CHAPTER 265
PRACTICE OF RESPIRATORY CARE PRACTITIONERS
645—265.1(152B,272C) Code of ethics.
	265.1(1) The respiratory care practitioner shall practice acceptable methods of treatment and shall not practice beyond the competence or exceed the authority vested in the practitioner by physicians.
	265.1(2) The respiratory care practitioner shall continually strive to increase and improve knowledge and skill and shall render to each patient the full measure of the practitioner’s ability. All services shall be provided with respect for the dignity of the patient, regardless of the patient’s social or economic status or personal attributes or the nature of the patient’s health problems.
	265.1(3) The respiratory care practitioner shall be responsible for the competent and efficient performance of assigned duties and shall expose incompetent, illegal or unethical conduct of members of the profession.
	265.1(4) The respiratory care practitioner shall hold in confidence all privileged information concerning the patient and refer all inquiries regarding the patient to the patient’s physician.
	265.1(5) The respiratory care practitioner shall not accept gratuities and shall guard against conflict of interest.
	265.1(6) The respiratory care practitioner shall uphold the dignity and honor of the profession and abide by its ethical principles.
	265.1(7) The respiratory care practitioner shall have knowledge of existing state and federal laws governing the practice of respiratory therapy and shall comply with those laws.
	265.1(8) The respiratory care practitioner shall cooperate with other health care professionals and participate in activities to promote community, state, and national efforts to meet the health needs of the public.
645—265.2(152B,272C) Intravenous administration. Starting an intravenous line or administering intravenous medications is not considered a competency within the scope of a licensed respiratory care practitioner. However, this rule does not preclude a licensed respiratory care practitioner from performing intravenous administration under the auspices of the employing agency if formal training is acquired and documented.
645—265.3(152B,272C) Polysomnography testing. Rescinded IAB 8/15/07, effective 9/19/07.
645—265.4(152B,272C) Setup and delivery of respiratory care equipment.
	265.4(1) Unlicensed personnel may deliver, set up, and test the operation of respiratory care equipment for a patient but may not perform any type of patient care. Instruction or demonstration of the equipment shall be limited to its mechanical operation (on and off switches, emergency button, cleaning, maintenance). Any instruction or demonstration to the patient regarding the clinical use of the equipment, the fitting of any device to the patient or making any adjustment, or any patient monitoring, patient assessment, or other procedures designed to evaluate the effectiveness of the treatment must be performed by a licensed respiratory therapist or other licensed health care provider allowed by Iowa law.
	265.4(2) Respiratory care equipment includes but is not limited to:
	a. 	Positive airway pressure (continuous positive airway pressure and bi-level positive airway pressure) devices and supplies;
	b. 	Airway clearance devices;
	c. 	Invasive and noninvasive mechanical ventilation devices and supplies;
	d. 	Nasotracheal and tracheal suctioning devices and supplies;
	e. 	Apnea monitors and alarms and supplies;
	f. 	Tracheostomy care devices and supplies;
	g. 	Respiratory diagnostic testing devices and supplies, including but not limited to pulse oximetry, CO2 monitoring, and spirometry devices and supplies; and
	h. 	Pulse-dose or demand-type oxygen conserving devices or any oxygen delivery systems beyond the capabilities of a simple mask or cannula or requiring particulate or molecular therapy in conjunction with oxygen.
[ARC 0537C, IAB 12/26/12, effective 1/30/13]
645—265.5(152B,272C) Respiratory care as a practice. “Respiratory care as a practice” means a health care profession, under medical direction, employed in the therapy, management, rehabilitation, diagnostic evaluation, and care of patients with deficiencies and abnormalities that affect the pulmonary system and associated aspects of cardiopulmonary and other systems’ functions, and includes, but is not limited, to the following direct and indirect respiratory care services that are safe, of comfort, aseptic, preventative, and restorative to the patient:
	1.	Observing and monitoring signs and symptoms, general behavior, reactions, and general physical responses to respiratory care treatment and diagnostic testing.
	2.	Determining whether the signs, symptoms, behavior, reactions, or general responses exhibit abnormal characteristics.
	3.	Performing pulmonary diagnostic testing.
	4.	Analyzing blood gases and respiratory secretions.
	5.	Measuring and monitoring hemodynamic and physiologic function related to cardiopulmonary pathophysiology.
	6.	Performing diagnostic and testing techniques in the medical management of patients to assist in diagnosis, monitoring, treatment, and research of pulmonary abnormalities, including measurement of ventilatory volumes, pressures, and flows; and collection of specimens of blood and from the respiratory tract.
	7.	Administering:
	●	Medical gases, aerosols, and humidification, not including general anesthesia.
	●	Lung expansion therapies.
	●	Bronchopulmonary hygiene therapies.
	●	Hyperbaric therapy.
	●	Pharmacologic and therapeutic agents necessary to implement therapeutic, disease prevention, pulmonary rehabilitative, or diagnostic regimens prescribed by a licensed physician, surgeon, or other qualified health care professional prescriber.
	8.	Maintaining natural and artificial airways.
	9.	Without cutting tissues, inserting and maintaining artificial airways.
	10.	Initiating, monitoring, modifying and discontinuing invasive or noninvasive mechanical ventilation.
	11.	Performing basic and advanced cardiopulmonary resuscitation.
	12.	Performing invasive procedures that relate to respiratory care.
	13.	Implementing changes in treatment regimen based on observed abnormalities and respiratory care protocols to include appropriate reporting and referral.
	14.	Managing asthma, COPD, and other respiratory diseases.
	15.	Performing cardiopulmonary rehabilitation.
	16.	Instructing patients in respiratory care, functional training in self-care and home respiratory care management and promoting the maintenance of respiratory care fitness, health, and quality of life.
	17.	Performing those advanced practice procedures that are permitted within the policies of the employing institution and for which the respiratory care practitioner has documented training and demonstrated competence.
	18.	Managing the clinical delivery of respiratory care services through the ongoing supervision, teaching, and evaluation of respiratory care.
	19.	Transcribing and implementing a written, verbal, or telephonic order from a licensed physician, surgeon, or other qualified health care professional prescriber pertaining to the practice of respiratory care.
[ARC 1453C, IAB 5/14/14, effective 6/18/14]
These rules are intended to implement Iowa Code chapters 147, 152B, and 272C.
[Filed 9/26/02, Notice 5/29/02—published 10/16/02, effective 11/20/02]
[Filed 7/23/07, Notice 5/23/07—published 8/15/07, effective 9/19/07]
[Filed ARC 0537C (Notice ARC 0221C, IAB 7/25/12), IAB 12/26/12, effective 1/30/13]
[Filed ARC 1453C (Notice ARC 1255C, IAB 12/25/13), IAB 5/14/14, effective 6/18/14]