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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

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

  • Pace = rate of progress or performance

  • Priority = meriting attention before competing alternatives

    Merriam-Webster’s Collegiate Dictionary,

    11th ed. 2004


Pacesetters


Medicare

Rationale = regulatory compliance

  • to stay out of jail

  • to get paid


Medicare

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

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


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


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


Medical Evaluation

Who:

referring physician

Medical Director

What:

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

Medicare Priorities


Physician Orders

NOT just referral, NOT one-time sig.:

admission & emergency

exercise prescrip- tion & risk stratification

discharge/follow-up

Medicare Priorities


Office Visit Records

Either/or

send completed form from rehab

retrieve progress note from office

Medicare Priorities


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


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


Pacesetters


Joint Commission on Accreditation of Healthcare Organizations

Rationale = institutional credibility

  • to improve image

  • to get paid


JCAHO Substitutes

State Department of Health (DOH)


JCAHO Priorities

National Patient Safety Goals


Improve the accuracy of patient identification

When providing any treatment, need 2 identifiers:

name & DOB

provided by patient

on each visit

NPSG #1


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


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


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


Reduce the risk of health-care associated infections

Hand hygiene = staff & patients

wound assessment & precautions = surgical & diabetic

special precautions for immune suppressed

NPSG #7


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


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


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 is assessed in all patients

At intake:

comprehensive assessment

Each visit:

re-assess & note

presence/absence

treatment plan

Pain (PC 8.10)


Pacesetters


AACVPR Program Certification

Rationale = peer review/comparison

  • to confirm program quality

  • ?? to get paid


Certification Purpose

Peer Review:

To assure that programs meet essential standards of care


Annual staff competencies

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

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

Certification Tab 1


Outcomes Assessment /Program Evaluation

Outcome Domains:

health = QOL

clinical = functional status (6’ walk)

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

Certification


Outcomes Assessment /Program Evaluation

service outcome = patient satisfaction measurement

Ongoing process, integrated into patient care

Certification


Feedback to Physicians

Entry/thank you letter

Office Visit report

change in condition report

discharge summary

drop-out letter

Certification


Care/Treatment Plan

Medical orders

Staff interventions

exercise

education

nutrition

psychosocial

Patient goals

Certification


Medical Emergency Plans & Preparations

Emergency orders/ treatment protocols:

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

regular emergency drills & mock codes

Certification


Physician Orders

Rehab referral

Exercise Rx: :

F = frequency

I = intensity

T = type, mode

T = time, duration

Plan for progression

Certification


Untoward Events

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

aborts exercise

and/or

requires medical advice/treatment

Certification


Pacesetters


Summary: Priorities I


Summary: Priorities II


Summary: Priorities II


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