We use a standing order that allows us to titrate from 2L up to 4L. This is built into our referral order. If they need more than 4L, we will send an order to their MD to continue with increased flow.
We assess saturations during their initial 6MWT. If we find they need oxygen or increased flow, we will go ahead and contact their referring physician at that point.
Also based off their initial evaluation with me I would monitor their response to their testings such as six minute walk test. And would know from that point , if they would need more oxygen then was was already on the referral form throughout duration of the program .
If that was the case I would put that into the initial plan of care , for the physician to sign off on .
I am an EP, and was the only one with just a few nurses. I educated patients on O2 use and titrations . this is came from experience , and working with respiratory therapists from my previous job at a different hospital. The hospital I currently resided didn’t have resources to provide us any therapists in our unit because there was no way to bill. Go figure. Lol. So I went to the medical director and lead respiratory therapist. They gave me the protocols . If or when someone needed oxygen more than what was prescribed to them initially , I would call the medical director directly to get the okay per case . This was also charted in their plan of care, and Scottcare chart. Sometimes it was using different hi flow cannulas , face masks etc. From there more education on their oxygen use was given .
We have an RRT in my cariac/pulmonary rehab... but maybe you could get a standing order for the titration.
Keep the titration within so many liters, for instance, and if the doctor oks that you can at least titrate a few liters. We don't titrate more than a liter or two most of the time, anyway. Anything more might need a physician's visit anyway.
Does anyone have any experience working in a Pulmonary Rehab program that is just EPs? Including a mix of both CEP and EP-C? We are looking to expand a program but it may run with just CEPs/EP-C. Off of that, does anyone have documentation clearly stating that CEPs cannot titrate or adjust a patient's supplemental O2?
I have worked in programs with RNs and RTs, and we understand that O2 is a "medication," but if the patient is on home O2 - my understanding would be that they should be able to self-titrate and a knowledgeable and competent CEP should be able to educate and explain proper titration in response to exercise training.