Section: Effective Date:

Policy #:
Sponsor: David Kelley Supersedes:
D.O.
Title: Respiratory/ICU
Medical Director
Author: Next Review Date:
Darla Harwood RRT
Title: Resp. Manager
Frequency Guidelines for ICU Protocol Therapy

APPLIES TO: Clarian Arnett Health or

X Clarian Arnett Hospital Clarian Arnett Clinic Clarian Arnett Surgery Center

I. PURPOSE
To provide frequency guidelines for the use of ICU protocol driven therapy in
a consistent manner based upon evaluations and objective scoring.

II. SCOPE
This policy applies to all Respiratory Care Practitioners (RCP’s), physicians,
and nursing staff.
III. POLICY STATEMENTS
The highest frequency of an order generated by protocol application will
generally be Q2 hours around the clock (ATC).
1
V. PROTOCOL:Adult Treatment Frequency Guidelines

Type of Indications Score

Procedure
Aerosols (incl. MDI, )
Q2-Q4, ATC & PRN Severe wheezing, severe dyspnea, unable to sleep 1&2
Q6 or QID, & PRN at night Moderate wheezing, Hx asthma 3
Q6 PRN Intermittent wheezing 4
Bronchopulm Hygiene
Q4 ATC Copious secretions, dyspnea, unable to sleep, mucus plug 1
QID & PRN at night Moderate secretions 2
TID Small amts secretions w/poor cough & hx secretions 3
Q shift W/A Unable to deep breathe and cough spontaneously 4

Lung Expansion
Therapy (incl.
EZPAP)
Q4 W/A & PRN at night Severe atelectasis, poor oxygenation 1
QID High risk for persistent atelectasis, existence of same 2
TID At risk for developing atelectasis 3
Q shift W/A Prevention of atelectasis 4
Instruct, 1 follow-up Patients able to perform well on their own 5

Policy #
Policy Name
Page 1 of 2
Some notes and definitions related to Treatment Frequency that apply to Adults AND
Pediatrics:
• PRN is defined as: when patient requires treatment in between regularly scheduled
times, but not more frequently than 2 hrs apart.
• Patients with aerosols more frequent than Q4 should be discussed with physician. Any
time clinical status deteriorates or adverse event occurs, contact physician. An example
of this would be when a patient’s score goes back one step instead of progressing
toward less intensive therapy.

Reassessment for patients on protocols will be performed in accordance with the patient’s
acuity level as indicated by the total score from the assessment tool. The acuity level
may change with each evaluation. The patient will be reassessed with each treatment
and therapy will be adjusted as needed.

Reassessment Frequency (may also use for Peds)

Reassessment Frequency
Assessment
Score
1 Daily*
2&3 48 hrs to 72 hrs maximum
4&5 If 2 consecutive reassessments remain unchanged and treatment is still required (as
opposed to being ready to DC), Reassessment may be extended to 7 days.
*If, after 3 days of daily evaluation, a patient with a score of 1 is found to be chronic but
stable, Reassessment may be performed Q3 days.

RESPONSIBILITY: Respiratory Care Department

APPROVAL BODY
Executive approval identified here (by Documentum Manager)
APPROVAL SIGNATURES

Policy #
Policy Name
Page 2 of 2