So yeah, well, . . .

A little less than a year ago, I got a job as part of a team building the electronic medical records for a local hospital.

We are Live--I'm growing in that career. And I am probably not going back to clinical care. So I'm having less to say to my fellow RTs. Stay strong, believe in yourself, never stop trying to make yourself happier. You, of all people, know that today is what counts.

Take care.

That was a long break!

I got a new job. I finally landed a Health IT job, and everything moved very quickly.

I am becoming certified in Epic Inpatient. As I take these classes and study the training "companions" (ie, manuals), my respect for the system is growing my leaps and bounds.

I applied for this job on August 4--a local hospital system with a serious Epic implementation going on was will to send me for training and pay for certification. So I didn't see things through to the end at the old job, but there was no chance they were going to invest in me like this.

So I've been to Verona, WI twice now, and a ton of validation meetings. And I am happily tired. And have been neglecting my blog.

Thanks for checking back!

AMIA 2008

I just received a brochure yesterday from the American Medical Informatics Association, regarding their 2008 Biomedical and Health Informatics Annual Symposium. I don't know about the timing, here, but it would be really nice to have a chance to go to one of these seminars.

I am still involved in our EMR implementation at our hospital. We are using EPIC, and I've been a Subject Matter Expert for the design and validation of ClinDoc. I've been spending about 2/3 or my time on EPIC, and about a third in the clinical environment, so I am in an interesting transitional kind of place in my career.

I do want to move toward informatics. Since ceasing the master's program, I've gotten slightly more clinically oriented, at least as far as the blog goes. I'm hoping to get my informatics role more clearly developed and defined. I have been looking for a job, but until this last weekend, most of what I was looking at were "partner" type jobs, where there would be a lot of traveling. Not ideal for a mom with smaller kids. I've applied and received a response from a hospital based EPIC opportunity in which they are hiring 8 people. So I hope my odds are good.

All in it's time.

Petered Out

My patient petered out after the first 24 to 36 hours. First she complained it was too strenuous, then that the mouthpiece was too large/hard, and painful to use.

I also am working on a project that is taking me out of the clinical setting, so I have been unable to follow through consistantly. I don't know if that has any affect.

So I was a little discouraged. I had hoped to get a few days of treatments in, so we could have something to really measure. Although, reports of fatigue and an uncomfortable mouthpiece is a measurement of success as well.

IPV (Intrapulmonary Percussive Ventilation)

According to the sales rep that came to our department, Percussionaire has only used word of mouth to get the word out regarding Intrapulmonary Percussive Ventilation device. This explains why we have hardly used it, despite the great reputation IPV has for airway clearance techniques.

First of all, this is one of the first hospitals I've worked at that really does CPT the way it ought to be done. We are actually allotted the 40-50 minutes it should take to position, percuss, vibrate, and coach our patients in huff coughing and other airway clearance maneuvers. Most of this therapy is oriented around our CF population, but obviously overflows to other pulmonary diseases.

So this weekend I had a patient, CF, increased oxygen requirement, retaining CO2, who is NOT getting the crap out of her lungs. I tell her I think there's more, and she complains that she feels like there's a plug she just can't get behind it.

We have an IPV 1-C, and have only ever implemented IPV on a different patient, with a "whatever the previous model" was version.

So it was a Saturday--not a good day to get residents to implement a new therapy. Also, not a good day to float to NICU at 3 pm, if I wanted to see this started. Fortunately the workload was a little slow, so I had time to hunt down a circuit, scrounge up the literature, and be somewhat prepared when I called the resident. Who had no idea what I was talking about--"I'll talk to Dr. McXXXX about it."

I've only worked day shift for part of this year, and I confess I don't know many of the attendings well. However, I've had a few opportunities to talk to Dr. McXXXX, and I had a good feeling she'd jump on this.

Which she did, because the order came through about 30 minutes after I requested it.

Well, I did have to float to NICU, so I got the circuit together, tried to assemble it, then left it in the hands of another therapist.

I found out the next day that they weren't able to maintain pressure, so she had gotten more CPT. Luckily for my NICU float, I had taken my turn for the weekend, so I was able to get my patient again. Once more, slow enoughworkload to research. I went to YouTube, and found this:

on assembling the Phasitron for hospital use, and this --on the inline cone assembly.

It turns out I had goofed, and set it up for inline use, using our diagrams. Once I set it up right, we were in business, and I was able to perform two IPV treatments that day. My patient brought up about 3 times the sputum that I was getting out of her the day before. Although she was still tachypneic, she was clearly working less and reported feeling like we had cleared her better.

I haven't worked clinically since then--I will have to follow through.

Being a Respiratory Therapist

I'm not sure I even know why I think Respiratory is so cool. It's probably not just one thing--and I guess I can think of three right away: 1) the science, 2) the devices, 3) the physical action.

I am at heart, a scientist. Probably that is why I get so annoyed, sometimes outright angry, when I am ordered by docs to do things that cannot be supported scientifically. It is an endless frustration of our profession to be at the direction, at least at times, of those who do not understand our modalities, and apply them because of the fated "we just think it will help". And this is one reason, I believe, that therapists get the "stuff" taken out of them. You can take the time to counsel with doctors, nurses, and whoever, provide excellent reasoning, and still get overridden on their whim.

I've always thought ventilators are cool. My favorite has been the workhorse Servo 900C, ever reliable. We use a lot--maybe too many--different devices at our shop. One of the great stresses of floating to the units, is that we haven't limited the scope of which devices we support. There's a tendency at our hospital to rent anything we don't have if a doctor wants to give it a try. The doctor who knows it is then the specialist in the equipment, and the therapists are sort of winging it. I think that the constant quality of dealing with the totally unexpected and largely untrained equipment situation contributes significantly to the low morale amongst our respiratory department.

Armchair type jobs don't suit me. I like the fact I have to run all over the place (and sometimes under!) to get at what I need to do. But I'm not getting any younger, as my feet especially will tell you. I have pretty significant foot problems, which is a major factor in considering a career switch.

I'm in a slump: I have an interview pending, but am suspecting they are going to want a lot of traveling, which is probably not going to happen if I have kids. A lot of the other positions that I've been looking at that would be a step up, also require extensive traveling. I'm not going to take that kind of time away from my family.

So I think I'm just flowing through the summer, dealing with our ups and downs at work. Ultimately, if I land the right health IT job, I could choose to do contingency to keep up my respiratory skills. Thing that worries me there, is that not doing it every day thing, where I will be perpetually a little rusty.

Just Musing.

Someone Beat Me To It!

At the beginning of the month I told my boss I need to write an article for the Respiratory Care about the need for informaticists specific to respiratory care. We need people with an IT background as well as a deep understanding of respiratory devices, modalities, and clinical terminology.

And then I get the April 2008 copy, with an article titled "Respiratory Care Informatics and the Practice of Respiratory Care" (Constance C Mussa, MSc, RRT). She is calling for respiratory care to focus on it's informatics needs, and to begin by developing our taxonomy and ontology.

Good idea! I wish I had thunk it!