Children's is searching for a Associate ECMO Specialist Respiratory Therapist who provides appropriate respiratory care specific to the pediatric population in accordance with the hospital policy/procedure. Assesses, plans and implements appropriate respiratory plan of care based on the cardiopulmonary needs of the patients. Evaluates effectiveness of plan of care and recommends revisions to the multidisciplinary care team. As an ECMO Specialist who has completed specialized training in the operation, maintenance, and application of circulatory technology (perform neonatal, pediatric and adult ECMO at Childrens) requiring extracorporeal membrane support. Demonstrates expanded knowledge base through participation in ECMO program projects and activities. Aimed at those with a desire to grow knowledge, skill and experience as a critical care clinician. Yearlong training to prepare for the role of ECMO specialist. Flexible schedule to cover the needs of the ECMO patient during an ECMO run. Varied schedules to include weekend and holiday patterns, 7am-7pm or 7pm-7am.
Assesses/reassesses the cardiopulmonary needs of the pediatric patient according to the department/area standards.
- Assessment is appropriate for developmental age of child and documentation.
- Provides input/feedback/recommendations to Physician or others in the interdisciplinary team.
- Identifies education needs of patient/caregiver.
- Identifies appropriate goals/outcomes and actions for clients (i.e. individualized, prioritized).
- Performs reassessment based on unit standards, protocols, and changes in patient condition. Communicates changes to appropriate persons (MD, CNC, family) as indicated
- Set up and operate devices such as mechanical ventilators, therapeutic gas administration apparatus, environmental control systems, and aerosol generators, following specified parameters of treatment.
- Determine requirements for treatment, such as type, methods and duration of therapy, precautions to be taken, and medication and dosages, compatible with physicians orders.
- Read physicians orders, measure arterial blood gases, and review patient information to assess patients condition.
- Explain treatment procedures to patients to gain cooperation and allay fears.
- Monitor patients physiological responses to therapy such as vital signs, arterial blood gases and blood chemistry changes and consult with physician if adverse reactions occur.
- Administer therapeutic gases including nitrogen, nitric oxide, heliox, etc.
- Enforce safety rules and ensure careful adherence to physicians orders.
- Maintain charts that contain patient pertinent identification and therapy information.
- Inspect, clean, test, and maintain respiratory therapy equipment to ensure equipment is functioning safely and efficiently and notify manager/supervisor when repairs are necessary.
- Educate patients and/or their families about the patients condition and teach appropriate disease management techniques such as breathing exercises and the use of medications and respiratory equipment.
- Perform broncho-pulmonary drainage and assist or instruct patients in performance of breathing exercises.
- Conduct lung capacity tests to evaluate patients cardiopulmonary functions.
- Provide emergency care, including artificial respiration, external cardiac massage, and assistance with cardiopulmonary resuscitation.
- Complete all required respiratory therapy competency tests within specified timeline.
- Demonstrate competency in identified technical skills for the respiratory department at the specific work area.
Manages the ongoing process of healthcare delivery to ECMO patients and families:
Assessment and Planning:
- Participates in the evaluation of patients as potential ECMO candidates.
- Works in collaboration with Perfusion to manage ECMO cannulation, decannulation, and stabilization procedures.
- Prepares and operates clinical equipment and circuitry per ECMO procedures/policies.
- Accurately assess and review with physician and ECMO team, pathophysiological changes within the patient and ECMO circuit. Differentiates patient versus circuit problems and intervenes appropriately.
- Based on clinical assessments, contributes to the development of individualized age and developmental appropriate plan of care with patient and family.
- Participates in ECMO case review and assists team members in defining learning outcomes.
- Participates in the collection/review of quality improvement initiatives and data for the ECMO program and ELSO data.
Develops individualized patient/family plan of care using practice guidelines/protocols to meet identified needs. (Plan of Care includes current and anticipated actions focused on care, education, discharge needs.)
- Utilizes assessment data from the healthcare team to individualize appropriate goals and actions for the patient, including collaboration with the family and the healthcare team.
- Utilizes individualized assessment data to develop the patient/familys plan of care.
- Formulates goals and outcomes based on assessment data.
- Revises plan of care based on patients condition, interdisciplinary input, and family needs.
- Demonstrates ability to prioritize patient interventions based on assessments/reassessments. Uses available staffing resources to support patient care needs as appropriate.
Implements Plan of Care:
- Oversees that the plan of care/goals are coordinated, implemented, evaluated, and revised as needed. Identifies the need for interdisciplinary involvement/outside resources and follows through. Uses appropriate resources (CNC, Educator, PCM, MD, etc) to ensure that clinical outcomes are achieved.
- Incorporates critical thinking into the delivery of clinical skills and in analyzing patient response to orders, tests, labs, medications, and treatments.
- Demonstrates clinical competence in administering interventions according to identified standards and age specific needs.
- Provides and/or coordinates with other disciplines patient/family education according to identified care needs, considering assessment of patient/familys readiness to learn.
- Works in collaboration with ECMO Team to assess clinical status and related lab results (ACT levels, blood gases and metabolic status). Notifies ECMO physician of clinical status/lab values, performing appropriate interventions and implementing physician orders within established guidelines/ECMO policy and procedures.
- Manages ECMO flow in relationship to established clinical parameters. Reviews daily parameters with the ECMO Team.
- Demonstrate proper blood sampling techniques from the ECMO circuit.
- Perform, manage and troubleshoot activated clotting times (ACT) as per ECMO protocol including management and administration of heparin drip per ECMO protocol.
- Administers all blood products/medications appropriately when ordered to be given through the ECMO circuit.
- Maintains and effectively assesses ECMO circuit function. Performs all circulatory technical skill with efficiency, accuracy and safety while anticipating, troubleshooting, intervening and managing crises/emergency situations according to policy and procedure maintaining professional composure.
- Role models proficiency in documenting appropriately by assimilating information related to interventions, plan of care and anticipated outcomes accurately into all ECMO records and teaching documents.
- Participates in patient management discussions to include: communicating anticipated patient needs/plan of care, suggesting clinical management options and providing feedback for interventions that improve patient outcomes.
Documentation reflects accurate assessment/evaluation, modification, and patients response to therapy, changes in condition, and therapeutic interventions/procedures.
- Entries in the medical record follow hospital policy (i.e., date, time, use of appropriate abbreviations, and legibility).
- Documentation is completed within established timeframes.
- Reviews and updates computerized care plan to accurately reflect the plan of care.
- Completes computerized documentation within established timeframes, including, but not limited to: Medication Administration Record, Allergies, Patient Information, etc.
- Completes and verifies accurate order entry in the computerized care plan
Actively engages in ECMO Specialist Fellowship through consistent participation in classroom and preceptor learning activities.
KNOWLEDGE, SKILLS AND ABILITIES:
- Attends scheduled residency classroom sessions and activities.
- Completes assigned verbal and written learning activities at defined due dates.
- Consistently participates in group discussion and reflection activities.
- Provides constructive feedback on Fellowship Program.
- Accepts constructive feedback from preceptor and residency staff.
- Engages in regular collaboration with assigned mentor throughout first year of employment.
- Completes/conducts EBP/PI project by end of year two of employment and presents results to defined group.
- Must be able to perform a variety of duties, often changing from one task to another of a different nature, without loss of efficiency or composure, and be able to perform under stressful conditions when confronted with multiple requests, demonstrating prioritizing skills.
- Excellent communication, assessment and patient care skills, as well as flexibility and ability to function in a high stress environment.
- Flexibility to work full time day/night shifts with possible over time during ECMO run.
EDUCATION AND EXPERIENCE:
- Graduate of an accredited AMA approved school of respiratory care accredited by the National Board of Respiratory Care required.
- Associates degree from an AMA accredited college or university in respiratory care required. Bachelors degree from an AMA approved accredited school in respiratory care preferred.
- Minimum 1 year experience as a Respiratory Therapist required, experience with pediatric patients and critical care preferred.
- Current and valid Nebraska license as a Respiratory Care Practitioner required.
- Current and valid National Registered Respiratory Therapist (RRT) credential required upon hire.
- Current and valid National Registered Neonatal/Pediatric Respiratory Therapist (RRT-NPS) credential within three years of hire.
- Current and valid Basic Life Support (BLS) through the American Heart Association is required.
- Pediatric Advanced Life Support (PALS) certification required within six months of hire date.