Ending the RT-Patient/
Ending the RT-Patient/Client Relationship
Sometimes it is necessary for an RT to end the therapeutic relationship with a patient/client. If the services of the RT are being discontinued because the individual no longer requires them, then it is usually a matter of making sure all of the proper documentation is in place and that the patient/client’s primary physician has been informed. If, however, the RT is no longer able to provide care to an individual still in need of services, then it is incumbent upon the Respiratory Therapist to ensure that care has been transferred to the most appropriate person and/or facility.
A patient/client being cared for by a home oxygen company has been formally warned twice that the oxygen will be removed due to safety concerns (i.e., smoking as well as unsafe handling and storage). On a subsequent visit the RT finds the patient smoking in their livingroom with the grandchildren playing nearby. How should the RT proceed?
The ethical principle involved is primarily the respect for free will, which must be balanced with the need to do good and do no harm.
Home care companies generally have explicit policies regarding oxygen and smoking. Failure to abide by this can result in removal of the oxygen for the safety of the patient, their family, and the healthcare team. The RT is required to follow organizational policies and work with the patient’s physician to find safe, alternative resolutions. Once the RT is satisfied all requirements have been met, they should remove the oxygen and instruct the patient to proceed to their local hospital. As always, documentation is extremely important.
It is important to note that if an RT is changing employers (e.g., moving from one home oxygen company to another) they should in no way endeavour to entice a patient/client to change companies as well. The therapist should, consider the best interest of the patient/client over their own needs.