Scope of Practice

(a)Registered Respiratory Therapists. The practice of respiratory care includes, but is not limited to, the services set forth in the law. The licensed Registered Respiratory Therapist provides these services for the assessment, treatment, management, evaluation and care of patients with deficiencies, abnormalities and diseases of the cardiopulmonary system with guidance from a qualified medical director, and pursuant to a referral from a physician who has medical responsibility for the patient.

(1)A person licensed under this Chapter as a Respiratory Therapist may evaluate and treat human ailments by respiratory therapy according to a physician’s consultation. The evaluation shall be the Therapist’s assessment of a patient’s problem and shall include a respiratory therapy diagnosis. If a patient’s problem is outside the scope of therapist, the therapist shall consult with a person licensed to practice medicine. If a patient, at any time, requires further medical evaluation or diagnostic testing, that patient shall be referred to an authorized health care practitioner.

(2)Direct referral of a patient by an authorized health care practitioner may be by telephone, letter or in person; provided, however, if the instructions are oral, the therapist may administer treatment accordingly, but must make a record describing the nature of the treatment, the date administered, the name of the person receiving the treatment and the name of the referring authorized health care practitioner.

(3)The practice of respiratory care by a licensed Registered Respiratory Therapist includes, but is not limited to, the following services:

(A)providing and monitoring therapeutic administration of medical gases, aerosolized humidification and pharmacological agents related to respiratory care procedures, but not including administration of anesthesia;

(B)carrying out therapeutic application and monitoring of mechanical ventilator support;

(C)providing cardiopulmonary resuscitation and maintenance of natural airways and insertion, and maintenance of artificial airways;

(D)assessing and monitoring signs, symptoms and general behavior relating to, respiratory care treatment or evaluation for treatment and diagnostic testing, including determination of whether the signs, symptoms, reactions, behavior or general response exhibit abnormal characteristics;

(E)obtaining physiological specimens and interpreting physiological data including:

(i)analyzing arterial and venous blood gases;

(ii)assessing respiratory secretions;

(iii)measuring ventilatory volumes, pressures, and flows; CH. 12 MEDICAL PRACTICES - PART II

(iv)testing pulmonary function;

(v)testing and studying the cardiopulmonary system;

(vi)diagnostic testing of breathing patterns related to sleeping disorders;

(vii)assisting hemodynamic monitoring and support of the cardiopulmonary system;

(viii)assessing and making suggestions for modifications in the treatment regimen based on abnormalities, protocols or changes in patient response to respiratory care treatment;

(ix)providing cardiopulmonary rehabilitation, including respiratory care-related educational components, postural drainage, chest physiotherapy, breathing exercises, aerosolized administration of medications, and equipment use and maintenance;

(x)instructing patients and their families in techniques for the prevention, alleviation and rehabilitation of deficiencies, abnormalities and diseases of the cardiopulmonary system;

(xi)assisting with management of the cardiopulmonary system and medical equipment during off-Guam transports;

(xii)transcribing and implementing physician orders for respiratory care services;

(F)services within the training and experience of the practitioner; and

(G)services within the parameters of the laws, rules and standards of the facilities in which the respiratory care practitioner practices.

(4)Respiratory care services provided by a licensed Registered Respiratory Therapist, whether delivered in a health care facility or the patient’s residence, must not be provided, except upon referral from a physician.

(b)Licensed Certified Respiratory Therapists.

(1)A licensed Certified Respiratory Therapist is not an independent practitioner, and works under the indirect supervision of the licensed Registered Respiratory Therapist.

(2)A licensed Certified Respiratory Therapist will follow the treatment program set by the licensed Registered Respiratory Therapist.

(3)The practice of respiratory care by a licensed Certified Respiratory Therapist includes, but is not limited to, the following services:

(A)providing and monitoring therapeutic administration of medical gases, aerosolized humidification, and pharmacological agents related to respiratory care procedures, but not including administration of anesthesia;

(B)carrying out therapeutic application and monitoring of mechanical ventilator support;

(C)providing cardiopulmonary resuscitation and maintenance of natural airways, and insertion and maintenance of artificial airways;

(D)assessing and monitoring signs, symptoms and general behavior relating to, respiratory care treatment or evaluation for treatment and diagnostic testing, including determination of whether the signs, symptoms, reactions, behavior or general response exhibit abnormal characteristics;

(E)obtaining physiological specimens and interpreting physiological data including: CH. 12 MEDICAL PRACTICES - PART II

(i)analyzing arterial and venous blood gases;

(ii)assessing respiratory secretions;

(iii)measuring ventilatory volumes, pressures, and flows;

(iv)testing pulmonary function;

(v)assessing and making suggestions for modifications in the treatment regimen based on abnormalities, protocols or changes in patient response to respiratory care treatment;

(vi)providing cardiopulmonary rehabilitation, including respiratory care-related educational components, postural drainage, chest physiotherapy, breathing exercises, aerosolized administration of medications, and equipment use and maintenance;

(vii)instructing patients and their families in techniques for the prevention, alleviation and rehabilitation of deficiencies, abnormalities and diseases of the cardiopulmonary system; and

(viii)transcribing and implementing physician orders for respiratory care services;

(F)services within the training and experience of the practitioner; and

(G)services within the parameters of the laws, rules and standards of the facilities in which the respiratory care practitioner practices.

(4)Respiratory care services provided by a licensed Registered Respiratory Therapist, whether delivered in a health care facility or the patient’s residence, must not be provided, except upon referral from a physician.