New Jersey Respiratory Associates supports Skilled Nursing Facilities in effectively managing their pulmonary patient populations. Our comprehensive clinical services include respiratory therapy visits, 24/7 respiratory support, educational initiatives, and assistance with program development. This protocol outlines the procedures for ordering and managing respiratory therapy visits. NJRA provides specialized respiratory care for residents with:
Obstructive Sleep Apnea (OSA)
Non-Invasive Ventilation (NIV) requirements
Tracheostomy care needs
General respiratory conditions requiring consultation
OSA and NIV Cases
Overview
Our company policy addresses the typical profile of Positive Airway Pressure (PAP) patients admitted to SNFs. Most use devices such as CPAP, BiPAP, AutoPAP, BiPAP ST, or Trilogy for non-invasive ventilation due to a recent or recurring Chronic Obstructive Pulmonary Disease (COPD) exacerbation, often secondary to undiagnosed OSA. Given that many of these patients are new to PAP therapy and rely on it to manage their CO₂ levels, we aim to ensure effective usage and compliance. Without compliance, there's a high risk of readmission due to hypercapnia. Therefore, we closely monitor these patients to promote adherence to their therapy. We recognize that each patient's situation is unique. For stable and fully compliant patients, we limit our intervention to an initial assessment or an assessment with one follow-up within a month, depending on the patient's needs.
Standard Orders
Initial Assessment: Residents requiring PAP devices will receive an assessment by an NJRA respiratory therapist within 24 hours of admission.
Customized Follow-Up: The therapist will recommend the frequency of follow-up visits based on the resident's status and compliance level.
Physician Approval: Recommendations will be discussed with nursing staff, who will then obtain physician approval for the orders.
Common Practice: Typically, the respiratory therapist will follow up weekly for six weeks.
Scaling Back Visits: After six weeks, visits may be reduced to every other week or monthly, depending on the resident's progress.
Non-Compliance: Residents determined to be non-compliant with their PAP therapy by nursing staff or the respiratory therapist may receive a recommendation to discontinue the use of their PAP device, pending physician approval. If the physician decides to continue PAP therapy, NJRA will reduce the frequency of visits but will continue to focus on compliance-building exercises during each session to encourage adherence to the therapy.
Tracheostomy Cases
Overview
Residents with tracheostomies will receive an assessment by an NJRA respiratory therapist upon admission. The therapist will recommend the frequency of follow-up visits based on the resident's condition and needs.
Standard Orders
Initial Assessment: Conducted upon admission by an NJRA respiratory therapist.
Customized Follow-Up: Recommendations for follow-up visits are made based on the resident's status.
Common Practice: Typically, the therapist will follow up once a week for six weeks.
Scaling Back Visits: After six weeks, visits may be reduced to every other week, depending on the resident's progress.
General Respiratory Consults
Overview
Physicians and nurses may request NJRA to provide respiratory consults for residents experiencing pulmonary events or requiring additional respiratory support. This includes residents with conditions such as COPD, pneumonia, or other respiratory ailments.
Standard Orders
Case-by-Case Assessment: Each resident is evaluated individually by an NJRA respiratory therapist.
Common Recommendations: May include incentive spirometry, deep breathing exercises, chest physiotherapy, or other therapeutic interventions.
Follow-Up: NJRA may continue to follow up with the resident as needed over a specified period, usually around three weeks.