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Keeping Pace: Essential Priorities for Programs & Practice PowerPoint PPT Presentation


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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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Keeping Pace: Essential Priorities for Programs & Practice

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Keeping pace essential priorities for programs practice l.jpg

Keeping Pace: Essential Priorities for Programs & Practice

Pat Comoss RN, BS, FAACVPR


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Purpose

  • Assess program status

  • Identify strengths & weaknesses

  • Prepare a priority driven Action Plan for performance improvement


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Purpose

  • unravel red tape

  • set realistic goals


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Definitions

  • Pace = rate of progress or performance

  • Priority = meriting attention before competing alternatives

    Merriam-Webster’s Collegiate Dictionary,

    11th ed. 2004


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Pacesetters


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Medicare

Rationale = regulatory compliance

  • to stay out of jail

  • to get paid


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Medicare

  • CR & PR are paid “incident to physician services”

  • staff-physician-patient interaction “periodically & sufficiently often” during course of rehab


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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


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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


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Medical Evaluation

Who:

referring physician

Medical Director

What:

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

Medicare Priorities


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Physician Orders

NOT just referral, NOT one-time sig.:

admission & emergency

exercise prescrip- tion & risk stratification

discharge/follow-up

Medicare Priorities


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Office Visit Records

Either/or

send completed form from rehab

retrieve progress note from office

Medicare Priorities


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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


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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


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Pacesetters


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Joint Commission on Accreditation of Healthcare Organizations

Rationale = institutional credibility

  • to improve image

  • to get paid


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JCAHO Substitutes

State Department of Health (DOH)


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JCAHO Priorities

National Patient Safety Goals


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Improve the accuracy of patient identification

When providing any treatment, need 2 identifiers:

name & DOB

provided by patient

on each visit

NPSG #1


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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


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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


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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


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Reduce the risk of health-care associated infections

Hand hygiene = staff & patients

wound assessment & precautions = surgical & diabetic

special precautions for immune suppressed

NPSG #7


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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


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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


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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


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Pain is assessed in all patients

At intake:

comprehensive assessment

Each visit:

re-assess & note

presence/absence

treatment plan

Pain (PC 8.10)


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Pacesetters


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AACVPR Program Certification

Rationale = peer review/comparison

  • to confirm program quality

  • ?? to get paid


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Certification Purpose

Peer Review:

To assure that programs meet essential standards of care


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Annual staff competencies

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

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

Certification Tab 1


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Outcomes Assessment /Program Evaluation

Outcome Domains:

health = QOL

clinical = functional status (6’ walk)

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

Certification


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Outcomes Assessment /Program Evaluation

service outcome = patient satisfaction measurement

Ongoing process, integrated into patient care

Certification


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Feedback to Physicians

Entry/thank you letter

Office Visit report

change in condition report

discharge summary

drop-out letter

Certification


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Care/Treatment Plan

Medical orders

Staff interventions

exercise

education

nutrition

psychosocial

Patient goals

Certification


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Medical Emergency Plans & Preparations

Emergency orders/ treatment protocols:

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

regular emergency drills & mock codes

Certification


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Physician Orders

Rehab referral

Exercise Rx: :

F = frequency

I = intensity

T = type, mode

T = time, duration

Plan for progression

Certification


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Untoward Events

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

aborts exercise

and/or

requires medical advice/treatment

Certification


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Pacesetters


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Summary: Priorities I


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Summary: Priorities II


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Summary: Priorities II


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