Respiratory Therapy

COPD Day 2017

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November 15th is the World Chronic Obstructive Lung Disease (COPD) Day.  Based on a study by World Health Organization (WHO) in 2015, COPD is responsible for “5% of all death globally that year” (WHO. Nov 2016).   When it comes to care for COPD patients, many names come to mind; One of these dedicated individuals is Mrs. Sheery Tse.

Sheery is an active RRT who works and volunteers with COPD patients at Markham-Stouffville Hospital and Scarborough and Rough Hospital (Birchmount site).

The first time I met Sheery was in May of 2017 at a social event for COPD patients, where she was facilitating it on her own time.  She is passionate about her work and is full of energy.  She is praised and respected by her patients and colleagues as she truly cares and advocates for her patients.  To get to know her better, I sent Sheery few questions:

  • When did you first hear about the respiratory therapy field? What made you decide to become an RT?  I heard about being an RT when I did some volunteering at HSC. There I ran into a high school mate who was working as a RT. After spending some time with her and the team, I decided to apply to Michener for the respiratory technology course as it was called many, many years ago.

 

  • What are some of your memorable jobs/roles so far?  In an acute setting I was always more interested in helping patients in the ER, providing care so they may breathe easier and giving a quick education of their puffer needs was very rewarding.
    Now I love doing education whether it’s in the COPD clinic or at a healthcare office, seeing the patients understand their airway disease and why certain puffers work and how is rewarding.

 

  • What are your career goals? (and do you feel that you have accomplished them?)  Given my age and how many years I’ve been in their field, I feel I have accomplished most of what I set out to do. Starting the COPD clinics in Markham and Scarborough from scratch has been very rewarding.
    There are still a few goals I would like to see happen, a support group with just patients input and more exercise sessions available would be the biggies. Patients self-management at home is another area I would to see happen too.

 

  • How did you get involved with patient education (with COPD patients)?When Dr. M. Forse first came up with the idea of having a clinic for COPD patients, it sounded like something I would enjoy. I applied and was chosen as the educator. Now came the challenge, getting certified as an educator and quite trained.

 

  • How does a typical day look like for you?
    Don’t think there is ever a truly typical day. It could be as simple as setting up for the clinic with patients charts and assessing the patients to triaging all new referrals, returning phone calls and emails from patients to meeting with pharma reps to hear what’s new, studies and of course being the nosy educator what’s on the pipeline for puffers. In between that I also need to triage patients into the exercise programs we have and call to see if they are willing to come in and for afternoons or evenings. Tuesday’s, Wednesday’s and Thursdays, I try to go to the exercise classes to provide some support and answer any question the participants may have. I’ve been called the “spy” as I do inform the respirologists if there are concerns about the participants, including possible flare up and low sats. Through these interactions we have been able to prevent patients from being seen in ER when the respirologists could fax a script for them, or as simple as asking if they started their on-hold meds. Low sats often, if they are with ProResp, I could get a RT to come assess on the track, other vendors, I ask the patients to contact their 02 providers and ask to be reassessed and the respirologist is informed.

 

  • What are some of the challenges and joys of working with COPD patients?
    Joys is seeing the patients in a follow up visit tell us how well they are doing, having the patients return from a trip they did not think they would be able to go on because of their airway disease, seeing how well they’re exercising. Challenges is trying to convince the patients they need to use their maintenance puffers regularly, and the same with those on 02. Most often, they are so used to being deconditioned and breathless, they’ve adapted to do without. Smokers are the biggest challenge, getting them to even think about quitting is often a huge step. Cutting back with each follow up is rewarding to hear, telling us they’ve actually quit is even more so.

 

  • Based on your experience, what are some of the common struggles for COPD patients, and how can RTs better assist these individuals?
    The most common struggle, is self-management and deconditioning. They’re breathless so often they feel they can’t do much. Try is one of my favourite word to use at the clinic and at exercise classes. Knowing if and when they need to be seen is a biggie too. They really are independent and don’t want to bother their healthcare team and often end up getting worse and needing to be admitted.   Providing tools for them to figure out if it’s a simple cold, a flare up or more is something all healthcare providers need to give so they may manage their disease better and hopefully not get to the point they become very ill.

 

  • What are your thoughts on the latest 2017 COPD Guidelines and New Medications in the market? *
    New guidelines are constantly changing, latest is to decrease use of ISC with COPD patients unless they have at least one exacerbation a year to decrease the chance of getting pneumonia. When we first started the COPD clinic we had short acting puffers (Ventolin, Atrovent) ICS(Flovent) combo (Advair, Symbicort) and a LAAC(Spiriva) that just came on the market. Now we have choices, we can provide patients with the puffers they need in a device that is easier for them to use so compliance increases. There may be more I the future, good for the patients, more challenging for healthcare providers as we will need to know them, how they work and how to use them to provide better support for patients.

 

  • Any advice or final thoughts to share with RTs?
    Final words, healthcare is an amazing profession, there are many different streams available, even for RTs from in hospital, to clinics, to home care. Patients safety and wellbeing should be the most important thought in our work. Giving patients respect, support and information should be on going.
    The best review in the COPD clinic is when the patient comes in, and asks for a hug, calls you by your name and remembers what you said and did for them. At the end of the day, my hours spent volunteering means they get the support they need. From a simple support I have been given so much more I return from them. It is very rewarding, even in sadness when they pass. We have family call to let us know how much they appreciate all the support we gave to their loved ones.

 

Thank you Sheery for your dedication and hard work!

*To the readers of this post, please continue to refer to the guidelines and medication pathways provided by the facilities/organization you work at.  The answers provided my Mrs. Tse is to provide perspective and is not to replace the protocols provided by your employer or RT governing body.

Here are some useful resources I came across:

-Canadian Thoracic Society.  https://cts.lung.ca/guidelines

–Alpha-1 antitrypsin deficiency targeted testing and augmentation therapy (2012)
https://cts.lung.ca/sites/default/files/documents/cts/1.%20FINAL%20A1AT%20GUIDELINE%20APRIL%202012.pdf

-Managing dyspnea in patients with advanced chronic obstructive pulmonary disease  (2011)
https://cts.lung.ca/sites/default/files/documents/cts/1.%20CTS%20COPD%20Dyspnea%20Guideline%202011%20EN.pdf

-Optimizing pulmonary rehabilitation in chronic obstructive pulmonary disease (2010)
https://cts.lung.ca/sites/default/files/documents/cts/CTS_COPD_Guidelines_Pulmonary_Rehab.pdf

 

-The Lung Association. Various PDF documents to study, to print and to share.  https://www.lung.ca/lung-health/lung-disease/chronic-obstructive-pulmonary-disease-copd/resources

 

-RTSO- COPD. https://lungontario.ca/disease/copd/

-Global Initiative for Chronic Obstructive Lung Disease . https://cts.lung.ca/sites/default/files/documents/cts/1.%20CTS%20COPD%20Dyspnea%20Guideline%202011%20EN.pdf http://goldcopd.org/wp-content/uploads/2016/12/wms-GOLD-2017-Pocket-Guide.pdf

 

Farzad ‘Raffi’ Refahi
Nov 15 2017

References:

-WHO. World Health Organization. COPD. Fact Sheet. November 2016.

http://www.who.int/mediacentre/factsheets/fs315/en/

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Working as an RT – Mieke Fraser

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  To share the views of an experienced RT for Respiratory Therapy Week, I reached out to Ms. Mieke Fraser.  I first met Mieke when she was one of  the supervising instructors for  Ventilation Lab during my studies at The Michener Institute.  I also ran into her at various professional development events including the latest Better Breathing and Canadian Network for Respiratory Care (CNRC) conferences.  She is passionate, caring and an authentic RT.  Her wisdom is built from years of experience, which includes but not limited to Mount Sinai Hospital and Bridgepoint Active Healthcare.  She is also in the process of getting ready for her upcoming talk at the CNRC National Respiratory Care and Education Conference in Calgary.  I asked Mieke what it means to her to be a respiratory therapist.  This is what she shared with us:

 

I was working with an enthusiastic and engaging RT student yesterday that brought to front of mind what it means to me, to be an RT:

First, it’s the moment of connection with a patient and then if I’m lucky, the building of a therapeutic relationship with the patient and their family. We are fortunate to be able to treat patients across the health care system.  I value being part of the team that helps patients with the most fundamental actions of life – their breathing.

Secondly, because I can make a human connection with them, and then help them with something as important as their breathing, I believe I can ease their suffering (maybe just a little or in some cases immensely).

We are a highly skilled and widely experienced profession.  As a brief example: in a given week, I could be optimizing ventilation for a patient in ICU, helping to protect lungs from injury and allow healing, recovery, and growth in NICU; providing treatment in the ED for patient with acute exacerbation of their chronic respiratory disease; providing education and facilitating greater self-management to that patient with chronic respiratory disease; counselling a patient towards smoking cessation; and, helping facilitate a peaceful death.

And finally, as a RT with a few years of experience, I value being able to share my experiences, my approach, my wisdom, my perspective, my skills and knowledge to the next generation of RTs.  Showing them how to assess a patient, to look at the details but also see the big picture, to make the differential list, to respectfully touch during assessment and treatments, to listen and connect with our patients, and so much more …

I am proud of the valuable role we have within a multi-disciplinary team, at times overshadowed by the larger-in-numbers presence of nursing and physicians.  I would have to say that those individuals – the patients and families – with whom we make that moment of connection know we are different, and maybe just a little bit special, for we intimately assist them with the most precious piece of their life – their breath.  For when you can’t breathe, nothing else matters.

Mieke
Mieke Fraser, BSc RRT CRE

Thank you Mieke for taking the time to share your thoughts with us!

Happy RT Week!

Farzad ‘Raffi’ Refahi
Oct 25, 2017
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PALS

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Last weekend, October 14th and 15th, I took part in the Pediatrics Advance Life Support (PALS) course.  This is a challenging and satisfying certificate which I look forward to every few years. Completion of PALS involves review and demonstration of various knowledge and skills as both a team member and as the lead.  There are many areas of individual growth in this certificate as health care providers (HCP) deal with a wide age range of patients, from neonatal to young adolescent.  Also, the topics covered include, but are not limited to, Systematic Assessments, Respiratory Distress and Failure, Bradycardia, Tachycardia, Cardiac Arrest, Shock (Hypovolemic/Distributive/Cardiogenic/Obstructive), and Post-Resuscitation Care.  Since many health concerns of children include respiratory components, PALS offers Respiratory Therapists a good chance to review their knowledge and skill-set.

Aside from the knowledge and hands on opportunities, there is a chance to work within inter-professional teams.  PALS helps HCP’s see scenarios from different angles and roles.  By better understanding the roles, team members can more effectively understand, anticipate and participate in the flow of patient care.

Reviewing the systematic approach in PALS is a mindset that can also be applied in adult populations and during Rapid Response Team assessments and interventions.  As a new graduate, one of my biggest challenges was attending to Rapid Response Calls.  The on-call Nurse and RT would reach the bed side first and would begin the quick assessment and at times, when appropriate, would initiate the required intervention even before the attending doctor would get there.  This certificate allowed me to better identify, organize and classify the available information, better narrow down the plausible causes, and provide better interventional care.

When compared to ACLS and NRP, PALS is usually not a required certificate in job postings, thus new graduates can better stand out when equipped with this qualification.  Even for RTs who have a few years of experience, completing this certificate can demonstrate a willingness and drive to learn and to improve.

This certificate is a useful asset and thus it is my personal recommendation to RTs and other HCPs to take their PALS.

 

Farzad Raffi Refahi
Oct 18, 2017
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Merci Christiane

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Ms. Christiane Menard is retiring from her position as the Executive Director of Canadian Society of Respiratory Therapists, after almost a decade of service (9 years).  As a thank you for her contributions to the respiratory therapy field, this blog post is dedicated to her.

The first time I met Christiane was at the 2016 Ottawa Conference.  Even as a relatively new respiratory therapist and a novice blogger, I was greeted with a big smile and a hug.  She is full of energy, passionate and is very driven.

From a quick glance at her career accomplishments you can see that Christiane’s dedication to excellence is evident.  Besides the position of Executive Director of CSRT, she held other positions such as the Communications Coordinator for Merck, Director with Society of Obstetricians and Gynecologists of Canada (overseeing Communications, Government Relations and Partnerships), and Director of Communications for the Canadian Association of Medical Radiation Technologists.

In 2017, she was the Honorary Lifetime Membership Recipient from CSRT.

I reached out to CSRT’s president, Mr. Jeff Dionne.  This is what he had to share about her:

When I think of Christiane, I think of a true visionary.  She took on the role as Executive Director for the Canadian Society of Respiratory Therapists during a time when things were quite unstable.  Our profession was going through an identity transformation; our membership numbers were steadily dropping, our impact within the RT community was dwindling, and our image as a national organization was blurry at best.  During her time as ED, we have witnessed numerous success stories emerge; from the Blueprint for Action for our profession in 2014, to our role in private practice, to the Anesthesia Assistant certification process, the CSRT is now a nationally recognized leader in the realm of professional association.  Not only have we seen our student memberships double, but we are also proud to say that we have well over 4,000 members in our association.  It has been through her tireless commitment and dedication for our profession that has placed us in such a positive situation for the years to come.  Thank you, Christiane.

 

I will share with you the brief conversation I had with Chriastiane.

  1. Looking back over the years as the Executive Director, what are some of the memorable moments that come to your mind that you can share with us?I have so many memorable moments and in each of these moments, it is the passion of the RT profession that was front and center.  Whenever I went to provincial meetings, I always tried to find out about RTs and to learn more about what they did and the projects in their region.  The most memorable moment was in 2014, I was in Vancouver for several meetings and on my way to the airport I accepted an invitation to visit the PROP program in Vancouver.  A young and most passionate RT named Esther Khor gave me the grand tour of her organization and it was the most amazing set up I have ever seen.  It was the first time, after working 40 years in the health care sector, that I saw an organization actually put in place a truly effective “patient centered approach” to care.  I immediately invited her and her patients to speak at the 2015 conference and I feel this was one of the most memorable presentation at a CSRT conference. 
  2. How has the RT field changed from your point of view?I see a profession that has gained a lot of confidence in their knowledge and clinical skills.  More and more RTs are working in less traditional roles like research, quality assurance, patient transport.  I am very proud of all the RTs who continue their education and keep building on their RT skills and knowledge.  Nine years ago, critical care was the most important area of practice.  Now we see more and more RTs working in community and home care.  Many RTs have entered a growing area of the health care that is most important – patient safety.  The profession constantly shows its versatility and ability to adapt to the changes required in the health care sector.  I have no doubt that RTs will continue to look for new applications of their skills and knowledge than any other profession. 
  3. What is next for you?I am retiring from being an Executive Director, but I love working.  I just feel I am no longer able to work at the Executive Director level and knew it was time to take a step back.  I plan to stay at CSRT in a lesser capacity for a number of months to support the transition of the new CEO.  I will then find some part-time work where I can still use my knowledge and skills.  As I will no longer travel for meetings, I look forward to attending more cultural events in Ottawa and going to the pool and gym more often. 
  4. What were some of the goals you set for yourself when you began as Executive Director and do you think you accomplished them?I had many objectives when I started – increase the CSRT membership, increase the number of participants at the CSRT conference, increase the income from sponsorship – and then I soon realized that none of these objectives could be achieved if we were not able to show the value of CSRT to our members and to our industry partners.  So I think we have achieved those objectives by showing value.  The most difficult objective to achieve had to do with the financial viability of the CSRT.  When I started in August 2009 we had absolutely no money in the bank … no money for rent, no money for payroll.  That was so overwhelming and I struggled with this for many years.  It took nine years, and inch by inch, we increased our financial stability.  This year is the first year that I feel we are on solid financial ground and that we do not have to borrow on the line of credit or on next year`s income to meet our financial commitments. 
  5. What are some words of advice for people in the industry who want to get more involved?Find something that is missing, something where you can make a difference, something that can be done better, and just do it!   If I look back at who has done just that I think of Jason Nickerson, who got involved in international health, not because of the money, but because there was a need and he knew he could make a difference.  Tom Piraino is another RT who saw a void in RT education with regards to the clinical applications of ventilation and he got involved in increasing knowledge and understanding in his institution, at the provincial level, at the national level and at the international level.  It just takes effort, constant effort, and you can achieve everything by doing an inch at a time, one step at a time.  The secret is to not get discouraged by hurdles … anyone can build a mountain one spoonful at a time! 
  6. What are some of the challenges you see in the future for RT’s and how can we as practicing RT’s prepare for those challenges?
    The biggest challenge for the RT profession is keeping up with the complexity of the health care sector.  As the health care sector always seems to be in transition, the RT profession will also continue to be in a transition and there is no way to go but forward and learn more complex clinical applications.  I do feel that the RT profession has been very quick to adapt to changes that have occurred in the past and I have no doubt that RTs will continue to increase their knowledge and clinical skills. RTs will surpass any challenge and will move forward where they are most needed and where they can make the most difference in the respiratory care of their patients.
     
  7.  Any final thoughts?
    My final thoughts ….I am so grateful that my last full time job was with the CSRT and that I had the privilege to have the trust and support of the RT profession who so generously shared their passion with me.   I can brag that my last job, after working in the health care sector for over 45 years, was the best ever!  Not many people brag about their job when they retire, but I do !

I want to thank Christiane for her dedication to our industry and for taking the time to speak with me.

 

Resources:
-Image: https://www.linkedin.com/in/christiane-menard-3946a140/detail/photo/

-Thank you to Carolyn McCoy and Jeff Dionne for taking the time to help me  with this article.

Farzad ‘Raffi’ Refahi HBSc RRT

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