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2011 NCSRC Newsletter, Issue 2

2011 Awards and Election Results

1. Educator of the Year: Lanny S. Inabnit, Stanly Community College
2. Physician of the Year: Toan Huynh, MD, Carolinas Medical Center
3. Clinical Practitioner of the Year: Christy Ginn, Martin General Hospital
4. Student Sputum Bowl Winners: Chris Denmark, Lauren Jackson, Ashley Peaden, and Kristy Hernandez; Pitt Community College
5. Practitioner Sputum Bowl Winners: Pat Daley-Missions Hospital, Asheville; Cathy Bitsche, Catawba Valley CC, Hickory; Robin Ross, Catawba Valley CC, Hickory
6. NCSRC Scholarship Winners: Kristy Hernandez, Pitt Community College and John Tally, Sandhills Community College

2011 NCSRC Officers/BOD
President Elect   Robin Ross
Vice-President    Ricky Bowen        
West BOD          Christy Stewart                
Central BOD       Lawson Millner, Lanny Inabnit, Myra Stearns  
Eastern BOD      Carolyn Bell, Wayne Trainor                                 
Treasurer            Joe Hylton                            
Secretary            Trisha Miller

Approve By-laws    87.4% Approve
3.8% Disapprove
8.6% No response

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A Message from the President

I would like to thank the membership for giving me the opportunity to serve as the 2011-2012 NCSRC President. The Society has undergone significant changes over the last year and we continue to work toward making improvements to better serve the membership and support the practice of respiratory therapy in our great state of North Carolina. With a weakened economy that has been slow in its recovery and an ever-changing healthcare system, we are faced with many challenges as we move forward. However, those challenges bring opportunities and I firmly believe that we, in North Carolina, will lead the way.
The following goals for my 2011-2012 term include:

I would like to thank all those who attended the 2011 NCSRC Symposium in Wilmington and helping to make it a wonderful success. A big thank you goes to the Program/Education Committee for their hard work in putting together an excellent agenda and to Ms. Lucille Goddard, RRT, RCP, our new Executive Secretary, for doing such an outstanding job in organizing and keeping it running smoothly. Many participants noticed some changes especially the elimination of the program booklet. In an effort to improve processes and be more environmentally friendly, we are transitioning to more electronic formats. We appreciate your feedback as we look to make improvements for next year.
Our membership continues to grow as we achieved a 6% increase this year and was recognized by the AARC as having one of the largest increases among the state chartered affiliates. So, thank you! We appreciate your support of the respiratory therapy profession with every new and renewed membership to the AARC. In addition, we want you to be involved with the NCSRC. This is your Society. We have opportunities to serve on one of our many committees.
Please do not hesitate to contact me if you have questions, concerns, suggestions, or want to become involved.
Best Regards,
Kim Clark, President – North Carolina Society for Respiratory Care
kclark@cvcc.edu

 

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A Message from the Past President

To our Members:

This has been an awesome year for the North Carolina Society for Respiratory Care.  The Board of Directors and its officers and committees have been hard at work to make YOUR Society one of the best in the country.  There are so many things I want to say and so many people I want to thank as I leave office.  To keep from unintentionally leaving someone out, I will simply say thank you to everyone who worked and supported us. 

I came into office with several goals.  I’m happy to say we were able to accomplish several of them this year:

                  Dr. Bruce Rubin
                  Dan Grady
                  Terry Smith
                  Rick Leonard

Because of the efforts of these four men and a very heartfelt presentation to the Board, Rick Sells will be remembered for years to come for his many accomplishments and contributions to the field of Respiratory Care. 

I’d also like to take this opportunity to introduce Lucille Goddard.  Lucille was hired in May to be the Society’s Administrative Secretary.  She is an RRT and licensed RCP in the state of NC.  She is married, has three kids, three dogs and is enjoying semi-retirement in Carolina Beach.  Lucille took this position with no orientation and was thrown into Symposium from the start.  For those of you who were able to attend Symposium, you probably had contact with Lucille at some point.  What a wonderful job she did working with our Program and Education Committee to help provide an excellent educational experience for everyone. 

As I turn over the Presidency to Dr. Kim Clark, I do so with a heavy heart.  I met many wonderful people and received many great stories.  I’ve heard from my critics, yet have several new friends.  I could never imagine what being the President of the North Carolina Society for Respiratory Care would be like.  As a member of the Society, I’d sit in the back and wonder who all those people were up there.  As a Board member, I’d sit and wonder how the Presidents knew what to do or what to say.  The closer I got to the Presidency as an officer, the more I learned – they were all just like me – normal people, volunteering their time to serve the therapists of this state.    

If you have an interest in getting involved, speak up.  If you’re not heard the first time, speak louder.  Baby steps will help you get where you want to go.  Never give up. 

Thank you,
Jill Saye

 

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Rapid Response Teams – Jhaymie Cappiello, BS, RRT

Rapid Response Teams
            It has been close to 7 years since the Institute for Healthcare Improvement (IHI) announced its’ 100,000 lives campaign and recommended the implementation of Rapid Response Teams. The impetus for the recommendation of RRTs was based on studies from the United Kingdom and Australia that showed implementation of these medical emergency teams would yield a decrease in unanticipated ICU admissions, decrease cardiac arrests and even improve mortality rates. (1)  Data thus far have shown RRTs have had an impact on decreasing the unanticipated ICU admission as well as decreases in the number of non ICU cardiac arrests both of which are very positive. However, in regard to mortality rates, there is no definitive answer. We lack strong evidence on mortality impact. The current literature is single center uncontrolled studies. Without a multicenter controlled trial, evidence on mortality impact is weak. Perhaps it is becoming far too difficult to develop a controlled study due to the great increase in awareness of catching and acting on the deteriorating patient early. If this be true, then focus should be placed on what we are getting. There is a growing body of literature that bring to light many facets of these RRT programs - impact on Do Not Resuscitate orders, nurse physician perceptions of  RRT program impact, consensus conference statements, Meta-Analysis outcome reports, and early warning criteria reviews to name a few. We also have our own institution’s data collection to review and evaluate; average time of RRT activation, number of RRTs’ per 100 admissions, RRT calls per year, reasons for activation and interventions per activation. What we do with this data and evidence is how we decide the direction, success, and impact of the RRT to make a safer environment.
            Activation criteria for RRT calls vary slightly amongst institutions but are all based on the IHI recommendations. Our criteria are as follows:
When the patient experiences ACUTE changes in their condition -

OR
If you are concerned or worried about your patient’s status

 These criteria are only useful in preventing deterioration if used properly. Rothschild (2) found that 45.3% of RRTs had only a single abnormal criterion that preceded an adverse event. The MERIT trial reported that 30% of their emergency response calls were transported to ICU. (3) It is the responsibility of the Rapid Response program to evaluate and train for effectiveness. Programs must closely monitor  the criteria used per call, numbers of calls per 1000 admissions, and patient disposition to detail the comfort of using the RRT as well as its’ clinical impact. It is important to note in reviewing this data that most RRT calls are activated by a professional whose primary obligation is as the patient advocate. Continuous feedback of these program data to the health care staff can improve awareness and comfort with team activation. Our RRT use has climbed from 19/month in 2006 to 75/month in 2010. The number one trigger for RRT activation since 2006 has been staff worry or concern. There is no such thing as a bad rapid response call.  Our almost 3 fold increase in RRT activations suggests that this “fear no call” attitude is facilitating RRT usage and providing learning opportunities in recognition and detection for the non ICU care team.
            The mere arrival of the RRT is THE intervention. Remember the patient advocate. Data available from a RRT response typically includes the interventions that were made at the point of care such as an increase in supplemental oxygen, administration of a fluid bolus, or performing diagnostic tests. While this data is helpful when reviewing resources needed, it is not the defining point. The arrival of a team that has the ability to assess and provide timely and warranted care or provide the needed assurance/education to the unit’s care team is the effectual intervention. In that regard the RRT succeeds. Sarani 2009 (4) concludes that both residents and RNs’ believe that these teams improve patient safety. In this study, RNs’ also stated that they would be more likely to apply for a job at those institutions that have an RRT program.
            Other important results from RRT programs involve the very thing that they were designed to prevent, end of life. Not for Resuscitation orders (DNR in the United States) were reviewed within the Merit study.(5)The authors concluded that when the emergency team attends to a patient and there is no adverse event associated with the team response, the likelihood of a Not for Resuscitation order increases. Perhaps RRT response facilitates conversations and allows for realizations and discussions to occur in a more controlled environment than the stressful confines of a critical care unit.
            The ability for the RRT to uncover system errors is another high value reward. Kaplan reviewed all surgical RRTs’ over a 15 month period that covered 98 RRT activations.(6) The author concluded that their RRT activations are more often preventable or potentially preventable. Routine systematic case review is now becoming a standard for all adverse events due to the rapid response system.
            Rapid Response Programs may not be the only hospital initiative that could save lives.  Other viable solutions may include increasing the presence of hospitalists or mid level providers or decreasing nurse patient ratios. However, the development and deployment of the RRT, has yielded a bounty of system wide improvements. Citing the endpoint of decreased hospital mortality rates may not be the justification these programs require. Evidence is mounting that these programs are having a positive system wide effect beyond the patient. Individual institutions should devote efforts toward improving the training, development, and utilization of these teams.

1. Effect of a Rapid Response System on Clinical Outcomes: Systematic Review and Meta Analysis, Ranji et al Journal of Hospital Medicine 2007, Vol 2. No 6 
2. Single Parameter Early Warning Criteria to Predict Life-Threatening Adverse Events, Rothschild, et al Journal of Patient Safety 2010, Vol 6, No 2
3.  Introduction of the Medical Emergency Team,(MET) system: a cluster randomized control trial, Hillman,  Lancet. 2005; 365: 2091-2097
4. Resident and RN Perceptions of the Impact of a Medical Emergency Team on Education and Patient safety in an Academic Medical Center, Sarani et al, Critical Care Medicine 2009, Vol 37 No 12
5. The Medical Emergency Team System and Not for Resuscitation Orders: results from the MERIT Study, Chen et al, Resuscitation 2008, 79, 391-397
6. Uncovering System Errors Using a Rapid Response Team: Cross Coverage Caught in the Crossfire, Kaplan et al Journal of Trauma, Vol 67, No 1

 

 

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Sputum Bowl – Ricky Bowen

2011 Sputum Bowl
I would like to thank everyone for their work and participation in this year’s Sputum Bowl that made it a success. The “Easy Breathers” of Pitt Community College won a spirited student competition and will represent the NCSRC in Tampa at the National Sputum Bowl. Congratulations to the Easy Breathers: Lauren Jackson, Chris Denmark, Ashley Peaden, Kristy Hernandez and their Coordinator Rusty Sugg.
Congratulations to the 4 Alveoli of Southwestern Community College for taking home second place honors.
Congratulations to the Catawba Valley team took home the honors of our practitioner competition and will also represent the NCSRC in Tampa.
Ricky W. Bowen

 

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