Key Takeaways
- The AARC Code of Ethics guides respiratory therapists to act with competence, integrity, and respect for patient autonomy
- Informed consent requires that the patient understands the procedure, risks, benefits, and alternatives before agreeing to treatment
- Patients have the right to refuse treatment, including mechanical ventilation, even if refusal may result in death
- Advance directives (living will, healthcare power of attorney, DNR/DNI) specify patient wishes when they cannot communicate
- SOAP notes: Subjective (what patient says), Objective (measurable data), Assessment (clinical interpretation), Plan (treatment plan)
- HIPAA protects patient health information; share only minimum necessary information with authorized personnel
- Evidence-based practice (EBP) integrates best research evidence, clinical expertise, and patient values
- Interdisciplinary communication uses SBAR: Situation, Background, Assessment, Recommendation
Professional Practice & Ethics
The TMC exam includes questions on professional practice, ethics, legal considerations, documentation, and communication. While these topics may seem less clinical than ventilator management or ABG interpretation, they are essential for safe, ethical, and effective respiratory care.
AARC Code of Ethics
The American Association for Respiratory Care (AARC) Code of Ethics establishes professional standards:
- Competence: Maintain and improve professional skills through continuing education
- Integrity: Act honestly and avoid conflicts of interest
- Patient welfare: Prioritize the patient's well-being above all other considerations
- Confidentiality: Protect patient information (HIPAA compliance)
- Non-discrimination: Provide care without regard to race, ethnicity, gender, religion, age, or socioeconomic status
- Respect for autonomy: Honor patient decisions, including the right to refuse treatment
- Collaboration: Work effectively with interdisciplinary healthcare teams
- Scope of practice: Practice within the legal scope defined by state licensure laws
Patient Rights and Legal Concepts
| Concept | Definition |
|---|---|
| Informed consent | Patient must understand the procedure, risks, benefits, and alternatives; must voluntarily agree; must be competent to decide |
| Implied consent | Assumed in emergency situations when the patient is unable to consent (unconscious, immediate life threat) |
| Right to refuse | Competent patients may refuse any treatment, including life-sustaining interventions |
| Advance directives | Legal documents specifying healthcare wishes when patient cannot communicate |
| Living will | Specifies what treatments the patient does and does not want |
| Healthcare power of attorney (proxy) | Designates a person to make medical decisions on the patient's behalf |
| DNR (Do Not Resuscitate) | No CPR if cardiac/respiratory arrest occurs |
| DNI (Do Not Intubate) | No endotracheal intubation; non-invasive support may still be provided |
| POLST/MOLST | Physician/Medical Orders for Life-Sustaining Treatment; portable, actionable medical orders |
Scope of Practice
Respiratory therapists operate under medical direction and within the scope defined by:
- State licensure laws (vary by state)
- Facility policies and procedures
- Physician orders (including protocols and standing orders)
- NBRC credentialing (CRT, RRT, specialty credentials)
Important: An RT should never perform a procedure outside their scope of practice, even if asked by a physician, unless the state allows it and the RT has been trained and credentialed.
Documentation
SOAP Note Format:
| Section | Content | Examples |
|---|---|---|
| S — Subjective | What the patient reports | "I feel short of breath," "My inhaler isn't helping" |
| O — Objective | Measurable clinical data | RR 28, SpO2 91% on 2 LPM NC, bilateral wheezes, peak flow 180 L/min |
| A — Assessment | Clinical interpretation | Acute asthma exacerbation with moderate airflow obstruction |
| P — Plan | Treatment plan and next steps | Albuterol SVN 2.5 mg, reassess in 30 minutes, notify physician |
Documentation Principles:
- Document objectively — record facts, not opinions
- Document in real time — as close to the intervention as possible
- Use approved abbreviations only
- If not documented, it was not done (legally)
- Never alter a medical record after the fact; use addendums if corrections needed
- Include patient response to therapy in every note
Communication — SBAR Framework
The SBAR framework is the standard for healthcare communication, particularly when reporting to physicians or during handoffs:
| Component | Content | Example |
|---|---|---|
| S — Situation | What is happening right now? | "I'm calling about Mr. Jones in Room 412. His SpO2 has dropped to 85% on 4 LPM NC." |
| B — Background | Relevant clinical context | "He was admitted yesterday with community-acquired pneumonia. He's been on antibiotics and 4 LPM NC since admission." |
| A — Assessment | Your clinical assessment | "I believe his pneumonia is worsening. CXR shows increased bilateral infiltrates. He's using accessory muscles." |
| R — Recommendation | What you suggest | "I recommend increasing to a non-rebreather mask and obtaining an ABG. Would you also like to consider BiPAP?" |
Evidence-Based Practice (EBP)
Evidence-based practice integrates three components:
- Best available research evidence — Clinical trials, systematic reviews, meta-analyses
- Clinical expertise — Your training, experience, and clinical judgment
- Patient values and preferences — What the patient wants and values
Levels of Evidence (strongest to weakest):
- Systematic reviews and meta-analyses of randomized controlled trials
- Randomized controlled trials (RCTs)
- Cohort studies and case-control studies
- Case series and case reports
- Expert opinion and clinical experience
Quality Improvement and Patient Safety
| Concept | Description |
|---|---|
| Root cause analysis (RCA) | Investigates the underlying cause of adverse events |
| Sentinel events | Unexpected events resulting in death or serious harm; require immediate investigation |
| Near misses | Events that could have caused harm but were caught before reaching the patient |
| Time-outs | Pre-procedure verification to confirm correct patient, procedure, and site |
| National Patient Safety Goals | Joint Commission goals including patient identification, communication, medication safety |
A competent adult patient with end-stage COPD tells the respiratory therapist, "I do not want to be intubated if I stop breathing." The RT should:
A respiratory therapist needs to call a physician about a deteriorating patient. Which communication framework should be used?
In a SOAP note, documenting "SpO2 92% on 3 LPM NC, bilateral expiratory wheezes, RR 26" belongs in which section?
Which of the following represents the STRONGEST level of evidence in evidence-based practice?
Which of the following are components of valid informed consent? (Select all that apply)
Select all that apply
A respiratory therapist accidentally administers the wrong medication to a patient but no harm occurs. This event is classified as a:
A patient who is unconscious and experiencing anaphylaxis arrives in the emergency department. What type of consent applies?
HIPAA regulations require respiratory therapists to:
An RT documents in the patient chart: "Patient seems to be faking symptoms." This documentation is inappropriate because it:
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