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Keeping Pace: Essential Priorities for Programs & Practice. Pat Comoss RN, BS, FAACVPR. Purpose . Assess program status Identify strengths & weaknesses Prepare a priority driven Action Plan for performance improvement . Purpose . unravel red tape set realistic goals. Definitions .

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purpose
Purpose
  • Assess program status
  • Identify strengths & weaknesses
  • Prepare a priority driven Action Plan for performance improvement
purpose3
Purpose
  • unravel red tape
  • set realistic goals
definitions
Definitions
  • Pace = rate of progress or performance
  • Priority = meriting attention before competing alternatives

Merriam-Webster’s Collegiate Dictionary,

11th ed. 2004

medicare
Medicare

Rationale = regulatory compliance

  • to stay out of jail
  • to get paid
medicare7
Medicare
  • CR & PR are paid “incident to physician services”
  • staff-physician-patient interaction “periodically & sufficiently often” during course of rehab
medicare priorities
Physician referral

Can be:

prescription form from MD office

referral form designed by program

electronic transmittal from inpatient unit

verbal order signed later

Medicare Priorities
medicare priorities9
Proof of qualifying diagnosis

Can NOT be just written on script or referral form

Must be confirmed by medical record:

discharge summary

test/procedure reprt

MD progress note

Medicare Priorities
medicare priorities10
Medical Evaluation

Who:

referring physician

Medical Director

What:

medical encounter that prompted decision to refer to/ approve rehab participation

Medicare Priorities
medicare priorities11
Physician Orders

NOT just referral, NOT one-time sig.:

admission & emergency

exercise prescrip- tion & risk stratification

discharge/follow-up

Medicare Priorities
medicare priorities12
Office Visit Records

Either/or

send completed form from rehab

retrieve progress note from office

Medicare Priorities
medicare priorities13
Report of Change in Medical Condition

MD notification during rehab when: new/different S/Sx

aborts exercise

and/or

requires medical advice/treatment

Medicare Priorities
medicare priorities14
Discharge report to “hand-off” patient to next provider

Cover letter with rehab results:

outcome sheet

discharge instruc- tions/home ex. plan

medication reconciliation

Medicare Priorities
joint commission on accreditation of healthcare organizations
Joint Commission on Accreditation of Healthcare Organizations

Rationale = institutional credibility

  • to improve image
  • to get paid
jcaho substitutes
JCAHO Substitutes

State Department of Health (DOH)

jcaho priorities
JCAHO Priorities

National Patient Safety Goals

npsg 1
Improve the accuracy of patient identification

When providing any treatment, need 2 identifiers:

name & DOB

provided by patient

on each visit

NPSG #1
npsg 2
Improve the effectiveness of communication among caregivers

“read-back” orders or test results received by phone

identify abbreviations NOT to be used

improve timeliness of reports

NPSG #2
npsg 221
Improve the effectiveness of communication among caregivers

Implement “hand-off” communications:

staff-to-staff

staff to ER

transfer = program to program

discharge = staff to physician

NPSG #2
npsg 3
Improve the safety of using medications

limit the number of drugs available outside of crash cart

label all medicine storage containers

lock when unattended

record when administered

NPSG #3
npsg 7
Reduce the risk of health-care associated infections

Hand hygiene = staff & patients

wound assessment & precautions = surgical & diabetic

special precautions for immune suppressed

NPSG #7
npsg 8
Accurately & completely reconcile medications across the continuum of care

At intake interview:

Prepare list of current meds. with patient

compare to prior official one

report discrepancies to MD

NPSG # 8
npsg 825
Accurately & completely reconcile medications across the continuum of care

During rehab:

list meds. on one form

update as changes occur

At exit interview:

verify if each is still being taken/not

NPSG # 8
npsg 9
Reduce the risk of patient harm from falls

Assess all patients for Fall Risk at intake & as needed

instruct all patients in proper use of exercise equipment

NPSG #9
pain pc 8 10
Pain is assessed in all patients

At intake:

comprehensive assessment

Each visit:

re-assess & note

presence/absence

treatment plan

Pain (PC 8.10)
aacvpr program certification
AACVPR Program Certification

Rationale = peer review/comparison

  • to confirm program quality
  • ?? to get paid
certification purpose
Certification Purpose

Peer Review:

To assure that programs meet essential standards of care

certification tab 1
Annual staff competencies

Standard skills demonstrated yearly, e.g. “skills day”

Selected skills taught & performed: new, high-risk, low volume, problematic

Certification Tab 1
certification
Outcomes Assessment /Program Evaluation

Outcome Domains:

health = QOL

clinical = functional status (6’ walk)

behavioral = self-reported habits: smoking, diet, activity

Certification
certification33
Outcomes Assessment /Program Evaluation

service outcome = patient satisfaction measurement

Ongoing process, integrated into patient care

Certification
certification34
Feedback to Physicians

Entry/thank you letter

Office Visit report

change in condition report

discharge summary

drop-out letter

Certification
certification35
Care/Treatment Plan

Medical orders

Staff interventions

exercise

education

nutrition

psychosocial

Patient goals

Certification
certification36
Medical Emergency Plans & Preparations

Emergency orders/ treatment protocols:

arrest, arrhythmia, angina, dyspnea, extreme blood sugars or B/P

regular emergency drills & mock codes

Certification
certification37
Physician Orders

Rehab referral

Exercise Rx: :

F = frequency

I = intensity

T = type, mode

T = time, duration

Plan for progression

Certification
certification38
Untoward Events

MD notification during rehab when: new/different S/Sx

aborts exercise

and/or

requires medical advice/treatment

Certification
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