West Virginia
Board of Respiratory Care
     

LPN in the Practice of Respiratory Care

10/17/2008

On May 10, 2004, our board provided the WV Medicaid Division with our position on the issue of Licensed Practical Nurses performing services in regard to the practice of respiratory care. At the time the initial statement was issued our board performed a review of the Licensed Practical Nurse’s curriculum in an effort to determine the elements of education that were equivalent to the education a Respiratory Therapist receives. The findings of the Board include the following;

  1. The Licensed Practical Nurse with training in pharmacology has sufficient training to deliver medications via nebulizer upon the written medical order of a physician or others with prescriptive authority.
  2. The Licensed Practical Nurse has sufficient training for use of low flow oxygen devices, specifically simple oxygen delivery via nasal cannula.
  3. There was not sufficient evidence to support the Licensed Practical Nurse in the set up and delivery of care for more complex respiratory care devices, such as, positive pressure and negative pressure devices to include the following:
  1. CPAP devices
  2. Bi-Level devices
  3. Non invasive mechanical ventilation.
  4. Mechanical ventilation via tracheotomy tube.
  5. Mechanical ventilation via endotracheal tube.
  6. Intermittent positive pressure breathing devices.
  7. Intra-pulmonary percussive ventilation.
  8. Negative pressure devices.
The West Virginia Board of Respiratory Care recognizes the above procedures (a-h) to be within the practice of a Licensed Respiratory Therapist. The scope reads "Practice of respiratory care" means the practice of respiratory care, and any part of respiratory care, by persons licensed under the provisions of this article and shall be limited to that which has been learned through formal or special training including performance evaluation to evaluate competence. The practice of respiratory care may be performed in any clinic, hospital, skilled nursing facility, private dwelling or other place deemed appropriate or necessary by the board in accordance with the prescription or verbal orders of a licensed physician or other legally authorized person with prescriptive authority, or under the direction of a qualified medical director. Practice of respiratory care includes, but is not limited to:
  1. The administration of pharmacological, diagnostic therapeutic agents related to respiratory care procedures necessary to implement a treatment, disease prevention, pulmonary rehabilitative or diagnostic regimen prescribed by a physician;
  2. Transcription and implementation of written or verbal orders of a physician or other legally authorized person with prescriptive authority, pertaining to the practice of respiratory care;
  3. Observing and monitoring signs and symptoms, general behavior, general physical response to respiratory care treatment and diagnostic testing, including determination of whether such signs, symptoms, reactions, behavior or general response exhibit abnormal characteristics;
  4. Based on observed abnormalities, appropriate reporting, referral or implementation of respiratory care protocols or changes in treatment pursuant to the written or verbal orders of a person with prescriptive authority under the laws of the state of West Virginia; or The initiation of emergency procedures under the regulations of the board or as otherwise permitted in the article.
  5. The WV Board of Examiners For Licensed Practical Nurses has accepted the WV Board of Respiratory Care’s position in regard to the use of LPN’s in the practice of respiratory care; 10/2008.