AARC Barriers to Protocol Implementation Survey Results A Project of the AARC Protocol Implementation Committee 2008 Slides developed to adjunct lectures supporting the use of respiratory care protocols

Survey Background In order to better develop a plan for the implementation and use of protocols the committee recognized that barriers exist Survey tools were developed to assess these barriers and perceptions Separate surveys were developed for both the Manager and Staff Therapist This slide presentation was developed from those surveys and is intended to assist in understanding the barriers and developing successful strategies to implement protocols 2

Protocol Definition For the purpose of both the Manager and Staff surveys, protocols were defined as: Initiation or modification of a patient care plan following a predetermined structured set of physician orders, instructions or interventions in which the therapist is allowed to initiate, discontinue, refine, transition, or restart therapy as the patient's medical condition dictates. Note: This definition should not be confused with programs that include discontinuation of therapy without a reorder, flagging therapy for physician reorder, standing orders or policies that dictate therapy durations.

Respondents Region - Manager Survey 459 respondents (post cards and email) We first focused on managers as we thought that would be the best starting place. In addition, the managers would direct future survey and questions.

Demographics – Manager Survey

Hospital Type - Manager Survey The majority were not for profit hospitals Evenly split between small and large hospitals

Department Profile - Manager Survey Mostly hospitals with < 25 FTEs The majority have at least one protocol as described

Protocol Use - Manager Survey The majority of hospitals do not have a comprehensive protocol program. Less than 50% of care is provided by protocols despite the evidence that protocols improve outcomes and reduce cost.

Types of Protocols in Place - Manager Survey An even mix of complex and simple protocols.

Medical Staff Order Practices - Manager Survey If you add the N/A (meaning they don’t have protocols established for physicians to order) to the 0-25% category, that is the majority of physicians.

Manager Perception of Medical Staff Opinion Many physicians are opposed or perceive they would lose control.

The Manager Survey Indicates the Following are NOT Barriers The medical directors of departments The managers of the department The nurses The administrators

Managers Perceive the Barrier as … It was apparent from the survey that the medical directors and managers felt that a portion of the barrier was that RT didn’t have the skills to function under protocols That perception MUST change….. I didn’t demonstrate this finding very well.

Staff Surveys Surveys were emailed to all identified as “staff” therapists in the AARC member database with1705 responses The following slides represent the perceptions of staff therapist of administration, medical staff, nurses and themselves

Respondents Region - Staff Survey

Demographics – Staff Survey

Staffed Bed Size – Staff Survey

Hospital Type - Staff Survey Investor Owned for Profit Same as manager’s survey, the majority are not-for-profit. Government owned Most are not affiliated with a medical school.

Do You Have Protocols? - Staff Survey Although staff reports most departments having protocols, the manager survey shows most do not have a comprehensive protocol system.

Staff Perception of Managers as Barriers Staff do not view a manager as a significant barrier.

Staff Perceptions of Medical Staff as Barriers Staff perceive physicians sense a loss of control as a significant barrier.

Staff Perception of Medical Directors as Barriers How do we get the understanding that the medical directors have to the rest of the medical staff? Medical directors do not pose a significant barrier to protocols

Staff Perceptions of Nurses as Barriers Nurses are not perceived as a significant barrier for most staff.

Staff Perception of Respiratory Therapist as Barriers Respiratory therapists do not view themselves as a significant barrier

Willingness to Learn Another Skill if Protocols Reduce the Need for RTs? – Staff Survey This demonstrates RTs adaptability and should serve the profession well in the future.

Do RTs View Themselves as Barriers? – Staff Survey Therapists do not view themselves as the barrier to protocols

Staff Survey Conclusions Medical staff are perceived as the most significant barrier to protocols. Most RT staff do not view themselves as significant barriers Staff therapists do not view administrators and manager as significant barriers Nearly all RTs are willing to learn additional skills if adoption of protocols will assure that patients receive appropriate care

A Note from the AARC Protocol Implementation Committee Please use these slides in assessing potential barriers when implementing programs in your facility You should assess if the specific barriers at your hospital are different, so you can develop a successful strategy to overcome those barriers For additional information visit the Protocol Resources at www.aarc.org You can also contact the Chair of the Protocol Implementation Committee for a complete file of the Manager and Staff Surveys