Pediatric Respiratory Home Care

The respiratory care practitioner (RCP)  provides an important role in home care for many pediatric patients.It is usual for the RCP  to have at least 1 year of acute care experience before working with home care.Experience in pediatrics is necesary as this crompises an important  part of home care.It is important that RPCs providing home care be licensed (states have different regulations).The main papulation receiving home care is the patient who is being discharged from the hospital and still requires ongoing care.Many patient are serviced by home care companies and many of the companies are durable medical equipment (DME) vendors. The RCP who is employed by the DME company will select, deliver, and set up the equipment in the home. The family will be educated in the requirements for monitoring and maintaining the equipment. The treating physician is responsible for prescribing the therapy. The RPC spends much of the time during the home visit teaching the family the safe and effective use of the equipment. A treatment plan is individualized and documentation is important. Appropriate follow-up is indicated.
Medicare does not reimburse for the RPC service whereas they will do so far nurshing visit. As a result, many companies utilize nurses to do the evaluation and education for patients on medicare.
RPCs employed by hospital are often part of the discharge planning team that orders specific home care treatments for children. Team members also include nurses and social workers who are responsible for evaluating the suitability of the caregivers and the home environment before the plan is initiated. The home environment needs to be evaluated for safety againts fire or other hazards, particularly if home mechanical ventilation is to be used. One of the issues includes the electrical system, as there may be various appliances connected to the same electrical circuit. Awareness of the amperage of the appliances reduces the chance that circuit will be overloaded. It is necessary to check the fuse boxes. Some older homes have inadequate circuits breakers and inappropriate fuses. Space for equipment and circuits is necessary and they need to be placed so that there is safe distance from heaters or any source of flame. Functioning smoke detectors are essential and fire extinguishers should be available and accesible.
Categories of home respiratory equipment include:
Category I : no prescription needed.
Category II : Prescription needed but the equipment is not considered life supporting. This includes oxygen delivery devices, nebulizers, suction machines, and oxiometers.
Category III : Prescription needed and equipment is considered life supporting. This include apnea monitors, pressure support for respiratory failure, and invasive or non-invasive mechanical ventilation.