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PEL/VIP: Respiratory Therapy – RT Modality Trigger Form Recommendations

  1. Receive Order or Referral for RT evaluation
  2. Review the Patients chart and history
  3. Interview and assess the patient
  4. Recommend RT therapies
  5. Document RT modalities and patient information on PEL provided tracking tools
  6. Perform RT follow up visits weekly and prn after initial eval, change therapy as needed

RT therapies indications

Bronchodilator therapy vs. MDI/DPI Therapy –

Indications for Nebulizer Indications for MDI/DPI

  1. Documented Pulmonary Disease 1. Patient is able to follow directions & cooperate
  2. FEV1 < 65% predicted 2. Patient can do a 5 second breath hold
  3. Wheezing / Bronchospasm 3. Patients RR is < 25/minute
  4. Acute Pulmonary Infection

Hyperinflation Therapy- Incentive Spirometry, Cough and Deep Breathing, & Splinting techniques


  1. Any patient scoring a 2 or greater on the pneumonia scoring tool
  2. Any patient with a pneumonia diagnosis or lung disease
  3. New presence of Atelectasis or Pneumonia
  4. Febrile patient

Bronchial Hygiene Therapy- Acapella, Flutter & VEST therapy


  1. Ineffective Cough
  2. Retained Secretions
  3. Any patients with Mucous Producing Disease
  4. Patients that have had recurrent pneumonias in past year
  5. Patients with an artificial airway

Patients on these therapies should be seen a minimum of weekly and prn until patients condition improves or is discharged from the facility or program

Please fax all documentation to 708 581-7990