Cardiopulmonary

6. CARDIOLOGY-PULMONARY STAFF
6.1 SECTION HEAD
6.1.1 Professional Preparation
6.1.1.1 Must be licensed physician of the Philippines under RA
1080
(with current PRC medical doctor license).
6.1.1.2 Should be a diplomate/ fellow of the Specialty and
Subspecialty
Society of good standing.
6.1.1.3 Should be a member of the accredited specialist
Philippine health
insurance.
6.1.2 Responsibilities
6.1.2.1 Performs quality patient care.
6.1.2.2 Has authority to execute hospital and section
policies and
guidelines.
6.1.2.3 Maintains the hospital standards and quality.
6.1.2.4 Coordinate with all the visiting and active
consultant.
6.1.2.5 Exercise administrative and operational duties.
6.1.2.6 Make the over-all administrative decisions and
planning.
6.1.2.7 Supervise all the cardiology staff and consultants.
6.1.2.8 Attend and participate in the clinical heads and
meeting activities.
6.1.2.9 Coordinate with the all staff concern and
suggestions for the
benefit of the cardiology
unit.
6.2 ACTIVE CONSULTANT
6.2.1 Professional Preparation
6.2.1.1 Must be a licensed physician of the Philippines under RA
1080
(with current PRC license medical doctor license.
6.2.1.2 Should be a diplomate/ fellow of the Specialty and
Subspecialty
Society of good standing.
6.2.1.3 Should be a member of the accredited specialist
Philippine health
insurance
6.2.1.4 Be recommended favorably by the section, Department
and
Hospital Credentials Committee
.
6.2.2 Responsibilities
6.2.2.1 Should use the available ancillary hospital
services.
6.2.2.2 Should attend 80% of the Section and Department
services.

6.2.2.3 Be willing to teach or educate the cardiology staff

6.2.2.5 Able to attend and be a resource speaker or reactor in
any hospital
conference once he was invited.
6.2.2.6 Willing to rotate as Cardio consultant of the month as
attending
physician of the service patients.
6.2.2.7 An active consultant who fails to meet the prescribed
requirements
in a year period
a. Removed from the 24 hour duty rotation in the
Department of Medicine.
b. Will be listed from the active consultant in the
Department of Medicine.
c. Preventing to be listed in decking schedule.
6.2.2.8 An active consultants who fails to meet the prescribed
requirements in second year.
a. The consultants will be dropped from the rooster
of
active consultant staff.
6.2.2.9 Re-appointment of active consultant is done yearly.
6.3 VISITING CONSULTANTS
6.3.1 Professional Preparation
6.3.1.1 Be licensed physician of the Philippine under RA 1080
(with current
PRC medical doctor license).
6.3.1.2 Be diplomate/ fellow of the Specialty and Subspecialty
Society of
good standing.
6.3.1.3 Be a member and accredited specialist of the Philippine
health
insurance.
6.3.1.4 Be recommended favorably by the Department and
Hospital
Credentials Committee.
6.3.2 Responsibilities
6.3.2.1 Utilize the ancillary service of the hospital
6.3.2.2 Adhere to the existing rules and regulations of the hospital and
endoscopy unit.
6.3.2.3 Attend at least 50% of the Unit and Departmental activities.
6.3.2.4 Re-appointment is done every 2 years.
6.4 CARDIOLOGY NURSE
6.4.1 Professional Preparation
6.4.1.1 Be a registered nurse in the Philippines with special
training in cardiology procedures
6.4.1.2 Possess a degree of Bachelor of Science in Nursing with at
least 6
months of relevant experience in cardiology
procedure.
6.4.1.3 Possess genuine interest and concern to work, have a
good moral
character and with good interpersonal
relationship with the patients
and other members
of the hospital teamwork.
6.4.1.4 Must be punctual at all times.

6.4.2 Rules of Conduct:

6.4.2.1 To observe proper decorum and wearing ID at the
endoscopy unit
at all times.
6.4.2.2 Behave professionally and any misbehavior or unethical
conduct
will subject for suspension and
termination of contract (see
hospital code of
conduct of
employee).
6.4.3 Responsibilities:
6.4.3.1 To assist in the cardiologist with efficient and outmost
professional
care
6.4.3.2 To get vital signs (Blood Pressure, Pulse/ Heart Rate,
Respiratory
Rate, Temperature) of the patient
before and after the procedure;
6.4.3.3 To carry out all orders of the Cardiologist
6.4.3.4 Responsible for the overall supervision of the cleanliness
of the
cardiology-pulmonary unit.
6.4.3.5 Accountability of the cardiology nurse of the different
equipment
in the cardiology unit.
6.4.3.6 To ensure that the policy is implemented
.
7.1 Stress test machine GE carestream Windows Based OS regular paper
printing (ink
jet
7.2 2D Echo Machine Philips iE33 or Siemens Sequola TDI TEE capable
7.3 Venous Arterial Carotid & Transcranial Duplex Scan Machine: Philips iu 22
7.4 ECG Machine GE mac 5500 MC 5500
7.5 Holter Machine: GE seerlight/ Rozinn Model RZ 153 + digital holter
recorder
7.6 Ambulatory BP monitoring device
7.7 Myocardial Perfusion Imaging; Brand Siemens, Model: Symbia S, Type:
Dual
7.8 BP Apparatus
8. MATERIALS/ SUPPLIES
8.1 ELECTROCARDIOGRAM (ECG/EKG)
ECG paper, Cotton balls and alcohol, Face mask, Tissue paper,
gel
8.2 AMBULATORY BP MONITORING
Cotton balls and alcohol, tissue paper and gel if needed.
8.3 TREADMILL EXERCISE STRESS TEST
Treadmill exercise test paper, cotton balls with alcohol and
electrodes.
Face mask and gel if needed
8.4 24-HOUR HOLTER MONITORING
Electrodes, micropore and holter diary. Face mask and gel if
needed.

Face

8.5 2D-ECHOCARDIOGRAPHY AND DOPPLER STUDY

Electrodes, DVD, ultrasonic gel, tissue paper, and 2D-Echo form.
mask if needed.

Venous

8.6 PERIPHERAL VENOUS DUPLEX SCAN

DVD, ultrasonic gel, tissue paper, clean gloves and Peripheral
Duplex Scan form. Face mask if needed.

Arterial

8.7 PERIPHERAL ARTERIAL DUPLEX SCAN

DVD, ultrasonic gel, tissue paper, clean gloves and Peripheral
Duplex Scan form. Face mask if needed

9. FORMS
9.1 ECG form
9.2 Peripheral Venous Duplex scan form
9.3 Peripheral Arterial Duplex scan form

1. PURPOSE
The aim of Heart and Lung Unit is to have a standard method to be followed by
the Cardiologists/ Pulmonologist/ Therapist in giving procedures/ treatments and
tests.
To establish and operate a Heart and Lung Unit where patient at the hospital, inhouse consultants, and those referred by other (outside) physicians can be taken
cared of as on an out-Patient basis serving Heart and Lung procedures/
treatment.
2. SCOPE
The Heart and Lung Unit will encompass an outpatient clinic for treating patients
scheduled for Electrocardiogram (ECG), 2D-Echocardiography, 24 Hour Holter
Monitoring, Treadmill Exercise Stress Test, Ambulatory BP Monitoring, Peripheral
Venous and Arterial Duplex Scan, Arterial Blood Gas Extraction, Incentive
Spirometry, Pulmonary Function Test, Peak Expiratory Rate, Pulse Oximetry,

Inhalation Therapy, and Chest Physiotherapy .that are done in a non-admitted

set up.
The areas covered include from Central Registration (names enlisted in the
bizbox before consultation & rendering procedure/ treatment), Cashier (settles
their bills after registration), Heart and Lung Unit ( render consultation and noninvasive diagnostic are done), up to their discharge.
3. POLICY
It is the policy of the Fe Del Mundo Medical Center (FDMMC) Heart and Lung Unit
to:
3.1. GENERAL POLICIES
3.1.1 Pulmonary Unit provides pulmonary services twenty four (24)
hours a day
for In-patients and Out-patient.
3.1.2 The Pulmonary Unit is open from Monday to Sunday.
3.1.3 The Respiratory Therapist are scheduled in three (3) shifts;
6:00 A.M. 2:00 P.M.
2:00 P.M. 10:00 P.M.
10:00 P.M. 6:00 A.M.
3.1.4 The Pulmonary Unit is composed of Section Head, Supervisor, and Respiratory
Therapist.
3.1.5 All pulmonary services are done according to doctors written order and/ or
request.
3.1.6 Services and process involved in the unit are as follows:
3.1.6.1 Rendering treatment - Inhalation therapy, oxygen therapy, chest
physiotherapy, ventilation therapy, and incentive
spirometers
3.1.6.2
Test for in- and out-patients - ABG, PFT, and PEFR
3.1.6.3
Charging of bills for In-and Out-patients
3.1.6.4
Requisition or Inventory of Supplies and solutions.
3.1.7 The Pulmonary staff administer medication (inhalation therapy) only on the
order
of a license physician for a specific patient. All s such orders shall be in
writing
and signed by the person when giving the order. All Pulmonary Staff
should be aware of the action and untoward reaction of the medicine they
administer. All
medicines are available at Pulmonary Unit.
3.1.8 All medication orders must include the name, exact dosage and frequency of
treatment. Pulmonary Staff has the duty to question the order if it is unclear or
seems inappropriate. To promote accuracy and consistency in giving
treatment to patient the following scheduled has been suggested:
OD 9AM
Q6 12AM/12PM/ - 6AM/6PM
TID 9AM. 1 PM 5 PM
Q8 6AM 2PM 10 PM
QID 8AM 12NN 4PM 8PM
Q12 9AM 9PM
Q4 1AM/1PM 5AM/5PM 9AM/9PM
3.1.9 Stat request examination or procedure are done on urgent cases, the result
shall
be released immediately after the procedure. The following are
considered STAT
request:
3.1.9.1 All pulmonary results needed immediately.
3.1.9.2
All results needed before releasing time.
3.1.9.3
All NOW request.

3.1.9.4 All request from critical areas like Intensive Care Unit
(ICU/PICU/NICU)
3.1.9.5 Operating Room and Emergency Room. During Code shall be
considered STAT.
3.1.10 For equipments repair:
3.1.10.1 Do not use malfunctioning equipment. Make all necessary repairs, or
ask an
authorized representative for servicing.
3.1.10.2 After repair, test the equipment to ensure that it is functioning
properly, in accordance with the manufacturers published specifications.
3.1.10.3 To ensure full reliability, have all repairs and service done by an
authorized representative. If this is not possible, replacement and
maintenance of parts should be performed by a competent, trained individual
with experience in repair, and appropriate testing and calibration equipment.
3.2 SPECIFIC POLICIES
3.2.1. Rendering treatment or test for In-and Out-patient
3.2.1.1 The Respiratory Therapist shall receive request from the system.
Respiratory Therapist shall verify the doctors order in the chart regarding the
ordered examination
(for In-patient). For Out-patients, the Respiratory
Therapist determine the doctors
signed request for the test/ procedure.
Patient will be scheduled for the said request/s.
The
Respiratory
Therapist
advises the patient to enroll at the registration.
3.2.1.2 Respiratory Therapist-on-duty ensures timely delivery of treatment to
patients.
3.2.1.3 Out-patients with pulmonary request are attended on first come first
serve basis except on emergencies.
3.2.1.4 No treatment or test is done without written request.
3.2.1.5 Respiratory Therapist make sure that they can comply with doctors
order by reviewing the patients chart and/ or doctors written request for
confirmation of the requested test or treatment.
3.2.1.6 Respiratory Therapiston-duty does calibration of ABG machine
and PFT machine every morning or as required prior to performing the
requested tests.
3.2.1.7 Respiratory Therapist-on-duty will monitor all oxygen set-up and
oxygen delivery devices as well as ventilators. Oxygen and ventilator rounds
are done every four (4) hours.
3.2.2 Charging of bills for In-and-Out patients
3.2.2.1 All items and supplies used during the patients procedures shall be
charged accordingly.
3.2.2.2 Cost of procedures vary according to the In-patients or Out-patients
status. In-patients rates will vary according to room accommodation.
3.2.2.3 Spirometry or PFT of all In-patients and Out-patients including those
under HMO, must be charge with a readers fee unless otherwise specified
on the request of the Attending Consultant
3.2.2.4 Data from charge slips shall be entered in a logbook and must be
signed by the receiving staff or personnel.
3.2.2.5 Respiratory Therapist-on-duty prepares charge slip for out-patient
and payment is made at the cashier by patient or relatives.
3.2.2.6 Patients senior citizen ID or PWD ID must be presented to
Respiratory Therapist-on-duty prior to charging process.

3.2.2.7 Out-patients shall present and provide a copy of official receipt to

Respiratory Therapist-on-duty before ordered procedure is done.
3.2.2.8 For HMO patients, Letter of Authorization (LOA) shall be presented to
Respiratory Therapist-on-duty prior to rendering of procedure. LOA should
bear the printed name and signature of the authorized representative.
3.2.3. Requisition and Inventory of supplies and solutions
3.2.3.1 The Respiratory Therapist is responsible for monitoring and ordering
supplies, reagents and solutions from pharmacy or purchasing department
for the unit.
3.2.3.2 Procurement of supplies is on weekly basis or before reaching 50% of
its stock level, whichever comes first.
3.2.3.3 The unit maintains listing of supplies in the supplies log book or
folder. All Respiratory Therapist are accountable for all stored medical
supplies and solutions.
3.2.3.4 A monthly or quarterly inventory report is logged and submitted to
purchasing department.
3.2.4. Maintenance of Pulmonary Equipment
3.2.4.1 Cleaning
3.2.4.1.1 Pulmonary Staff clean and disinfect machines and
equipment (pulse
ox, nebulizers, ABG machines, ventilators, percussor, and others)
thoroughly after each use.
3.2.4.1.2 The manufacturers recommendation for cleaning shall be
complied with.
3.2.4.1.3 Each machine shall be allowed to dry completely in clean,
dry and sanitary.
3.2.4.2
Storage
3.2.4.2.1 All machines shall be stored in clean and dry and sanitary
location and protected against extremes in temperature, excessive
moisture, damaging chemicals sunlight and dirt.
3.2.4.3 Maintenance and Repair
3.2.4.3.1 Only the manufacturers authorized/ approved replacement
parts will be utilized manufacturers parts will not be interchanged unless the
parts are listed as a substitute by the original manufacturers.
3.2.4.3.2 All defective parts shall be replaced.
3.2.4.3.3 The manufacturers recommendation for repair and
maintenance
work shall be complied with.
3.2.4.3.4 Only those property trained or certified by the manufacturers
shall be allowed to conduct repair or maintenance work on the
machine/
equipment
3.2.5 Physicians Telephone or Verbal Order
3.2.5.1 A Respiratory Therapist is obligated to carry out a Physicians order
except when the therapist believes an order to be inappropriate.
3.2.5.2 A Respiratory Therapist carrying out an inaccurate order may be
legally
responsible for any harm suffered by the patients.
3.2.5.3 The Respiratory Therapist should clarify with the Nurse-on-duty or the
Physician any unclear and/ or inappropriate order.
3.2.5.4 The respiratory Therapist should follow specific guidelines for
telephone/
verbal orders:
3.2.5.4.1 Date and time entry

3.2.5.4.2 Repeat the order to the physician and record the order.
3.2.5.4.3 Sign the order; begin with t.o (telephone order), write the
Physicians name, and then sign the order.
3.2.5.4.4 If another nurse witnessed the
order, the nurses signature
follows.
3.2.5.4.5 The Physician needs to counter sign the order within a time
frame
according to FDMMCs policy. The timeframe is within an
hour up to twenty four
24 hours.
3.2.5.5 The Respiratory Therapist should ensure that all components of
a
medication order are documented. Components of a medication order:
3.2.5.5.1 Date and time of order was written
3.2.5.5.2 Medication time
3.2.5.5.3 Medication dosage
3.2.5.5.4 Frequency of medications
3.2.5.5.5 Physicians or health care providers signature.
3.2.5.6 The Respiratory Therapist should carry out immediately if
accurate and
proper and no discrepancy with the orders being given. All Physicians
order must carried out within an hour to the most and all
emergency or STAT
orders must be carried out at once.
3.3. ADMINISTRATIVE GUIDELINES
3.3.1 Mechanical Ventilation and Weaning
3.3.1.1 The Mechanical Ventilators for Adults, Pediatrics, and Neonates are
available at the Pulmonary Unit, Ventilator set-up, hooking, monitoring,
change of tubing and troubleshooting are performed by the Respiratory
Therapist.
3.3.1.2 The necessary charges will be made once a particular ventilator unit
has been brought out to the ICU or NICU with a corresponding Physicians
order regardless whether the said machine was hooked to the patient or not.
3.3.1.3 If the Mechanical Ventilators are on a standby or reserved, a
corresponding charge will be made on a daily basis particularly if the
ventilator is at the ICU, NICU or PICU.
3.3.1.4 The Pulmonary Unit discourages manipulation of mechanical
ventilators by unauthorized personnel.
3.3.1.5 Weaning methods available are SIMV mode, ASV mode, PSV mode, Tpiece and Spontaneous Breathing Parameters.
3.3.2 Arterial Blood Gas (ABG)
3.3.2.1 Request for In-Patient procedures
3.3.2.1.1 The Attending Physicians request for ABG is in the chart
stating
the specific condition at which the ABG will be taken as well as
the time
the test should be taken.
3.3.2.1.2 Condition should be specific and stated clearly (if the
patient is
at room air, nasal cannula, oxygen mask, tracheostomy,
Fio2, tidal
volume, respiratory rate, PRRP, Pressure support,
mode of mechanical
ventilator, or in T-piece, tracheostomy, etc.).
3.3.2.1.3 The Nurse will fill-up the designated forms bearing the
patients
data including: name, age, sex, date and time to be taken,
condition and

position of the patient. The Pulmonary Unit will be informed of the

request and the Respiratory Therapist will proceed to the
patients room
for blood extraction.
3.3.2.1.4 The Nurse and the Respiratory Therapist should ensure that
the
desired setting is correct and should be in placed at least thirty (30)
minutes prior to extraction. If the desired setting is not in place, the
Respiratory Therapist will make the necessary
corrections and will
extract
blood after thirty (30) minutes. Initial results will be relayed to
the Nurse
station.
3.3.2.1.5 If the results are deemed incorrect or in doubt, the
Physician can request for repeat ABG free of charge provided, it
is
done within 15 minutes of receipt ot results. Repeat
request can be
done only once.
3.3.2.2
Request for Out-Patient (OPD) Procedures
3.3.2.2.1 A request form will be filled up by the Physician, stating the
specific condition at which the ABG will be taken. Condition
should be specific and stated clearly (if the patient is at room air, nasal
cannula, oxygen mask,
tracheostomy, Fio2, tidal volume, respiratory rate,
PEEP, Pressure support, mode of mechanical ventilator, or in T-piece, etc.)
and the patients data
including: name, age, sex, date and time to be taken, condition and
position of the patient. The patient will be instructed to proceed to
Pulmonary Unit, where
the blood will be extracted. After the procedure, the
copy of the initial results will
be given to the patient.
3.3.3 Pulmonary Function Test (PFT)
3.3.3.1 For both In-Patient and Out-Patient, the patient will be instructed to
withhold all inhaled and oral medicine including: Beta2 Agonist (6 hours for short
acting and 12
hours for long actin). Then a request form should be filled up
bearing the Patients data including: name, age, sex, height, weight, diagnosis of
the patient. And in addition, all current medication should be informed of the
request.
3.3.3.2 If the patient has taken such medication prior to actual procedure, the
Respiratory Therapist should notify the patients Attending Physician to verify
whether to proceed or to forgo the examination. The PFT procedure is available
from Monday to Saturday from 9:00 A.M. to 5:00 P.M. Official
results will be
given after three (3) working days but the initial unofficial result can be given to
the patient, if he/ she requested a copy.
3.3.4 Inhalation Therapy
3.3.4.1 Request for In-Patients Procedure
3.3.4.1.1 Treatment request for In-Patients should be properly filled
up bearing the patients data including: name, age, sex,
patients
condition, an other particulars such as
medication, dosage, and frequency
must be stated clearly.
3.3.4.1.2 The Pulmonary Unit suggests that the treatment time be
specified by the Attending Physician. Whether treatment
time be done on
waking hours or pulmonary treatment time.
If the Attending Physician
requested that the treatment
should be done during waking hours no
treatment shall be
performed after 10:00 P.M. and it shall commence at
5:00
A.M., the following day to give patients enough time to rest during

the night. Considering these, the Pulmonary Staff will fill up a

medication
sheet, and indicate the name of the Respiratory
Therapist-on duty, date,
time, and specific medication given.
Inhalation therapy will be given
based on initial order unless the
doctor will revised the treatment time. If
the patient refused
the treatment, the Pulmonary Staff should inform the
Nurse-on-duty of Medical Residence-on-duty.
3.3.4.1.3 In Pediatric treatment, nebulization will be done after the
Pediatric resident doctor on duty has made an
assessment of the patient
and will inform the Respiratory
Therapist to proceed the treatment.
Respiratory Therapist will
not proceed with nebulization if the Attending
Physician or
the Doctor-on-duty has not given any signal to go ahead with
procedure.
3.3.4.2
Request for Out-Patient Procedure
3.3.4.2.1 Pediatric nebulization will undergo the same procedure. All
charges will
be covered through the proper office.
3.3.5 Peak Flow Expiratory (PEFR)
3.3.5.1 All request for PEFR determination should be properly filled up bearing
the patients data including: name, age, sex, height, weight, and frequency of
determination.
Upon receiving the request, the Respiratory Therapist will
proceed to the patient to
perform the test. PEFR determination and
monitoring will be done before and after the
bronchodilator use unless
specified by the Attending Physician.
3.3.6 Chest Physiotherapy
3.3.6.1 The Respiratory Therapist utilizes either manual or mechanical
method
perscussion for patients with thick retained secretions. And it must be
done after doing inhalation.
3.3.7 Incentive Spirometry
3.3.7.1 Given for pre and post operative patients, to prevent lung collapse or
atelectasis. Timing and frequency of the procedure should be specified
by the Attending Medical Doctor.
3.3.8 Pulse Oximetry
3.3.8.1 Pulmonary Unit have pulse oximeter. It measures oxygen saturation in
the body and pulse rate of the patient. No reservations shall be made, strictly first
come first serve basis.
4. MATERIALS/ SUPPLIES
Medical supplies, medical equipment
5. RESPONSIBILITIES
Section Head administrative function, responsible for evaluation of staff
(Respiratory
Therapist)
Supervisor Takes responsibility in the supervision of pulmonary staff in all aspects
of work and or services and prepares work schedule.
a. Represents the section in hospital meetings.
b. Trains newly hired Respiratory Therapist

c. Monitors functionality of different pulmonary equipments and reports to the

section Head if there is anything malfunctioning.
d. Responsible in the procurement and monitoring of pulmonary supplies and
reagents.
e. Checks and calibrates pulmonary equipments.
f. Maintains orderliness and cleanliness of the Unit.
g. Performs other tasks that may be assigned by the immediate superior.
h. Maintaining appropriate surveillance of working conditions of the machines.
i. Assuring that subordinates comply with the requirements of this policy.
j. Proper knowledge which shall include proper use of equipment and cleaning
techniques
Respiratory Therapist responsible for his/ her assigned duties.
a. Administer therapeutic gas via oxygen delivery system such as nasal
cannula, oxygen mask (simple, partial, non-rebreathing mask), venturi, etc.
b. Administer aerosol drugs with the use of nebulizers as well as as in-line from
mechanical ventilated patient.
c. Performs chest physiotherapy, chest percussion, vibration (manual or
mechanical), postural drainage.
d. Educates patients with breathing exercises, proper cough maneuver.
e. Instruct patients for lung expansion therapy with the use of INCENTIVE
Spirometry.
f. Perform extraction for Arterial Blood Gas (ABG) analysis and interpretation.
g. Administer respirator to patients needing Ventilatory support to include
troubleshooting and routine ventilator rounds every two (2) hours.
h. Administer respirator to patients needing Ventilatory support.
i. Determine Spontaneous Breathing Parameters, Positive Expiratory Flow Rate,
and Pulse Oximetry.
j. Assist the Physician in weaning the patients from mechanical ventilator.
k. Observe and evaluate immediate response and reaction of patients
undergoing ventilator therapy
l. Perform and assist the patient during Pulmonary Function Test: Simple
spirometry with or without bronchodilator/ bronchoprovocative test.
m. Assume responsibility for proper functioning and care of respirators and other
respiratory equipment
n. Assume responsibility for proper disinfecting and sterilization of all respiratory
equipment. Perform other duties that may be assigned from time to time.
All Pulmonary Personnel shall be responsible for:
a. Using the equipment properly.
b. Making sure that all equipment are functioning and in good condition.
6. DEFINITION OF TERMS
Heart and Lung Unit - the unit wherein all non-invasive diagnostic examinations
are
done
.
Central Registration - wherein the patient needs to be enlisted into the system
before consultation and rendering the examination
Cashier the person with whom the patient settles their bills after registration.

Mechanical Ventilation a method to mechanically assist or replace spontaneous

breathing.
Weaning a process/ gradual withdrawal from ventilator support
Arterial Blood Gas (ABG) evaluate acid base status, ventilation and arterial
oxygenation.
Pulmonary Function Test (PFT) group of test to measure lung volume and capacity.
Incentive Spirometry (IS) a method of encouraging voluntary deep breathing.
Peak Expiratory Flow Rate (PEFR) a test that measure how fast a person can
exhale.
Inhalation Therapy various method of treatment that work when you inhale.
Chest Physiotherapy a technique used to mobilize or loose secretions in the lungs
and the respiratory tract.
RT Respiratory Therapist
7. REFERENCE DOCUMENTS
Guidelines on Assessment and Treatment of Patients with Special Need
Policy and Procedure on Patient Evaluation eport
Policies, Rules and regulations on Release of Hospital records
8. PROCEDURE
8.1 The RT shall receive request from the system. RT shall verify the doctors order
in the chart
regarding the ordered examination (for in patient). For out patients, the RT shall
determine the
doctors signed request for the test/procedure. Patient will be scheduled for the
said request/s.
The RT advises the patient to enroll at the registration section.
8.2 The RT shall prepare the equipment needed. Refer to Pulmonary Unit work
instructions on
preparation of equipments. Procedures that can be done both in patients room and
at
Pulmonary Unit includes aerosol therapy, chest physiotherapy and incentive
spirometry.
Mechanical ventilation is done only at IMU while pulmonary function test shall be
done at the
Pulmonary Unit.
8.3 The RT shall wash hands and apply necessary/needed isolation/ precaution
barriers.

8.4 For In- patients, RT identifies the patient through patients acknowledgement of
name and
patient ID band.
8.5 The RT shall introduce self and his/ her department. He/ she shall explain the
procedure and the purpose of the procedure and verify if the patient understood
the
given explanation.
8.6 For out- patients,
8.6.1 The RT shall verify patients name and check the doctors request.
8.6.2 The RT shall sit the patient comfortably in the unit and respect
patients
privacy and dignity.
8.6.3 The patient shall sign consent form.
8.7 The RT shall assess and monitor vital signs of the patient and shall verify for
indications, contraindications or possible hazards of the procedure. If the blood
pressure is more than 140/ 90 mm Hg, the respiratory therapist shall inform the
nursing staff to notify the attending physician for clearance prior to performing the
required procedure. For out
patients, the procedure is deferred unless the
patient presents clearance from the attending physician.
8.8 The RT shall perform the required procedure. Refer to work instructions
regarding
procedures.
8.9 In the event of sudden change of patient status during the procedure, such as
but not
limited to the following:
8.9.1 Abrupt increase or decrease of vital signs to as much as 20% of the
baseline
8.9.2 Sudden headache, chest pain, hemoptysis, or sharp body ache,
decreasing level
of consciousness. The RT shall discontinue the therapy
and refer the event to the
Attending Physician and / or Resident on Duty
immediately.
8.10 After the procedure has been performed, the RT shall re-assess general
condition of the patient.
8.11 The RT shall educate the patient and his/ her family members regarding the
procedure and record it in Health Education Acknowledgement Form. Patient/
relative shall sign in
the acknowledgement portion of the form.
8.12 The RT shall wash hands and dispose off used materials in the appropriate
disposal bins. Rinse the materials used (e.g Neb Kit, mouth piece for IS) with water
and air dry before repacking in the plastic.
8.13 The RT shall post and record the procedure done to the patient in Pulmonary
Unit Patient Chart and RCD Patient Logbook. And make appropriate endorsement.
8.14 The RT shall hand out to patient/ relative Patient Evaluation Form and shall
collect it before the patient/ relative leaves RCD. Refer to Patient Survey Form
Policy and Procedure.
8.15 For PFT:
8.15.1 The RT shall forward the Pulmonary Function Test print out (PFT) to the
Pulmonologist for interpretation.
8.15.2 The RT shall transcribe correctly the interpretation made by the
Pulmonologist in the Pulmonary Unit Official Result form.
8.15.3The RT shall file PFT result by date in a folder.

8.15.4 The RT shall issue the official result to the requesting party. As
evidence that the requesting party received the official result, receiving party shall
acknowledge by signing in the logbook.
8.16 All information in the RCD Patient Chart and RCD Patient Logbook must be
kept confidential as per Policies, Rules and Regulations on Release of Hospital
Records.
8.17 Maintenance of Equipment:
8.17.1 Daily endorsement of machine and equipment as part of maintenance.
8.17.2 Machines or equipment that are found defective should be reported
immediately to the Engineering Department. The staff from engineering
will check/ assess the machine, they will make a
recommendation forwarded to
Purchasing Department to coordinate to the supplier.
8.17.3 Instructions from the supplier to follow in Cleaning Respiratory
Therapy
Equipment:
8.17.3.1 Personnel responsible for cleaning the equipment should
be instructed
in proper handling methods necessary to
reduce the risk of infection and reduce
contamination
of
the
cleaning area.
8.17.3.2 Manufacturers recommendations for equipment disassembly,
cleaning,
pasteurization, and sterilization should be followed.
8.17.3.3 All equipment should be thoroughly washed and rinsed before
attempting pasteurization or sterilization. Debris interferes with the
action of
pasteurization and sterilization.
8.17.3.4 The exterior surfaces of large pieces of equipment
(Ventilators, PFT
Machines, ABG Machines, Portable Suction Units,
IPPB Machines, End Tidal
CO2 Monitor) should be cleaned and
disinfected between patients.
8.17.3.5 All equipments should be covered when not in use.
9. FORMS
Health Education Acknowledgement Form

A. ADMINISTRATIVE POLICIES

The Heart and Lung Unit can be used by all affiliated physicians, of
FDMMC provided they are able to comply with all the requirements
of the FDMMC to be submitted to their department and approved by
the respective chairman.

The chairman of Heart and Lung Unit is an active affiliated

Cardiologist of good
medical standing and should be appointed
by the Medical Director of the FDMMC upon recommendation of the
chairman of the Department of Medicine. He/ she must be a
certified Fellow of the Philippine College of Physicians, and Fellow
of Philippine Heart Association/ Philippine College of Cardiology.

The Co-Chairman of Heart and Lung Unit is an active affiliated

Pulmonologist of good medical standing and should be appointed by
the Medical Director of the FDMMC upon recommendation of the
chairman of the Department of Medicine. He/ she must be a
certified Fellow of the Philippine College of Physicians and Fellow of
the Philippine Society of Pulmonary Medicine.

All regular or non-critically ill patients in the floor/ unit should be

seen within twenty four (24) hours from admission or referral and
should make daily rounds and must put entry to chart every visit.

All Intensive Care Unit (ICU) or emergent cases should be seen

within twelve (12) hours from admission or referral and should
make more than once daily rounds as necessary and must put entry
to chart for every visit.

All long standing/ status quo patients may be seen in less than
once daily if no new or active medical attention is needed and only
waiting to be discharged from the hospital due to non-medical
reasons or other hospital policy issues.

The cardiovascular diagnostic procedures will be officially read only

by affiliated Cardiologist and he/ she must be a certified Fellow of of
the Philippine College of Cardiology.

The pulmonary diagnostic procedures will be officially read only by

affiliated Pulmonologist and he/ she must be a certified Fellow of
the Philippine College of Physicians and Fellow of the Philippine
Society of Pulmonary Medicine.

The ICU will be supervised by the current Chairman and CoChairman of the Heart and Lung Unit and he/ she must be a certified
Fellow of Philippine College of Physicians, Fellow of the Philippine
Heart Association/ Philippine College of Cardiology or Fellow of the
Philippine Society of Pulmonary Medicine.

While the cardiac catheterization laboratory/ facility is not available

temporarily in FDMMC, the affiliated interventional cardiologist and
electrophysiologist will be allowed to do the procedures upon
formal letter of request signed by chairman of Internal Medicine in
other three accredited medical centers of the Pinehurst Medical
Services , Incorporation, namely:; VRP Medical Center, Medical
Center Manila, and Unihealth Tagaytay Hospital and Medical Center.

The patients of Cardiac Rehabilitation Center facility when available

or if there will be in-patients for cardiac rehabilitation comanagement he/ she will be supervised only by affiliated cardiac
rehabilitation Cardiologists or by choice of requesting physician and
he/ she must be a certified Fellow of the Philippine College of
Physicians, Fellow of the Philippine Heart Association/ Philippine
College of Cardiology, and Member or Fellow of Council on Cardiac
Rehabilitation Society of the Philippines.

All affiliated clinicians of the Department of Medicine of FDMMC are

required to attend medical staff meeting every three (3) months
(January-April-July-November) during the 4th Wednesday of the
scheduled month at 1:30 P.M. to be conducted by Dr. Mariano
Lopez, the Medical Director.

An affiliated Cardiologist or Pulmonologist may be requested to give

lecture pertaining his/ her specialty or expertise and the topic and
schedule of lecture will be announced by the Chairman of the
Department of Medicine at least one month prior to the schedule.

An affiliated Cardiologist or Pulmonologist must attend to at least

50% of the department meetings, conferences or grand rounds in a
year to maintain good medical standing in the medical center.

An affiliated Cardiologist/ Pulmonologists are permitted to give

suggestions or requests either by personal or written statement to
be forwarded to the office of the Department of Medicine for
approval by Head of Heart and lung Unit, Chairman of the
Department of Medicine and the Medical Director for final approval.