Evidence-Based and Reflective Practice

In order to provide the highest level of quality patient care, RT’s must apply current and best practice guidelines and research in their clinical practice. Evidence-based medicine challenges the notion that practitioners should continue to adhere to “accepted” medical practices that are no longer relevant or validated. Rather, it is an RT’s responsibility to demonstrate professional excellence and practice competently and with integrity, ensuring that they seek opportunities for professional development and lifelong learning.

An internal medicine specialist has ordered an inappropriately high tidal volume (>10 ml/kg) for a patient/client with ARDS and has not written on order to ventilate to ABGs.

The hospital has a policy that the NHLBI ARDS Mechanical Ventilation Protocol should be implemented for individuals who meet the inclusion criteria. How should the RT proceed?

The ethical principle involved are to do good and do no harm.

First, the RT is required to act in the patient/client’s best interest. If the practitioner has sound reason to question any medical order, then they should immediately bring this to the attention of the individual who wrote the order. Sometimes a careful and well-informed explanation on the part of the RT can be enough to have the order changed. If not, then how the RT proceeds will vary depending on how detrimental they feel the existing order will potentially be for the patient/client. In this scenario, if the RT was not satisfied with the outcome of the discussion with the ordering physician, then there is usually another level of administration to take their concerns (e.g., chief of staff, administrator on-call, etc.). In the interim, the patient/client should be set on whatever set of parameters that are considered to be safe and everything must be carefully documented. All other staff caring for the patient/client (i.e. bedside nurse), should also be informed.