
      Once a source of potential risk to a patient, visitor or employee is identified, steps are
      taken to ensure safety.
      1.        The immediate risk is eliminated and appropriate action(s) to protect the
                individual and others is implemented.
      2.        Notification of the Clinical Instructor regarding the injury or potential for loss must
                occur immediately by telephone and followed by documentation (i.e. Incident
                Report).


Orientation, Training and Continuing Education
All student receive a general orientation to each clinical affiliate and one specific to the Department.
Competency is a way to check to see if you can demonstrate the skills needed to do your job.
Students are required to demonstrate competency in the following areas annually:
         1.      Safety (general safety, fire safety, infection control, hazardous materials and body
                 mechanics)
         2.      Age specific training (understanding the needs of people at all ages and stages)
         3.      Standard precautions
         4.      OSHA Guidelines for Bloodborne and Airborne Pathogens
         6.      Healthcare Provider Cardiopulmonary Resuscitation (CPR)

\
Incident Report
An incident report is the formal documentation of any event such as an unexpected outcome or
occurrence that is not consistent with the normal or usual operation of the department or medical
facility.



                                                                                                      30
An incident report is filed on all incidents that occur on/offsite at any hospital function that involves
patients, visitors or employees. The report must be factual and is not filed in the patient record. The
person who witnesses the incident must complete the incident report.

Report are forwarded to Employee Health for employee incidents or to Risk Management for all
others. Examples of patient, visitor or employee incidents are falls, medication errors, needle sticks
and damaged or lost property. Incident report forms are available in each department.


Fire Safety
Pull stations are strategically located throughout the Hospital at about every 50 feet apart and at
each exit. Pulling where indicted activates all alarms. You should locate where they are on your
unit/department.

Fire extinguishers are located at various locations. Water pressure fire extinguishers should not be
used on electrical or flammable liquid (B) fires.

        Fire Safety Procedure             R        - Rescue individuals in immediate danger
                                         A         - Pull the fire Alarm
                                         C         - Close the doors
                                         E         - Extinguish the fire, if possible

        Fire Extinguisher Use              P        -Pull the pin
                                           A        -Aim the extinguisher
                                           S        -Squeeze the levers
                                           S        -Sweep the extinguisher contents at the base of
                                               the fire

REMEMBER:        * Do not panic            * Do not shout fire       * Do not use the elevators


Medical Equipment
The Biomedical Engineering Department inspects all equipment to ensure that equipment is safe
for use. Electrical safety testing must be conducted on each piece of equipment before it is
delivered to the specific area for use.

If equipment fails during testing or actual use, you should remove it from service as soon as
possible and attach a tag that says "DO NOT USE." Any medical personnel who discovers,
witnesses or is notified of a medical device which has or may have caused or contributed to a
death, serious illness or injury should immediately notify the charge nurse and the attending
physician.

With the approval of the patient's caregiver, personally-owned grooming equipment (e.g. hair
dryers, curling irons, shavers) is allowed in general patient care areas. Medical device related
deaths, serious illnesses and serious injuries must be reported via special report forms to the FDA.
These forms will be completed by Safety and Risk Management upon receiving an Incident Report
or phone call reporting a serious event.


Medical Gas System Failure
In an emergency, any employee who has knowledge, can turn off the zone valve in an area were a
condition exists. Alarm activations must be reported to the your Clinical Instructor. A designated
supervisor is responsible for turning off the medical gas zone valves in the event of an emergency.
These valves are located on the nursing units and other departments in the Hospital. You should
know if your department has them and where they are. Labels tell users what the valve controls. If
the information is not there or is confusing, contact Maintenance.

                                                                                                      31
Electrical Safety Electrical Safety
To protect patients, employees, visitors and students from electrical hazards, the following safety
precautions shall be followed for all electrical devices and equipment: Do not use "cheater"
adapters, multiple outlet adapters or extension cords. Do not unplug a device by pulling on the cord
but rather grasp the plug at the outlet.

Report immediately any device and remove it from service if:
$       it has been dropped, abused or liquid spilled on it
$       anyone has received a shock from its use
$       there is evidence of overheating by smell or touch
$       a wire, especially a power cord, has been frayed, worn, burned or cut
$       broken or loose plug
$       loose cable connectors
$       loose switches or control knobs
$       switches/ knobs or other controls that do not consistently produce the expected result

Know how to prevent electrical accidents. Inspect cords and keep away from rough, sharp, hot or
greasy surfaces. make sure the device has a 3-prong plug. Do not touch electrical equipment if you
are in or near wet areas.


Electrical Interruption
In the event of a power failure, the emergency generator will automatically engage within 10
seconds. All patient care areas and service access areas are equipped with emergency power
including all exit lights, emergency hall lights and all RED electrical receptacles. Become familiar
with the location of emergency power within your area before a problem is encountered.

Reporting of any abnormal utility operating condition should be made to your Clinical Instructor,
who will in turn notify Maintenance.


Latex Allergies
Latex is found in many products commonly used in healthcare and the home. Exposure to latex
may cause a hypersensitivity either locally at the site of contact (i.e. contact dermatitis) or a
systemic reaction (i.e. anaphylaxis).

Individuals at high risk for latex allergies include those with spina bifida, congenital genitourinary
abnormalities, atopic dermatitis patients, patients who have undergone multiple surgical
procedures, a history of occupational contact with latex products, patients with eczema and
patients with fruit allergies (avocados, bananas, chestnuts, etc. ).


Security
Security officers perform many services at the clinical sites. They are available 24 hours a day,
seven days a week and help provide a safe and secure environment for employees, visitors and
patients. They control parking and traffic flow, make periodic patrols in/outside the medical center
checking for fire, vandalism, theft, illegal entry, unauthorized persons, unsecured areas, and other
safety hazards. Some general precautions you should take for your safety are as follows:
1)      Keep all personal belongings locked up and do not carry large amounts of money
2)      If someone forgets to secure an area or personal property, keep an eye on it
3)      Report all suspicious persons or improperly secured area to security immediately
4)      When working after hours, let security know where you are by dialing the operator
5)      When leaving an area, remember to turn off all equipment.
6)      Identification - Students are required to wear name badge at all times.



                                                                                                         32
Please contact a security officer if you have any questions or concerns. Security should by notified
immediately whenever a security issue or ,disturbance occurs. This includes situations where
someone's personal property is missing or when someone is in danger.

Infection Control
Know where the location of your department Infection Control Manual. Important standards to
remember regarding infection control are: Bloodborne Pathogens, Airborne Pathogens, Standard
Precautions and the exposure control plan.


Exposure to Bloodborne Pathogens
^Everyone who has potential contact with blood or body fluids or anyone who is doing a task
where there is potential for exposure. Examples include Maintenance staff who fixed equipment
which is contaminated with blood or housekeeping cleaning a floor where a blood/body fluid spill
occurred.

Dispose infectious waste in appropriately marked containers. They are removed by the
housekeeping staff for pickup by a licensed waste hauler. In the case of a blood spill, you should
use a spill kit to clean it up.

Wear personal protective equipment such as gloves, masks, gowns/aprons and eye protection to
prevent exposure. Failure to comply with this safety standards can subject you or others to injury
and the clinical affiliate to a fine.


Exposure to Airborne Pathogens
Hospitals have designated rooms for patients suspected of having Tuberculosis or other airborne
diseases. Upon admission to the hospital there are signs and symptoms such as bloody sputum,
persistent cough, etc. that automatically put a patient into isolation until a Chest X-Ray and 2 step
Mantoux test are performed. Fit tested masks specifically designed for protection from TB are
provided to staff who need to enter a patients room with TB.


Standard Precautions
Treat all patients as if their blood and body fluids are infectious. Students are expected to practice
standard precautions at all times and are required to wash hands before and after each patient,
and any contact exposure situation.


Patient Lifting and Moving
Use of poor body mechanics is a major cause of back injuries. Below are some tips that can reduce
the risk of back injury.
 1.      When lifting, keep your center of gravity (belly button) over your base of support and your
         feet shoulder width apart. If lifting a patient, also get the patients center of gravity over
         his/her base of support.
2.       Prior to the actual lift, firm your stomach muscles. Keep your back as straight as
         possible, squat at the knees, and lift with your legs. Avoid bending forward at the waist,
         even if handling only minimal weight.
3.       Avoid bending and twisting at the waist at the same time. This combination of motions is
         the potentially injurious to your back. Turn your body with small, pivoting foot steps.
4.       Keep the load as close to your body as possible. Hug that patient.
5.       Always take the time to arrange the environment to your best advantage before starting the
         lift. Raise the bed, move the bed, rearrange furniture, make sure that all equipment
         attached to the patient is free and clear.
6.       Get help, and/or use mechanical assistive devices if you have any doubt about your ability
         to safely manage the load.

                                                                                                     33
7.      Synchronize everyone's efforts with a clear understanding of what everyone is going to do
        so that everyone lifts, pushes, pulls together. Always use a slow 3 count, from one
        designated person.
8.      Give clear, simple instructions to the patient. Allow the patient adequate time to process
        the instructions and to then respond.

If you are injured at the clinical site, report the injury immediately to your Clinical Instructor.

Emergency Preparedness
A disaster can occur at any time and may involve any of a number of sets of circumstances. One of
the hospitals responsibilities is to be prepared to take care of the victims of a disaster. A disaster
plan is provided and designed for staff to follow an orderly method for the expansion of medical
services. Each department is assigned specific duties and responsibilities.


Emergency Codes
Emergency codes or given over the hospital public address system. Some examples of codes
are listed here as guidelines only, not every hospital uses these same codes.

                 Name of Code                        Definition
                 Code 99                             Cardiac Arrest
                 Code Red                            Fire Emergency
                 Code Brown                          Child Abduction
                 Code Pink                           Disruptive Behavior
                 Code Orange                         Hazardous Device
                 Code Yellow                         Bomb Threat
                 Code Green                          Oxygen Loss
                 Code White                          Hazardous Weather
                 Code Gray                           Evacuation


Hazard Communication
The Occupational Safety and Health Administration (OSHA) has coined the Hazard
Communication Standard as the "Employee Right to Know" Law. You have a right to know what
occupational hazards you work with and how they can impact your health. The hospitals are
committed to providing you with a safe working environment informing you of what hazards are
associated with or which are present within your work area to help you make knowledgeable
decisions about any personal risks of employment.

There are three important elements of the Hazard Communication Standard:
       1. Training on the safe use of chemicals.
       2. Material Safety Data Sheets (MSDS)
       3. Warning Labels on Containers

You will be trained on the safe use of chemicals in your work environment upon orientation to your
Department, annually and as necessary thereafter. The material safety data sheet (MSDS) is a
document which describes the properties of a product, its physical and health hazards and
precautions of safe handling, storage and spill control.
Material Safety Data Sheets (MSDS)Material Safety Data Sheets (MSDS)
Material Safety Data Sheets provide detailed safety information about a hazardous material.
Each chemical on the department inventory has a MSDS, and is located in a MSDS binder which is
bright yellow with black stripes and the letters MSDS.




                                                                                                      34
Hazardous Material Inventory
The list is located in the front of the MSDS Binder (MSDS Binders are available from the Safety
Office) Hazardous Materials          -Read container labels for information
                           -Refer to the Material Safety Data Sheet (MSDS)


Hazardous Waste Spill
Unless trained to clean up spills, you should prevent anyone from walking through or disturbing the
spill and notify the Respiratory Care Department

The MSDS sheets are kept in each department or unit. If you spot a hazardous spill, you should
take the following action:
1.      Determine the necessity for treating anyone exposed to the material and assess the type of
        spill and the degree of the hazard involved using your MSDS;
2.      Follow the procedures listed on the MSDS to clean and contain the spill. Use appropriate
        spill kits
3.      Complete an incident report;
4.      Know the location, content and usage of any spill kit(s) on your unit/department.




                                                                                                  35
                                      Age Specific Care
The following are a list of age specific competencies in which students must demonstrate
proficiency.
Neonate (Birth - 28 days) Neonate (Birth - 28 days)
         Communication Considerations
                 Introduce yourself to the caregiver
                 Explain procedures to the caregiver
         Comfort Considerations
                 Keep patient warm and dry
                 Allow for usual feeding schedule
                 Do not keep patient continuously under bright lights
                 Maintain reduced noise levels
         Safety Considerations
                 Keep side rails up
                 Provide neonate with nonflammable toys
                 Avoid leaving small objects within reach including toys that could cause choking
                 Patient feels safe when cuddled and supported
                 Transport in size-appropriate means (bassinet, stroller, crib)

Infant (29 days - 1 year) Infant (29 days - 1 year)
        Communication Considerations
                Introduce yourself to the caregiver
                Talk slowly and calmly to infant
                Try to initiate eye contact with infant, but to not force
        Comfort Considerations
                Keep patient warm and dry
                Allow for usual feeding schedule
                Allow familiar caregiver close by
                Allow infant to keep pacifier, blanket or comfort toy
        Safety Considerations
                Infant has stranger anxiety
                Do not separate from caregiver unless absolutely necessary
                Transport in as small as possible means: crib, stroller or wagon with side rails
                Keep side rails up
                Provide infant/baby with nonflammable toys only
                Avoid leaving small objects within reach including toys that could cause choking

Toddler (1 - 3 years) Toddler (1 - 3 years)
       Communication Considerations
                Introduce yourself
                Self-centered thinking. Patient can understand simple commands and may choose
                to cooperate
                Do not rush patient. Needs time to think about what has been asked of him
                Allow to touch equipment if safe to do so
                Ask caregiver to explain directions to child in familiar words
       Comfort Considerations
                Keep patient warm if not active
                Do not separate child from favorite pacifier, blanket, comfort toy or adult
       Safety Considerations
                Can tolerate short separation from parent
                Do not leave unsupervised; child does not recognize danger
                Clumsy. Trips easily
                Transport in crib, stroller or wagon with side rails
                Keep side rails up
                Provide toddler with nonflammable toys only

                                                                                                    36
               Avoid leaving small objects within reach including toys that could cause choking

Preschooler (3 - 5 years) Preschooler (3 - 5 years)
       Communication Consideration
               Introduce yourself
               Talk to child in simple language.
               Let child explore and touch equipment if safe to do
               Since child has imagination, use familiar characters in conversation and
explanation
               (e.g. Sesame Street, Disney, Barney)
               Include caregiver in explanations
               If shy or frightened, may accept explanations and exams given on Teddy or other
               toy
       Comfort Considerations
               Allow familiar things or faces nearby
               Allow child to talk and verbalize fears
               Can tolerate some separation from parent
       Safety Considerations
               Able to recognize danger and obey simple commands
               Cannot understand reasons as to why something is acceptable or unacceptable
               Needs close supervision
               Transport in crib, wagon or on cart with side rails
               Keep side rails up

School Age (6 - 12 years)School Age (6 - 12 years)
       Communication Considerations
               Introduce yourself
               Able to understand more complex explanations
               Talk to child directly. Allow time for questions
               Still likes to explore equipment before use
               Likes to get involved and make decisions
       Comfort Considerations
               Be subtle in encouraging child to keep comfort object with him
               May need parent
               Use calm, unrushed approach. Allow time for repeated questions
               Permit child some input on decisions
       Safety Considerations
               Curious
               Able to accept limits
               Transport in wheelchair or on cart with side rails

Adolescent (13 - 18 years) Adolescent (13 - 18 years)
      Communication Considerations
              Introduce yourself
              Able to understand more complex explanations
              Talk to child directly. Allow time for questions
              Still likes to explore equipment before use
              Likes to get involved and make decisions
      Comfort Considerations
              Be subtle in encouraging child to keep comfort object with him
              May need parent
              Use calm, unrushed approach. Allow time for repeated questions
              Permit child some input on decisions
      Safety Considerations
              Curious
              Able to accept limits

                                                                                                  37
              Transport in wheelchair or on cart with side rails
Young Adult (19 - 44 years) Young Adult (19 - 44 years)
      Communication Considerations
              Introduce yourself
              Use adult vocabulary. Do not talk down to youth
              Very curious
              Allow time for questions
              Needs privacy
      Comfort Considerations
              Maintain privacy, is very modest
              Take time for explanations
              Sometimes is comfortable knowing that parent is close by
              Permit adult to accompany youth if desired
      Safety Considerations
              Starting to be independent
              Can recognize danger
              Transport as an adult

Adult/Middle Age (45 - 65 years) Adult/Middle Age (45 - 65 years)
       Communication Considerations
               Introduce yourself
               Call patient by title and last name unless patient asks to be called by another name
               Do not address patients with honey, sweetie, dear, etc.
               Explain procedures to patient. Give details
               Allow time for questions
               Be respectful
       Comfort Considerations
               Maintain patient's adult privileges: decision making, privacy, routine of personal
               habits as much as hospital policy permits
               Offer assistance with personal care
               Inform of available services such as newspapers, coffee, mail, etc.
               Inform of hospital/departmental policies such as no smoking, visiting hours,
               phones
       Safety Considerations
               Patient’s present condition may place patient at risk for falling.
               Keep equipment, cords, supplies and linen out of patient's path
               Maintain well-lit area. Use night lights if patient desires
               Supply with walking aids if used at home (cane, walker, crutches). Keep these
               within patient's reach

Late Adult (65 years +)Late Adult (65 years +)
       Communication Considerations
                Introduce yourself
                Do not rush patient
                Talk to patient respectfully
                Call patient by title and last name unless patient asks to be called by another name
                Do not address patients with honey, sweetie, dear, etc.
                Determine if patient uses hearing aid
                Make sure hearing aid is worn
                Speak slowly and clearly, looking at the patient while you speak
                Do not stand in front of the light source when talking with patient
                Use a deeper voice. Do not shout at the patient
                Patient may need pencil and paper to communicate messages
                Give step-by-step explanations and instructions as needed
       Comfort Considerations


                                                                                                 38
        Maintain patient’s adult privileges: decision-making, privacy, routine of personal
        habits as hospital policy permits
        Offer assistance with personal care
        Inform of available services such as newspaper, coffee, mail, etc.
        Inform of hospital departmental policies such as no smoking, visiting hours

        Do not rush patient
        Follow home or nursing home habits as much as hospital policy permits
        Tell confused patients who you are, where they are and what time of day it is every
        time you meet them. If patient is confused, do not try to correct them or argue with
        patient
        Ask family to bring familiar objects to keep at bedside (robe, blanket, pictures)
        Keep patient warm. May need extra sheet or blanket
        Keep water cup, tissues, phone, call light, etc. within reach
        Ask if tap or ice water is preferred
Safety Considerations
        Do not rush patient
        Find out if patient is at risk for falls.
        Keep equipment, cords, supplies and line out of patient's path
        Determine if patient uses an aid at home (cane, Walker, crutches, etc.) When
        walking, keep these within patients reach
        Weak and/or confused patients may need frequent reminders to remain seated
        May need repeated offers of assistance with any needs (personal needs included)
        Maintain well-lit area. Use night lights
        Put objects where patient can see them
        Determine if patient wears glasses
        Have patient wear glasses while awake
        Use caution with temperature of fluids, bath water, heating pads or other
        equipment
        Transport using wheelchair or stretcher with side rails
        Weak or confused patients or patients in danger of falling may need safety belt or
        other safety device.
        Check-with patients nurse to plan for safe transport




                                                                                             39
                                      Clinical Affiliate Numbers

              Clinical Starting Times                  Clinical Site        Phone Number
                                                       Coordinators
Belmont Community Hospital        7:00 & 3:00
Barbara Starkey
(740) 671-1221


East Ohio Regional Hospital       6:00 & 2:00
 Critical Care/Floors              6:00 - 3:30     Lynn Swider         (740) 633- 4315
 Cardiac Testing/Rehabilitation                    German Ortiz

Healthsouth Rehabilitation Center 7:00
Zona Harris
1-800-388 -2451


Ohio Valley Medical Center        6:45 & 2:45
 Critical Care/Floors              6:45 - 3:30     Sue Champion        (304) 234- 8281
 Surgery                           7:00 - 3:00
 Pulmonary Testing                 8:00 - 4:00
 Cardiac Testing                   6:30 - 4:00
 Sleep Lab                         8:30p - 7:00a
Ruby Memorial Hospital 6:45 & 2:45
 NICU/PICU/Adult ICU                               Brad Foringer       (304) 598- 4106
                                                   Pete Hornbeck
                                                   Rodney Vest
Trinity Health Systems            6:00 - 2:30
         Trinity East                              Tom VanKirk         740-264-8194
         Trinity West
Wheeling Hospital                 6:00 & 2:00
 Critical Care/Floors              6:00 - 2:30     William Boring      (304) 243-5088
 Surgery                           6:00 - 2:30
 Pulmonary Testing                 8:00 - 4:00
 Cardiac Testing                   6:30 - 3:00
Barnesville Hospital              6:45 & 2:45
Jeff Britton
(740) 425 - 5144
 (740) 484 - 5291
Weirton Medical Center            6:30 -3:00
Debbie Sparks
(304) 797 - 6050


DeFelice Care                     7:00 - 3:00
Misty Forgac
(304) 232 - 4210


                                                                                         40
Physician Rounds                Arranged
Dr. Robert Altmeyer
 Dr. Richard Ryncarz
 Dr. Melvin Saludes
UPMC                            6:30
         Presbyterian                               Ray Tuttle             412-692-4256 Call-
         Shadyside                                  Al Augustine              offs
                                                    Ed Conigliano          412-647-8179
Wetzel County Hospital          7:00
Rich Pancake




NOTE: Clinical starting times may change. Please arrive at least 20 - 30 minutes prior to the
      actual start times in order to change clothes, prepare for assignments and get to your
      assigned area.



                               Clinical Records Management


Description
Use the following forms to document and evaluate your clinical/lab attendance and progress in the
Respiratory Care Program. These records, along with your clinical journal, are your responsibility
to maintain and keep up-to-date.

These records document your clinical/lab experiences in the Clinical Practice Courses. Without
proper documentation you will receive an INCOMPLETE for the course! This is considered a part of
your records, give yourself all the credit you deserve by documenting your learning experiences
thoroughly.

Instructions
1)      Attendance Summary Record
        Each assigned clinical/lab day is documented on this summary form. Each clinical
        experience will be documented with the daily progress report and needs to be completed
        and signed by the clinical instructor/preceptor.

        Clinical/lab hours are required and are an essential part of your education. It is your
        responsibility for contacting the appropriate instructor and making arrangements to make
        up missed time.

2)      Program Learning Outcomes
        The Program Learning Outcomes Record is documentation of completed skills that are
        based on the NBRC Examination Test Matrix.

        Use the columns designated Lab, Lecture and Clinical to document completion of
        Competency.
        The Director of Clinical Education or the Program Director will sign the
        designated areas as verification of the completed proficiency.




                                                                                                41
Remember:    It is always your responsibility, to notify the Clinical Preceptors/Instructors of your
             need to obtain a clinical practice and demonstration of a competency to be
             checked-off.

3)   Daily Progress Report
     Daily performance/competency assessment is a process used to ensure both performance
     and competencies are met for the student to working with the Healthcare System. The
     process provides an opportunity for the students and faculty to set learning goals for
     improvement of performance and career development. Information gathered from
     performance/competency assessments are used to improve the performance and patient
     satisfaction. Students are always encouraged to identify education and training needs, or
     other related needs, necessary to improve job performance and satisfaction.

     The clinical practice progress report is a record of your daily activities and an evaluation
              of your progress concerning knowledge, psychomotor skills and professional
     behavior. Part A is to be completed by the student and then submitted to clinical instructor
     for completion of Part B. The instructor will return the completed form to you or to the
              Department as per policy. OVMC and Ruby Memorial require all Progress Reports
     be submitted to the Respiratory Care Department.

4)   DataARC Software
     Clinical Records Management System. Instructions will be provided.




       CLINICAL COMPETENCY
          DOCUMENTATION
                                                                                                   42
PROGRAM LEARNING OUTCOMES

INSTRUCTIONS: The learning outcomes are based on the National Board for Respiratory Care
      (NBRC) Examination Matrix. It will serve as a guide for assessing knowledge and skills
      required to successfully complete this program and preparing you for the NBRC
      Examinations.

I.     Select, Review, Obtain, and Interpret Data:

       SETTING: In any patient care setting the respiratory therapy reviews existing clinical data,
       collects additional Clinical data and recommends obtaining additional pertinent data. The
       practitioner interprets all data the appropriateness of the prescribed respiratory care, and
       participates the development of the respiratory care plan.




                                                                                                 43
                                             Competency
                              Competency                                    Lecture      Campus     Clinics
Review and interpret existing data in patient records




Patient history [e.g., present illness, admission notes, respiratory care orders, progress notes]




physical examination [e.g. vital signs, physical findings]




lab data [e.g. CBC, chemistries, electrolytes, coagulation studies, Gram stain, culture and
sensitivities, urinalysis]




pulmonary function and blood gas results




radiologic studies e. radiologic studies [e.g., x-rays of chest/upper airway, CT, MRI]




Results of respiratory monitoring




pulmonary mechanics [e.g., maximum inspiratory pressure (MIP), vital capacity]




respiratory monitoring [e.g., rate, tidal volume, minute volume, I:E, inspiratory and expiratory
pressures; flow, volume and pressure waveforms]
lung compliance, airway resistance, work of breathing




dead space to tidal volume ratio (VD/VT)




noninvasive monitoring [e.g., capnography, pulse oxirnetry, transcutaneous 02/CO2




results of cardiovascular monitoring




ECG, blood pressure, heart rate




fluid balance (intake and output)
Competency
Lecture
Campus
Clinics


hemodynamic monitoring [e.g., central venous pressure, cardiac output, pulmonary capillary wedge
pressure, pulmonary artery pressures, mixed venous 02, C(a-v)O2, shunt studies (Qs/Qt)]




maternal and neonatal history and data [e.g., Apgar scores, gestational age, L/S ratio, pre/post-
ductal oxygenation studies]




other diagnostic studies [e.g., EEG, intracranial pressure monitoring, metabolic studies (VO2, V02,
nutritional assessment), ventilation/perfusion scan, pulmonary angiography, sleep studies, other
ultrasonography]




Recommend procedures to obtain additional data




CBC, electrolytes, other blood chemistries




x-ray of chest and upper airway, CT scan, bronchoscopy, V/Q lung scan, barium swallow




Gram stain, culture and sensitivities




lung mechanics [e.g. lung compliance, airway resistance, work of breathing]
Vd/Vt, Qs/Qt, cardiac output, stress testing




ECG, echocardiography, pulse oximetry, transcutaneous 02/CO2 monitoring




blood gas analysis, insertion of arterial, umbilical and/or central venous, pulmonary artery
monitoring




spirometry before and/or after bronchodilator, maximum voluntary ventilation, diffusing capacity,
functional residual capacity, flow-volume loops, body plethysmography, nitrogen washout
distribution test, total lung capacity, C02 response curve, closing volume, airway resistance,
bronchoprovocation, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP)




Assess patients overall respiratory status by inspection




general appearance, muscle wasting, venous distention, peripheral edema, diaphoresis, digital
clubbing, cyanosis, capillary refill




chest configuration, evidence of diaphragmatic movement, breathing pattern, accessory muscle
activity, asymmetrical chest movement, intercostal and/or sternal retractions, nasal flaring
character of cough amount, character of sputum




chest transilluminations , Apgar score, gestational age
heart rate, rhythm, force




Assess patient's learning needs [e.g., age and language appropriateness, education level, prior
disease and medication knowledge]




Interview patient




level of consciousness, orientation to time, place, and person emotional state ability to cooperate




presence of dyspnea and/or orthopnea, sputum production, exercise tolerance and activities of
daily living




physical environment, social support systems, nutritional status




Review of chest x-ray




presence and position of foreign bodies




presence of, or changes in, pneumothorax or subcutaneous emphysema, other extra-pulmonary
air, consolidation and/or atelectasis, pulmonary infiltrates
position of endotracheal or tracheostomy tube, evidence of endotracheal or tracheostomy tube cuff
hyperinflation




position of chest tube(s), nasogastric and/or feeding tube, pulmonary artery catheter (Swan-Ganz),
pacemaker, CVP, and other catheter




position of, or changes in, hemidiaphragms, hyperinflation, pleural fluid, pulmonary edema,
mediastinal shift, patency and size of major airways presence of changes in extra-pulmonary air,
consolidation, atelectasis, pulmonary infiltrates




Review of lateral neck x-ray




presence of epiglottitis and subglottic edema




presence or position of foreign bodies




airway narrowing




Perform, interpret of diagnostic procedures




ECG, pulse oximetry, transcutaneous 02/CO2 monitoring, capnography, mass spectrometry
tidal volume, minute volume, I:E




blood gas analysis, P(A-a)02, alveolar ventilation, VD/VT, QS/Qt, mixed venous sampling




 peak flow, maximum inspiratory pressure, maximum expiratory pressure, forced vital capacity,
timed forced expiratory volumes [e.g., FEVI], lung compliance, lung mechanics




cardiac output, pulmonary capillary wedge pressure, central venous pressure, pulmonary artery
pressures, fluid balance (intake and output)




pulmonary & systemic vascular resistance




apnea monitoring, sleep studies, respiratory impedance plethysmography




ECG, pulse oximetry, tc 02/CO2 monitoring




fluid balance (intake and output)
spirometry before and/or after bronchodilator, maximum voluntary ventilation, diffusing capacity,
functional residual capacity, flow-volume loops, body plethysmography, nitrogen washout
distribution test, total lung capacity, C02 response curve, closing volume, airway resistance




Vd/Vt, Qs/Qt, mixed venous sampling, C(a-v)02, cardiac output, pulmonary capillary wedge
pressure, central venous pressure, pulmonary artery pressures




arterial sampling and analysis, co-oximetry, P(A-a)02




sleep studies, metabolic studies [e.g., indirect calorimetry], cardiopulmonary stress testing




ventilator flow, volume and pressure waveforms, lung compliance




Interpret results from insertion of invasive monitoring




arterial and umbilical monitoring lines




peripheral venipuncture or intravenous lines




Determine appropriateness of prescribed therapeutic plan
analyze data to determine pathophysiologic state




review planned therapy to establish therapeutic goals




determine appropriateness of prescribed therapeutic goals for pathophysiologic state




recommend changes in therapeutic plan




perform respiratory care quality assurance




develop quality improvement program




review interdisciplinary patient and family care plan




Participate in development of respiratory care plans [e.g. case management, develop and
apply protocols, disease management education]
_____________________________________________   ___________________________
Director of Clinical Education                  Date
II.     Select, Assemble, and Check Equipment for proper function, operation and
        cleanliness.

        SETTING: In any patient care setting, the respiratory therapist selects, assembles, tests,
          operates and assures cleanliness of all equipment used in providing respiratory care.
          The respiratory therapist checks all equipment for malfunctions and take actions to
          correct malfunctions of equipment.

                             Competency                                   Lecture     Campus         Clinics
 Assemble, test, operate equipment appropriate to the respiratory
 care plan.
 Oxygen administration devices
  nasal cannula, mask, reservoir mask (partial rebreathing,
 nonrebreathing), face tents, transtracheal oxygen catheter, oxygen
 conserving cannulas
 air entrainment devices tracheostomy collar T-Adapter (Brigg’s
 adaptor) face tents oxygen hoods and tents
 CPAP devices (mask and nasal)
 Humidifiers
 Bubble, passover, cascade, wick
 heat moisture exchangers
 Aerosol Generators
 pneumatic nebulizer
 ultrasonic nebulizer
 Ventilators
 pneumatic, electric, microprocessor
 high frequency
 noninvasive
 Artificial Airways
 oral and nasopharyngeal airways
 oral and nasal endotracheal tube

 tracheostomy tubes and buttons
 intubation equipment [e.g., laryngoscope and blades, exhaled C02
 detection devices]
 other airways [e.g., laryngeal mask airway (LMA), Esophageal
 Tracheal Combitube (ETC)
                             Competency                               Lecture   Campus   Clinics
Assemble, test, operate equipment appropriate to the respiratory
care plan.
Oxygen administration devices
 nasal cannula, mask, reservoir mask (partial rebreathing,
nonrebreathing), face tents, transtracheal oxygen catheter, oxygen
conserving cannulas
air entrainment devices tracheostomy collar T-Adapter (Brigg’s
adaptor) face tents oxygen hoods and tents
CPAP devices (mask and nasal)
Suctioning devices
suction catheters
specimen collectors
oropharyngeal suction devices
Gas delivery, metering and clinical analyzing devices
regulators and reducing valves connectors, flowmeters air/oxygen
blenders pulse dose systems
oxygen concentrators, air compressors, liquid O2 systems
gas cylinders, bulk systems and manifolds
capnograph, blood gas analyzer and sampling devices, co-oxirneter,
transcutaneous 02/CO2 monitor, pulse oximeter
CO, He, 02 and specialty gas analyzers compressors gas analyzer and
sampling devices
Resuscitation devices
mouth-to-mouth mask resuscitators

manual resuscitators (bag-valve)
Patient breathing circuits
IPPB
H-valve assembly
CPAP PEEP valve assembly
Incentive breathing devices
Percussors and vibrators
Environmental devices
 incubators, radiant warmers
 aerosol (mist) tents
gas scavenging systems
Positive expiratory pressure device (PEP)
Flutter Valve mucous clearance device
other therapeutic gases [e.g., 02/CO2, He/02]
Manometers and gauge
water, mercury and aneroid, inspiratory/expiratory pressure meters,
cuff pressure manometers
respirometers [e.g., flow-sensing devices (pneumotachometer),
volume displacement]
electrocardiography devices [e.g., ECG oscilloscope monitors, ECG
machines (12-lead), Holter monitors]
hemodynamic monitoring devices
central venous catheters, pulmonary artery catheters [e.g. Swan-
Ganz], cardiac output, SaO2 monitors
arterial catheters
vacuum systems [e.g., pumps, regulators, collection bottles, pleural
drainage devices]
metered dose inhalers and spacers
Small Particle Aerosol Generators (SPAG)
bronchoscopes
Assure Equipment Cleanliness
determine appropriate agent and technique for disinfection and/or
sterilization
perform procedures for disinfection and/or sterilization
monitor effectiveness of sterilization procedures
Correct equipment malfunctions
Perform quality controls




_____________________________________________                      ___________________________
Director of Clinical Education   Date
III.    Initiate, Conduct and Modify Prescribed Therapeutic Procedures

SETTING: In any patient care setting the respiratory therapy practitioner maintains patient records
       and communicates relevant information to members of the health care team, initiate,
       conducts procedures to achieve the desired objectives of one or more specific
       objectives.

                              Competency                                  Lecture    Campus      Clinics
 Explain planned therapy and goals to patient in understandable
 terms to achieve optimal therapeutic outcome
 counsel patient’s and family concerning smoking cessation
 Participate in disease management education
 Protect patient from nosocomial infection by adherence to
 infection control policies and procedures (universal precautions,
 blood and body fluid precautions, etc.)
 Evaluate and monitor patients response to respiratory care
 Maintain records and communication
 record therapy and results using conventional terminology as required
 in the healthcare setting
 verify computations and erroneous data
 Communicate information regarding patient’s clinical status to
 the appropriate members of the health care team
 communicate information relevant to coordinating patient care and
 discharge planning (e.g. scheduling, avoiding conflicts, sequencing
 therapies)
 apply computer technology to patient management [e.g., ventilator
 waveform analysis, electronic charting, patient care algorithms]
 communicate results of therapy and alter therapy per protocol
 Maintain a patent airway
 insert oro- and nasopharyngeal airway
 select endotracheal or tracheostomy tube
 perform endotracheal intubation
 change tracheostomy tube
 maintain proper cuff inflation
 position of endotracheal or tracheostomy tube
 maintain adequate humidification
                                Competency                                Lecture   Campus   Clinics
extubate the patient
properly position patient
identify endotracheal tube placement by available means
Remove bronchopulmonary secretions
perform postural drainage, perform percussion and/or vibration
suction endotracheal and tracheostomy tubes, perform nasotracheal or
orotracheal auctioning, select closed system suction catheter
administer aerosol therapy, administer prescribed agents [e.g.,
bronchodilators, corticosteroids, saline, mucolytics]
instruct and encourage bronchopulmonary hygiene techniques [e.g.,
coughing techniques, autogenic drainage, positive expiratory pressure
device (PEP), intrapulmonary percussive ventilation , Flutter, High
Frequency Chest Wall Oscillation
Achieve adequate spontaneous and artificial ventilation
instruct in proper breathing techniques, inspiratory muscle training
techniques, encourage deep breathing,
instruct/monitor techniques of incentive spirometry
initiate and adjust IPPB therapy
select appropriate ventilator
initiate and adjust continuous mechanical ventilation when no settings
are specified
initiate and select appropriate settings for high frequency ventilation
initiate nasal/mask ventilation, initiate and adjust external negative
pressure ventilation
initiate and adjust ventilator modes
initiate and adjust independent lung ventilation
administer prescribed bronchoactive agents
institute and modify weaning procedures
Achieve adequate arterial and tissue oxygenation
initiate and adjust CPAP, PEEP and noninvasive positive pressure
initiate and adjust combinations of ventilatory techniques [e.g., SIMV,
PEEP, PS, PCV]
                             Competency                                    Lecture   Campus   Clinics
position patient to minimize hypoxemia (on or off ventilator), prevent
procedure-associated hypoxemia [e.g. oxygenate before and after
suctioning and equipment changes]
Terminate treatment based on patient’s adverse reaction to therapy
being administered
Modify management of artificial airways
Modify bronchial hygiene alter duration of treatment alter equipment
used alter techniques coordinate sequence of therapies alter position of
patient
alter endotracheal or tracheostomy tube position, change endotracheal
or tracheostomy tube
change type of humidification equipment
Terminate treatment based on patient’s adverse reaction to therapy
being administered
Modify management of artificial airways
Modify bronchial hygiene alter duration of treatment alter equipment
used alter techniques coordinate sequence of therapies alter position of
patient
alter endotracheal or tracheostomy tube position, change endotracheal
or tracheostomy tube
change type of humidification equipment
initiate suctioning
inflate and deflate cuff
Modify incentive breathing devices
Modify aerosol therapy
modify patient breathing pattern
change type of equipment, change aerosol output
change dilution of medication, adjust temperature of aerosol
Modify oxygen therapy
change mode of administration, adjust flow, adjust FiO2
set up or change an O2 blender
set up an O2 concentrator or liquid O2 system
Modify suctioning
                               Competency                                    Lecture   Campus   Clinics
alter frequency and duration of suctioning
change size and type of catheter
alter negative pressure
instill irrigating solutions
Modify mechanical ventilation
change patient breathing circuitry, change type of ventilator
adjust ventilator settings [e.g., tidal volume, F,02, inspiratory plateau,
PEEP and CPAP levels, pressure support and pressure control levels,
noninvasive positive pressure, alarm settings)
Modify weaning procedures
Modify IPPB
adjust sensitivity, flow, volume, pressure, Fi02
adjust expiratory retard
change patient-machine interface [e.g., mouthpiece, mask]
change mechanical dead space
use or change artificial airway [e.g., endotracheal tube, tracheostomy
change ventilatory techniques [e.g., tidal volume, respiratory rate,
ventilatory mode, inspiratory effort (sensitivity),
PEEP/CPAP, mean airway pressure, pressure support, inverse ratio
ventilation, noninvasive positive pressure]
wean or change weaning procedures and extubation
institute bronchopulmonary hygiene procedures [e.g., positive
expiratory pressure (PEP), IS, intrapulmonary percussive ventilation
(IPV), CPT]
modify treatments based on patient response [e.g., change duration of
therapy, change position)
change aerosol drug dosage or concentration
insert chest tube
Initiate, conduct, or modify respiratory care techniques in an
emergency setting
treat cardiopulmonary collapse according to ACLS standards
treat tension pneumothorax
participate in land/air transport
                             Competency                                   Lecture   Campus   Clinics
Act as an assistant to the physician performing special procedures
bronchoscopy
tracheal aspiration
tracheostomy
cardiopulmonary stress testing
percutaneous needle biopsies of the lung
sleep studies
cardioversion
intubation
insertion of chest tubes
insertion of lines for invasive monitoring
Initiate and conduct pulmonary rehabilitation and home care
monitor and maintain home respiratory care equipment, maintain
apnea monitors
explain therapy and goals to patient in understandable terms to achieve
optimal therapeutic outcomes
assure safety and infection control
modify respiratory care procedures for use in the home
implement and monitor graded exercise program
conduct patient education and disease management programs




_____________________________________________                    __________________________
Director of Clinical Education                                  Date
                                 Competency Verification


Instructions: Please notify your clinical/lab instructor to be evaluated in performing each
proficiency. When you have successfully demonstrated proficiency in performing the task to
acceptable standards, the instructor will sign and document the date of completion. (Reference:
White “ Basic Clinical Lab Competency for Respiratory Care”)
                                  Competency
        Competency             Lecture     Instructor’s    Clinic      Instructors
                               Date of      Signature     Date of       Signature
                                Completi                  Completion
                                   on

Infection Controls

Handwashing

OSHA Guidelines

Isolation Procedures

Equipment Processing

Patient Assessment

Vital Signs

Breath Sounds

Physical Assessment

X-Ray Review

Oxygen Therapy

Oxygen Supply Systems

Oxygen Administration

Pulmonary Function Testing

Bedside Testing

Basic Spirometry

Basic Therapeutic
Procedures

Metered Dose Inhaler (MDI)
   Administration

Humidity and Aerosol Therapy

Small Volume Nebulizer
   Therapy

Patient Positioning

Chest Percussion Therapy

Incentive Spirometry

PEP Therapy

IPPB Therapy
Non Invasive Monitoring

Electrocardiogram

Pulse Oximetry

Transcutaneous Monitoring

End Tidal Monitoring

Advanced Procedures

Arterial Puncture

Arterial Line Sampling

ABG Analysis

Airway Management

Manual Resuscitation

Intubation

Extubation

Oral/Nasal Airways

Nasotracheal Suctioning

Endotracheal Suctioning

Monitoring Cuff Pressures

Tracheostomy/Stoma Care

Mechanical Ventilation

Initiation of Continuous
Mechanical Ventilation

Monitoring Continuous
   Mechanical Ventilation

Ventilator Circuit Change

Special Ventilator
   Procedures

Spontaneous Ventilation
Parameters

PEEP/CPAP

IMV/SIMV

Bi-level Positive Airway
     Pressure
IMV and CPAP

Pressure Support

Static/Dynamic Pressure

Neonatal/Pediatric
   Mechanical Ventilation

Initiation of Newborn/Pediatric
Mechanical Ventilation

Monitoring Newborn/Pediatric
   Mechanical Ventilation

Miscellaneous

Healthcare Provider CPR

Bronchoscopy




_____________________________________________    __________________________
Director of Clinical Education                  Date
Clinical
Records

								
To top