Keeping Pace: Essential Priorities for Programs & Practice

1. Keeping Pace: Essential Priorities for Programs & Practice Pat Comoss RN, BS, FAACVPR

2. Purpose • Assess program status • Identify strengths & weaknesses • Prepare a priority driven Action Plan for performance improvement

3. Purpose • unravel red tape • set realistic goals

4. Definitions • Pace = rate of progress or performance • Priority = meriting attention before competing alternatives Merriam-Webster’s Collegiate Dictionary, 11th ed. 2004

5. Pacesetters

6. Medicare Rationale = regulatory compliance • to stay out of jail • to get paid

7. Medicare • CR & PR are paid “incident to physician services” • staff-physician-patient interaction “periodically & sufficiently often” during course of rehab

8. 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

9. 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

10. Medical Evaluation Who: referring physician Medical Director What: medical encounter that prompted decision to refer to/ approve rehab participation Medicare Priorities

11. Physician Orders NOT just referral, NOT one-time sig.: admission & emergency exercise prescrip- tion & risk stratification discharge/follow-up Medicare Priorities

12. Office Visit Records Either/or send completed form from rehab retrieve progress note from office Medicare Priorities

13. 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

14. 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

15. Pacesetters

16. Joint Commission on Accreditation of Healthcare Organizations Rationale = institutional credibility • to improve image • to get paid

17. JCAHO Substitutes State Department of Health (DOH)

18. JCAHO Priorities National Patient Safety Goals

19. Improve the accuracy of patient identification When providing any treatment, need 2 identifiers: name & DOB provided by patient on each visit NPSG #1

20. 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

21. 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

22. 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

23. Reduce the risk of health-care associated infections Hand hygiene = staff & patients wound assessment & precautions = surgical & diabetic special precautions for immune suppressed NPSG #7

24. 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

25. 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

26. 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

27. Pain is assessed in all patients At intake: comprehensive assessment Each visit: re-assess & note presence/absence treatment plan Pain (PC 8.10)

28. Pacesetters

29. AACVPR Program Certification Rationale = peer review/comparison • to confirm program quality • ?? to get paid

30. Certification Purpose Peer Review: To assure that programs meet essential standards of care

31. Annual staff competencies Standard skills demonstrated yearly, e.g. “skills day” Selected skills taught & performed: new, high-risk, low volume, problematic Certification Tab 1

32. Outcomes Assessment /Program Evaluation Outcome Domains: health = QOL clinical = functional status (6’ walk) behavioral = self-reported habits: smoking, diet, activity Certification

33. Outcomes Assessment /Program Evaluation service outcome = patient satisfaction measurement Ongoing process, integrated into patient care Certification

34. Feedback to Physicians Entry/thank you letter Office Visit report change in condition report discharge summary drop-out letter Certification

35. Care/Treatment Plan Medical orders Staff interventions exercise education nutrition psychosocial Patient goals Certification

36. Medical Emergency Plans & Preparations Emergency orders/ treatment protocols: arrest, arrhythmia, angina, dyspnea, extreme blood sugars or B/P regular emergency drills & mock codes Certification

37. Physician Orders Rehab referral Exercise Rx: : F = frequency I = intensity T = type, mode T = time, duration Plan for progression Certification

38. Untoward Events MD notification during rehab when: new/different S/Sx aborts exercise and/or requires medical advice/treatment Certification

39. Pacesetters

40. Summary: Priorities I

41. Summary: Priorities II

42. Summary: Priorities II