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Respiratory Therapy Treatment for Bronchiolitis – Pediatric – Inpatient/Emergency Department [136]

Respiratory Therapy Treatment for Bronchiolitis – Pediatric – Inpatient/Emergency Department [136] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Inpatient Delegation Protocols





Delegation Protocol Number: 136

Delegation Protocol Title:
Respiratory Therapy Treatment for Bronchiolitis – Pediatric – Inpatient/Emergency Department

Delegation Protocol Applies To:
UW Health Inpatient and Emergency Department: Pediatrics

Target Patient Population:
All Pediatric patients with an order for Respiratory Therapy Protocol – Bronchiolitis

Delegation Protocol Champions:
Kristin Shadman, MD – Pediatrics Hospitalist
Vanessa Tamas, MD – Pediatrics Emergency Medicine

Delegation Protocol Reviewer:
Rhonda Yngsdal‐Krenz, RT – Respiratory Therapy – AFCH

Responsible Department:
Respiratory Therapy Department

Purpose Statement:
This protocol delegates authority from the ordering provider to the Respiratory Care Practitioner (RCP)
or Respiratory Therapist to place orders clearly indicated in either of the following algorithms:
1. AFCH Bronchiolitis Inpatient Treatment Algorithm
2. Emergency Department Bronchiolitis Treatment Algorithm

Who May Carry Out This Delegation Protocol:
Respiratory Care Practitioners (RCPs) or Respiratory Therapists (RTs) trained in the use of this protocol.

Guidelines for Implementation:
1. This delegation protocol is initiated when the order for “Respiratory Therapy Protocol –
Bronchiolitis” has been ordered. The RT will follow the workflow outlined in either the AFCH
Bronchiolitis Inpatient Treatment Algorithm or the Emergency Department Bronchiolitis Treatment
Algorithm.
2. The protocol does not apply to any of the following exclusion criteria:
2.1. Patient is intubated or on a ventilator
2.2. Patient has cystic fibrosis, bronchopulmonary dysplasia, or spinal muscular atrophy
2.3. Patient has immunodeficiencies
2.4. Patient has Chronic Lung Disease
2.5. Patient has Hemodynamically Significant Heart Disease
2.6. Patient is prematurity with gestational age less than 35 weeks
2.7. Patient is admitted to the Pediatric Intensive Care Unit
2.8. Patient is in severe respiratory distress
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org


Order Mode:
Cosign Required, Protocol/Policy

References:
1. Pinto JM, Schairer JL, Petrova A. Duration of Hospitalization in Association with Type of Inhalation
Therapy Used in the Management of Children with nonsevere, Acute Bronchiolitis. Pediatrics &
Neonatology, Sept 14, 2015.
2. Gadomski AM, Scribani MB. Bronchodilators for bronchiolitis (Review). The Chocrane Collaboration,
2014, Issue 6.

Collateral Documents/Tools:
1. Diagnosis, Management and Prevention of Bronchiolitis – Pediatric – Inpatient/Ambulatory Clinical
Practice Guideline
2. AFCH Bronchiolitis Treatment Algorithm
3. Emergency Department Bronchiolitis Treatment Algorithm
4. ED – Bronchiolitis – Pediatric [5798]
5. IP – Bronchiolitis – Pediatric – Admission [3902]

Approved By:
UWHC Respiratory Care Committee: January 2016
UWHC Pharmacy and Therapeutics Committee: February 2016
UWHC Medical Board: March 2016

Effective Date: March 2016

Scheduled for Review: March 2019
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org