Chair
Melinda Gaylor–Childress, MEd, RRT
Director Training and Accreditation
Advanced Lifeline Services Inc
10503 Timberwood Circle, Suite 215
Louisville, KY
502–426–1958, ext. 122, 502–426–2337 (fax)
melinda.g@alsvents.com

I’m happy to report membership in the section is continuing to grow. Each new membership and renewal makes our section stronger and stronger. With your support, this section can continue to thrive. That is why I would like to take this opportunity to encourage greater participation in section activities. Please consider writing an article for the Bulletin, and make sure to visit the section web site on an ongoing basis. Your suggestions for additional links and submission of shared policies/forms will be greatly appreciated as we continue to update and improve the content on the site.

I also hope to see more members attending this year’s AARC International Respiratory Congress. The meeting is set for December 4–7 in New Orleans and will offer a variety of presentations related to long–term care. Our section will meet on Monday, December 6, from 11:30 a.m. to noon, so mark your calendars and plan to attend. Also, remember that Respiratory Care Week is coming up October 24–30. The events scheduled for that week will provide an excellent opportunity to showcase your long–term care programs and facilities to people in your community.

If you have not yet provided the AARC with your e–mail address, please go to the update page on the AARC web site and provide the address so that you can receive a quarterly e–mail alert when each new issue of the Bulletin is ready for viewing on the section web site. Members with an e–mail address on file also receive our monthly, e–mail newsletter with timely news and information about long–term care and links to important stories and resources on the AARC web site.

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Recently, I sent out an e–mail to members of the section e–mail list asking what type of remote alarm systems are being used in their vent units. Although not required in most states, remote alarm systems provide increased awareness of the patient’s condition and/or need for immediate attention.

Unfortunately, since the introduction of the prospective payment system, subacute units have dwindled, causing manufacturers to either eliminate or stop servicing remote alarm products. This is a real concern for units that rely on these systems. Of course, there are other alternatives, such as wiring the ventilator to the nurse call system or using another type of remote alarm, but compatibility and cost make those alternatives problematic. For example, I was recently quoted about $75K for a system for a 10–bed unit –– a ridiculous price, given the reimbursement in LTC.

Members who responded to my e–mail reported using the following models of remote systems:

• Aequitron Medical Remote Model 6217
• Hudson RCI Venti Alarm (Hudson will stop servicing these alarms as of December 2005, if not earlier, due to lack of parts)
• Integration of a nurse call system with Space Labs monitoring system

If you are using something different, please e–mail me and let me know which make and model you are currently using. This has become a significant issue, and I am sure that as we get closer to the end of 2005 more members will start to experience problems with choosing an alternative type of remote alarm system.

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Respiratory care is a rapidly growing profession. By the end of the decade, it is estimated that 29,000 additional therapists will be needed in the United States. Producing increasing numbers of well–trained therapists is essential to maintaining a quality health care workforce. But educational programs can’t do it alone. Clinical facilities must step up to the plate and offer to serve as clinical rotation sites.

As a clinical rotation site, your institution plays a key role in the education of future respiratory care practitioners. And successful clinical education benefits the clinical institution as well as the student. Indeed, one reason most departments participate in clinical instruction is the edge it gives them in attracting quality graduates to their staff. Clearly, the quality of the people you hire in the future is a direct reflection on the quality of the clinical experience students encounter during their rotations. The educational institution and the clinical affiliate both have a role to play in this process.

The role of the educational institution is to:

• Prepare the student didactically to function in the clinical environment.
• Mandate that each student remain in the laboratory phase until critical clinical knowledge and skill have been acquired, as demonstrated by assessment.
• Provide the institution with clinical objectives for each rotation and all policies and procedures related to the clinical experience.
• Provide the institution with accurate clinical rotation schedules in a timely manner.
• Orient students to the cultural and ethical expectations of the facility.
• Maintain two–way communication between the facility and the educational institution.

The role of the clinical affiliate is to:

• Foster an environment that rewards employees for serving as student preceptors.
• Be familiar with the clinical policies and procedures of the educational institution.
• Promote student access to quality clinical education experiences.
• Provide feedback on student performance.
• Respond as appropriate to feedback provided by the educational institution.

One of the key challenges for respiratory students is applying the information learned in the classroom accurately and effectively to the clinical environment. Educational and clinical institutions working together to provide quality clinical experiences will greatly enhance this process.

References

• Kocher, K, Chapman, S, Dronsky, M, “Respiratory Care Practitioners in California,” The Center for the Health Professions, University of California, San Francisco, July 2003.
• Hill, TV, The Relationship Between Critical Thinking and Decision–Making in Respiratory Care Students, Respiratory Care, May 2002

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On March 26, 2004, the Centers for Disease Control and Prevention (CDC) released an updated version of its Guidelines for Preventing Health Care–Associated Pneumonia. According to Bill Dubbs, AARC director of education and management, there are several areas of these guidelines where the cited literature evidence does not seem to support the recommendations, but the following section is of particular concern to the AARC:

Small–volume medication nebulizers: in–line and hand–held nebulizers:

a. Between treatments on the same patient clean, disinfect, rinse with sterile water (if rinsing is needed), and dry small–volume in–line or hand–held medication nebulizers.

The previous guidelines, released in 1994, state: Between treatments on the same patient, disinfect, rinse with sterile water, OR air–dry small–volume medication nebulizers. (Emphasis added.)

According to Dubbs, the simple removal of the word “or” significantly changes the requirements of the Guideline.

After speaking with Michele Pearson, MD, at the CDC, the AARC sent a letter to officially register its concern, pointing out that in none of the three studies cited in the 2004 Guidelines and used as the basis for making this recommendation is disinfection of the nebulizer between treatments on the same patient indicated. The AARC also sees no scientific evidence that would support, for the sake of patient safety, a requirement to disinfect nebulizers between uses on the same patient. In the absence of any scientific support, the Association does not believe there is justification for making a significant change from the 1994 Guidelines regarding the disinfection of nebulizers. The AARC also pointed out in the letter that, if implemented, there will be a considerable cost associated with this amended guideline.

Stay tuned to the AARC web site for updates. You can also read the new CDC guidelines in their entirety in your August 2004 issue of the Respiratory Care journal, along with an editorial in which Dean Hess offers further comment on the issues surrounding these guidelines.

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Medicaid hikes offset by rising litigation costs: A new study from the American Health Care Association finds rising lawsuit and liability insurance costs are cutting into Medicare funding increases for SNFs. According to the Aon Risk Consultants poll, on average, general liability and professional liability costs per SNF bed rose from $310 in 1992 to $2,290 in 2003.

Staffing problems abound: The California Healthcare Foundation finds that nearly 80% of freestanding SNFs in the state failed to comply with federal care and safety regulations during recent mandatory inspections. At the same time, abuse and substandard care complaints rose by 38%, and over two–thirds of SNF nursing staff left their jobs in 2002, with some homes experiencing up to 300% turnover.

Did you know? Beverly Enterprises is the largest nursing home chain in the U.S. in terms of number of facilities, but Manor Care takes the top spot in number of beds. The figures come from the “Top 50 Nursing Home Chains of 2003,” published by health care information company Verispan. Rounding out the top ten list of chains with the most facilities are Mariner Health Care, Kindred Healthcare, Life Care Centers of America, Evangelical Lutheran Good Samaritan, Genesis Health Ventures, Trans Healthcare, Extendicare Health Services, and Sun Healthcare Group.

Don’t expect to see drug cards in SNFs: Most SNF residents won’t be eligible for Medicare’s new drug discount cards, says a report from Annett News Service. Only those residents who do not already receive drug benefits through Medicaid, Medicare, or another source will be eligible for the card, which provides up to $600 in subsidies this year and next year. According to an official quoted in the article, only about 3% of SNF residents fit that category. A pharmacist also quoted said that the discount cards would be incompatible with SNF drug distribution systems and would be too difficult for SNFs to use.

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Specialty Practitioner of the Year: Submit your 2004 nominations online.

Recruit a new member: Know an AARC member who could benefit from section membership? Direct them to section sign up. It's the easiest way to add section membership to their overall membership package.

Section e–mail list: Start networking with your colleagues via the section e–mail list.

Bulletin Deadlines: Winter Issue: December 10; Spring Issue: March 10; Summer Issue: June 10; Fall Issue: September 10.

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