InspirEvolution 2014

Clinical Education
Forum
Research Stream
Submitted by:
Akhilesh Patel, BSc, RRT
Nancy Garvey, RRT, CAE,
MAppSc
RTSO Research Committee
Co-Chairs

Akhilesh Patel, Marianne Ng and

Nancy Garvey

The Respiratory Therapy Society of Ontario (RTSO) Research

Committee is committed to building research, evaluation and
quality improvement capacity amongst members in order to
improve health outcomes for Ontarians. The InspirEvolution
2014 Research Stream, held on November 22, 2014, was a
success, allowing colleagues to share their knowledge and
experiences and inspiring others to implement or participate
in similar initiatives.
The session began with two main presentations followed
by poster presentations. Robyn Klages presented on the
evidence-based intubation annual certification program that
has been implemented at William Osler Health Center. In their
panel presentation, Tiffany Tram, Ashley Waugh and Dr. Mika
Nonoyama discussed their research experiences and answered
questions regarding what stirred their interest in research.
Both presentations were well-received!
To conclude the research stream, there were six poster
presentations. Each year, an award is given for the top-ranked
Registered Respiratory Therapist (RRT) poster. We would
like to congratulate Marianne Ng as the winner of the
poster presentation entitled Knowledge translation
of evidence based medicine in RT: Attitudes,
knowledge, practice and perceived barriers. An
award is also given for the top-ranked student poster.
There were no submissions in 2014, however, we
encourage students to take part in future poster
presentations, as this is a great opportunity for
learning and research exposure. We would like to thank
everyone who submitted abstracts for poster presentations; it
was a successful event!

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InspirEvolution
2014 Clinical
Education
Forum
Research Stream

RTSO 2014 Advanced Practice

Education Awards

This past year (2014) marked the second year

of collaboration between Abbvie and the
RTSO. Abbvie graciously sponsored an
advanced practice bursary program for
RRTs pursuing advanced certification
through the Anaesthesia Assistant
program. This funding would occur over
the course of three years, with a total of
four $5,000 awards.

Akhilesh Patel,
Nancy Garvey,
Amanda So and
Rob Krakauer
from Abbvie

Two candidates were successful

recipients of the award in 2014. Abbvie
and the RTSO would like to congratulate
Amanda So and Chantelle Ireland for their
achievements and to wish them continued
success as they complete the Anaesthesia
Assistant program.
The RTSO offers Advanced Practice Education
Awards of up to $1,500 to RRTs in the pursuit
of advanced knowledge and skills related
to respiratory care. The RTSO would like to
congratulate Sandy Lam on obtaining the
award in 2014 and wish her all the best as she
obtains her Certified Respiratory Educator
(CRE) designation.

Akhilesh Patel, Nancy Garvey, Chantelle

Ireland and Rob Krakauer from Abbvie

The RTSO would like to thank all applicants

and continue to encourage RTSO members
to apply for the various awards listed on
the RTSO website (http://rtsoresearch.ca/
funding/#fundingawards).

Sandy Lam
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Abstract Submissions

Poster
Winner

Knowledge translation of evidence based medicine in RT:

Attitudes, knowledge, practice and perceived barriers.
Marianne Ng, , Carol S. Heck , Tiffany Tram, Jacky Wu, Amanda Bickley,
Odisho Odisho, Ellaha Wahaj, Ummaima Ali

Introduction:
Few studies regarding Respiratory Therapists (RT) understanding and views towards Evidence Based
Medicine (EBM), a process in which clinicians systematically evaluate the most recent research to
address questions encountered in clinical practice, have been conducted. Objectives of the current
study were to identify attitudes, beliefs, knowledge/understanding of research, and perceived
barriers to implementation of EBM amongst RTs in Ontario.
Method:
A link for an electronic survey probing these domains was placed in the Fall 2013 College of
Respiratory Therapists of Ontario and Respiratory Therapy Society Ontario newsletters. All RTs
registered with the college and employed in Ontario (n= 1808 ) who received the newsletter were
eligible to participate. The BARRIERs scale questionnaire from Jette D.U et al. (2003) and Funk S.G et
al. (1995) was adapted so as to be specific for RT practice
Results:
Of the 294 respondents, the majority (76.3%) were females from Greater Toronto area (54.1%),
working full time (76.6%) for an average of 16.210.3 years primarily in teaching hospitals (78.4%).
Results indicated that the majority of RTs hold positive attitudes towards applying EBM in their
daily practice. The majority of respondents agreed or strongly agreed that EBM is necessary in RT
practice (87.2%), that it improves the quality of patient care (89.6%) and helps clinicians making
decisions about care (79.8%). However 73.0% identified the need to increase the use of EBM in their
daily practice. Barriers to implementation of research could be categorized as characteristics of
the organization (settings, barriers, limitations), characteristics of the adopter (RTs values, skills and
awareness), characteristics of the communication (presentation and accessibility), and characteristics
of the innovation (quality of the research). Barriers to remaining updated and applying EBM were
identified as was lack of time and skills to gather and analyze information from the literature and a
lack of support from management and other members of the healthcare team to implement new
ideas into practice.

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Abstract Submissions
Conclusion:
Identifying factors influencing the knowledge translation of EBM into practice can potentially
facilitate development and implementation of appropriate strategies to capitalize on facilitators and
address barriers to promote application of EBM in the clinical setting. Intervention(s) can be tailored
to address the needs in specific context and collaborative effort would be explored among different
institution, community, regulatory body and education facilities.

THE NON-TRADITIONAL ROLES OF REGISTERED RESPIRATORY THERAPISTS

(RRTs) IN ONTARIO: A HIGHLIGHT OF THE GROWING ROLES OF THE PROFESSION
RESPONDING TO ONTARIOS CHANGING HEALTH CARE LANDSCAPE
Sara Han; Carole Madeley; Dilshad Moosa,
Ontario Lung Association; Respiratory Health Programs; 18 Wynford Dr. Toronto, ON, M3C 0K8
Background/Introduction:
Registered Respiratory Therapists (RRTs) have traditionally been working within a hospital setting
caring for acute patients. Currently 2,347 (80%) of RRTs in Ontario are working in a hospital setting,
38 (1%) work in primary care 335 (11%) work in home care companies and 8 (< 1%) work in CCAC1.
Ontarios health system is changing and the burden of chronic disease is growing as the population
ages. This requires our profession to respond to these changes and evolve to meet the demands of
our patients and the current health climate. Several RRTs in Ontario have paved the way for nontraditional roles and positions in the health care system setting new boundaries for others to follow.
Non-Traditional RRT roles are defined as RRTs working outside of the acute care hospital setting and
working within the community-at-large2. Our objective is to highlight and investigate the diversity
of skills that RRTs have and how these transferrable skills have led to various non-traditional roles
for the profession and to empower current and future RRTs to grow and adapt with changes to our
health care system.
Methods:
We categorized non-traditional RRT community roles as follows: Primary Care/Chronic Disease
Management, Management/Administration, Research/Post-Secondary Education, Clinical Education,
Home Care/Case Management, Provincial Initiative Project Leads, Non-Profit Organizations, and
Knowledge Translation. An online survey was conducted through FluidSurveys.com with questions
related to education, experience and role. The 10 RRTs that were selected to complete the survey
were most representative of the categories that were chosen and had perceived expertise,
leadership and success in their current roles.
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Results:
The online survey was completed by 10 RRTs that were selected according to the categories
chosen and perceived expertise and success. 10 responded to the survey. Of those who responded,
50% were in the position for 0-5 years and 50% for 5-10 years. The following additional skills
were mentioned by the respondents: Project management and administration skills (90%),
communication skills and research skills (100%) and additional schooling (60%). Additional
certifications, quality monitoring and curriculum design were described by 80% of the respondents
as other requirements needed. 5 out of 10 respondents had a Masters level education and 1
was working towards achieving one. 1 respondent also had a Doctorate degree. We asked the
respondents to provide a token of advice for current RRTs or incoming new graduates interested in
exploring alternate career paths (e.g., Apply for positions that are not necessarily RT specific).
Summary:
As Ontarios health care landscape is evolving, so is our Respiratory Therapy profession highlighting
our diverse skill set as a member of the broader health care team. The College of Respiratory
Therapists of Ontario (CRTO) has introduced a new professional development framework for
Respiratory Therapists titled, GROW. Our survey showcases the non-traditional roles and diverse
skill sets of RRTs aligned with the GROW framework. The following advices were vital to obtaining
non-traditional roles: Apply for jobs that are not RT-specific, Be your best advocate, Find a good
mentor and Be a systems thinker. In conclusion, we aspire to inspire other RRTs to think beyond their
walls and continue highlighting the strengths of the profession emphasizing our importance as
contributing members of the broader health care team.
1
2

College of Respiratory Therapists of Ontario (CRTO) 2014 registration database

RTSO airwaves Winter 2014 edition

HOME MECHANICAL VENTILATION IN CANADA: A NATIONAL SURVEY

Louise Rose, Douglas McKim, Sherry Katz, David Leasa, Mika Nonoyama, Cheryl Petersen, Roger
Goldstein, Jeremy Road.
Introduction:
No comprehensive Canadian national data describes prevalence and service provision for ventilator
assisted individuals (VAIs) living at home, data critical to healthcare system planning for appropriate
resourcing. Our objective was to generate national data profiling service providers, users, types of
services, criteria for initiation and monitoring, ventilator servicing arrangements, education, and
barriers to home transition.
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Abstract Submissions
Methods:
Eligible service providers delivering services to VAIs living at home were identified from a national
provider inventory and snowball referrals. The survey was administered via a weblink from August
2012 to April 2013.
Results:
The survey response rate was 152/171 (89%). We identified 4334 VAIs; an estimated prevalence of
12.9 per 100,000 population, 73% receiving non-invasive ventilation (NIV) and 28% intermittent
positive pressure ventilation (IPPV) (9% not reported). Services were delivered by 39 institutional
providers and 113 community providers. We identified variation in initiation criteria for NIV, with
polysomnography demonstrating nocturnal hypoventilation (57%), daytime hypercapnia (38%),
and nocturnal hypercapnia (32%) as the most common criteria. Various models of ventilator
servicing were reported. Most (64%) providers stated caregiver competency was a pre-requisite for
home discharge, however, repeated competency assessment and re-training was offered by only
45%. Important barriers to transition home were: insufficient funding for paid caregivers, equipment,
and supplies; a shortage of paid caregivers; and negotiating public funding arrangements.
Conclusions:
Ventilator support in the community appears well-established, with most individuals managed
with NIV. Although caregiver competencies are a pre-requisite to discharge, ongoing assessment
and retraining was infrequent. Funding and caregiver availability were important barriers to
transition home.

INSTUTIONAL CARE FOR LONG-TERM MECHANICAL VENTILATION IN CANADA:

A NATIONAL SURVEY
Louise Rose, Douglas McKim, Sherry Katz, David Leasa, Mika Nonoyama, Cheryl Petersen, Monica
Avendano, Roger Goldstein.
Introduction:
No national Canadian data define resource requirements and care delivery for ventilator assisted
individuals (VAIs) requiring long-term institutional care. Such data will assist in planning healthcare
services to this population. Objective: To describe institutional and patient characteristics,
prevalence, equipment used, care elements and admission barriers for VAIs requiring long-term
institutional care.
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Methods:
Centres were identified from a national inventory and snowball referrals. We provided the survey
via weblink from December 2012 to April 2013. Weekly reminders were sent for six weeks.
Results:
Response rate was 54/64 (84%) with 44 adult and 10 paediatric centres providing data on 428 VAIs
(301 invasive ventilation; 127 NIV), equivalent to 1.3 VAIs per 100,000 population. A further 106
VAIs were on wait-lists in 18 centres. More VAIs with progressive neuromuscular disease received
invasive ventilation than NIV (P<0.001); more VAIs with COPD (P<0.001), obesity hypoventilation
syndrome (P<0.001), and central hypoventilation syndrome (P = 0.02) required NIV. All centres used
positive pressure ventilators, 21% diaphragmatic pacing, 15% negative pressure, and 13% phrenic
nerve stimulation. Most centres used lung volume recruitment (55%), manually (71%) and mechanically
assisted cough (55%). Lack of beds and provincial funding were common admission barriers.
Conclusions:
Variable models and care practices exist for institutionalized care of Canadian VAIs. Patient
prevalence was 1.3/100,000 Canadians.

PAST, PRESENT AND THE FUTURE OF RESPIRATORY RESEARCH: A SURVEY OF

CANADIAN ALLIED HEALTH PROFESSIONALS
Mika Nonoyama, Sunita Mathur, Rosemary Herbert, Heather Jenkins, Michelle Lobchuk, Michelle
McEvoy.
Introduction:
The Canadian Respiratory Health Professionals (CRHP) is the multidisciplinary allied health
professional group of the Canadian Lung Association and has a growing number of highly qualified
researchers. The landscape of allied health professional respiratory research in Canada has not
been described.
Objectives:
To describe the level of respiratory research engagement; identify barriers and facilitators to
research engagement; describe the experience and interest in developing research skills; and
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Abstract Submissions
identify priority areas of future respiratory research among allied health professionals. Methods:
An online survey of CRHP members was used to collect demographics; barriers and facilitators to
conducting research; areas of and future directions in respiratory research; research funding and
mentorship. Experience with and interest in upskilling research skills was also evaluated.
Results:
119 surveys were completed (22% response rate) of which 69 respondents (58%) were engaged
in respiratory research. Reasons for not being involved in respiratory research were lack of
mentorship, support and funding. Top research areas were chronic obstructive pulmonary disease
(74%) and asthma (41%). Top facilitators for research engagement were amount of funding (29%)
and mentorship (28%). Respondents rated their experience in research skills as low but had
expressed high interest in improving their research skills.
Conclusions:
We identified areas of development such as research skills, greater funding opportunities and
mentorship to increase the research capacity of allied health professionals in respiratory health.
Allied health researchers have an important role in contributing to the national respiratory
research strategy to increase interdisciplinary engagement and build collaborative teams.

RESPIRATORY THERAPY INTEGRATING SIMULATION INTO CLINICAL PRACTICE

Tony Raso; Robyn Klages; Carla Steele; Jenny Wood; Domenic Capolongo
William Osler Health System; Respiratory Therapy Services, 2100 Bovaird Drive East, Brampton,
L6R 3J7
Introduction:
The Respiratory Therapy Department at our institution is moving away from skill certification
(for example 6 intubations/year to maintain competency) to objective based educational
requirements. It can be difficult to maintain competency with a skill such as pediatric or neonatal
intubation where the opportunity is infrequently encountered. This also holds true for some
airway adjuncts such as the bougie tube and the Glidescope. Respiratory Therapists typically work
independently with a great sense of autonomy within the hospital setting. Individual skill level
is not assessed and opportunities for bedside coaching or mentoring rarely happen. Objectives:
To see if a standardized curriculum focusing on objective based educational requirements would
be a better indicator of skill competency than a number based system. The simulation lab would
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Abstract Submissions
provide the environment that would recreate situations that would be similar to ones that might
be encountered clinically and allow for both individual therapist and team assessment. Therapists
would be assessed on adult, pediatric and neonatal intubation skill as well as management of an
airway from the routine to the more difficult utilizing various adjuncts both familiar and unfamiliar.
Methods:
Each therapist is given access to an airway learning package. Prior to the simulation session
the therapist must achieve an 80% pass on a multiple-choice test. Simulation workshops are
scheduled once a month and all staff rotate through the simulation lab on an assigned schedule.
Post simulation scenario, time is given for reflective learning and facilitated debriefing. Individual
and team performances are assessed and an individual written evaluation is sent to each therapist
following their simulation lab performance. Staff also evaluates the session.
Results:
Using the simulation lab allowed for a standardized curriculum that reduced testing variability
as each therapist received the same scenarios. It allowed the facilitators to gauge practice and
identify individual strengths, weaknesses and areas for therapist self-improvement. It was noted
that situations not frequently encountered were not handled well, such as neonatal resuscitation
scenarios. Therapists also showed a varying level of comfort and expertise with airway adjuncts
such as the bougie tube and Glidescope. Situational leadership and communication skills were also
identified as soft skills that needed support. The debriefing allowed for clarification of policy and
procedure statements as well as insight into decision making. Therapist feedback has been very
positive although some found it quite stressful.
Conclusion:
The simulation lab is becoming an integral part of our education platform and is now being
utilized for all of our objective based educational requirements from adult arterial line insertion
to ventilator management. This approach allows more than just skill assessment. It assesses
knowledge, skill and judgment. It is surprising to learn what people do not know. We no longer
assume anything and instead focus on providing an environment that is very interactive,
supportive and conducive to learning. Our objective based learning requirements are now done
yearly with a focus on skill and knowledge retention on previously learned material.

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Interested in Research?
Here an the opportuntiy for you
To all RTSO Members
The RTSO Research Committee (RC) has made some significant gains over its short history
due to the contributions and support of some fabulous members! At the end of March 2015,
Akhilesh Patel, the current Co-chair, will be stepping down after 4 years of dedicated service.
We are aiming to recruit a new member to fill his position, in particular:
A current member in good standing of the CRTO and RTSO
Someone who has previous and/or current research, quality improvement and/or program
evaluation experience
An RRT who may have a Bachelors or Masters or PhD or in the process of pursuing post
graduate studies.
We would like the successful applicant to be available to start a 2 year term on April 1, 2015.
Please submit a cover letter describing your background and interests in research, quality
improvement and/or program evaluation and a resume through the RTSO Office office@rtso.ca
by February 20th.
Visit www.rtso.ca for the current Terms of Reference, RC Framework, Work Plan and a brief slide
deck summarizing current RC activities FYI.
We know there are some great candidates out there! If any of you have any questions, please
dont hesitate to be in touch with either Akhilesh or Nancy Garvey.
Nancy Garvey RRT, MAppSc and Akhilesh Patel RRT, BSc
Co-Chairs, RTSO Research Committee on behalf of our current members:
Mika Nonoyama RRT, PhD, RTSO Clinical Scientist
Shelley Prevost RRT, MAppSc
Brooke Read RRT, BSc, MHS
Louise Chartrand RRT, MA, PhD(c)
Marianne Ng RRT, BSc
Ashley Waugh RRT, BSc

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