A Respiratory Therapist (RT) is a licensed medical professional specializing in the diagnosis, treatment, and management of patients with cardiopulmonary disorders, including conditions affecting the lungs and heart like asthma and Chronic Obstructive Pulmonary Disease (COPD). The direct answer to whether a standard RT can write a prescription is no. Independent prescribing authority is not included in the traditional scope of practice. The RT role focuses instead on administering physician-ordered treatments and managing respiratory support devices.
The Core Role of Respiratory Therapists
Respiratory therapists are highly specialized clinicians whose primary focus is on the mechanics and function of the patient’s breathing. Their initial training centers on advanced patient assessment techniques, such as auscultating lung sounds to identify abnormal breath patterns and interpreting complex arterial blood gas results. This diagnostic support is then used to guide the implementation of physician-ordered care.
RTs are the primary managers of life-support equipment, particularly mechanical ventilators, in critical care settings. They monitor ventilator settings, adjust pressures and volumes, and assess lung compliance to optimize the patient’s oxygenation and ventilation. They also perform various diagnostic procedures, including bedside spirometry and full pulmonary function testing, to evaluate lung capacity and airflow mechanics. Beyond the acute setting, RTs dedicate time to patient education, teaching individuals with chronic conditions how to use their inhalers correctly and manage their disease state.
Prescribing Authority and Regulatory Limitations
The ability to write a new, independent prescription is a legal authority known as prescriptive authority, which is strictly defined by state licensing boards. In most jurisdictions, this authority is exclusively reserved for physicians, advanced practice nurses, and physician assistants who have met specific, advanced educational and regulatory requirements. Respiratory therapists, while highly trained, are licensed under a scope of practice that historically does not encompass the origination of new drug orders.
This regulatory limitation ensures a clear separation between the practitioner who diagnoses and orders the treatment and the clinician who administers and manages the treatment. The educational pathway for a registered RT focuses intensely on cardiopulmonary physiology, equipment management, and drug administration, but it does not include the extensive pharmacology and differential diagnosis training required for independent prescribing.
A few states are beginning to recognize an “Advanced Practice Respiratory Therapist” (APRT). An APRT may be granted delegated prescriptive authority, though this is often restricted from controlled substances and requires continuous physician supervision.
Medication Administration Under Protocol and Delegation
While RTs cannot originate a prescription, they are intimately involved in the delivery and management of respiratory medications through standing orders and clinical protocols. A standing order is a pre-approved, physician-signed directive that allows the RT to initiate or adjust a specific therapy based on the patient’s immediate condition, using predefined clinical parameters. For example, a physician may write an order for “Bronchodilator Therapy per Respiratory Therapy Protocol.”
Under this umbrella order, the RT has the autonomy to select the drug (e.g., albuterol, levalbuterol, or ipratropium), determine the dose and frequency, and titrate the treatment based on the patient’s response. If a patient’s wheezing improves or their Peak Expiratory Flow (PEF) increases significantly, the RT may decrease the frequency of nebulized treatments according to the protocol’s discontinuation criteria.
RTs are also responsible for administering inhaled medications, such as corticosteroids and inhaled nitric oxide. They titrate medical gases, including oxygen and helium-oxygen mixtures, to maintain target saturation levels as delegated by the physician. This process is a form of delegated practice, where the RT acts as an adjuster and administrator of the prescribed treatment.