Using
Certification
for
Program
Improvement
Gayla Oakley RN, FAACVPR
Dir. Cardiology Services and Prevention
Boone County Health Center
Albion, Nebraska
Objectives
1.
Understand the certification application and
requirements.
2.
Identify the importance of program
certification.
3.
Identify methods or process of improving
your program through certification
The AACVPR Cardiac and Pulmonary
Rehabilitation Program Certification process
is the only
peer
reviewed
accreditation
process
designed to review individual
process
designed to review individual
programs for adherence to standards and
guidelines developed and published by the
AACVPR and other professional societies.
For the purposes of AACVPR Certification…
A
program
must
comply
with
current
standards
and
guidelines
as
approved
by
the
AACVPR
Board
of
Directors.
The certification committee’s role is to measure your
program according to these standards
.
Certification
AACVPR Program Certification is valid for a period
of three (3) years with the expectation that all stated
program certification requirements will be adhered to
th
h t th
ti
i d
throughout the entire period.
Because you were certified does not mean that the
information that you submitted last time will be
automatically accepted for the next recertification.
The requirements change from year to year as
research and guidelines change
.
Be
Prepared
BEFORE You
Apply
Certification is for Early Outpatient Cardiac or
Pulmonary rehabilitation.
Your program must be in operation for one year prior
to appl ing
to applying.
In order to participate in the AACVPR Program
Certification process, you must have a current
AACVPR member within your program.
Review the application content and requirements.
Certification and Recertification applications are now
identical.
Check the certification application resource page and and the
following available resources on the
AACVPR
website
www.aacvpr.org
•Position Papers
•Scientific Statements
If
You’re
Not
SURE…
Scientific Statements •Guidelines •JCRP •Cardiac and Pulmonary Rehab Fundamentals •Certification Application Resource Page •Application Manual •Application Webcast •FAQ Section •Discussion Forum •Members Only Section •Enhanced educational opportunities
The
Application
Staff
Competency
AACVPR defines
competency as skills,
knowledge and critical
thinking required to operate
effectively in a Cardiac or
Pulmonary program.
y p g
For the purposes of
certification must provide
evidence of annual
assessment of
clinical/professional staff
for competency and specific
to CR/PR rehab
•Ways to assess competency Check off stations, Test/quizzes, Return demonstration, Article review with post testStaff
Competency
Core
Competencies
(New for 2012)
Individuals who provide cardiac or
pulmonary rehab services should possess a
common core of professional and clinical
competencies, regardless of their academic
discipline.
For the purposes of AACVPR Program
Certification programs must provide evidence
of a
minimum
of
two
assessed competencies
specific to the Core Competencies
Core
Competencies
Cardiac
“Core Competencies for Cardiac
Rehabilitation/Secondary Prevention
Rehabilitation/Secondary Prevention
Professionals: 2010 Update”
.
Core
Competencies
Cardiac
Patient assessment
Nutritional counseling
Weight management
Blood pressure management
Blood pressure management
Lipid management
Diabetes management
Tobacco cessation
Psychosocial management
Physical activity counseling
Exercise training evaluation
Core
Competencies
Pulmonary
“Clinical Competency Guidelines for
Pulmonary Rehabilitation Professions”
Pulmonary Rehabilitation Professions
.
Core
Competencies
Pulmonary
(1)
Assessment
:
–
Pathophysiology
and
comorbidity
–
Professional
communication
(2)
Intervention:
–
Professional
communication
–
Patient
education
and
training
–
Patient
education
and
training
–
Exercise
–
Psychosocial
g
–
Exercise
–
Psychosocial
–
Emergency
procedures
(3)
Outcome
evaluation
and
follow
up
Staff
Competency
Requirements
Competencies must be assessed for all
professional/clinical staff who directly report to the
Cardiac or Pulmonary Rehab director or manager.
Staff competencies must be submitted in the
required
table
format.
Staff listed on the submitted Staff Competency Table
must match the clinical staff members listed on the
Program Intake Form exactly.
You do not need to report competencies for the
program medical director, ancillary or administrative
staff, or consultants.
A minimum of two assessed competencies specific to
the Core Components
Name of Employee Competency with Date Competency with Date Competency with Date Competency with Date
Angie Swantek EKG Quiz 5/5/2011
Glucometer return demo 6/15/2011
Waist circ return demo 7/20/2011
Crash cart scavenger hunt 8/9/2011 Janet Feik EKG Quiz
5/5/2011
Glucometer return demo 6/15/2011
Waist circ return demo 7/20/2011
Crash cart scavenger hunt 8/9/2011 Sharon Kunzman EKG Quiz Glucometer return Waist circ return Crash cart
Required
Table
Format
for
Staff
Competencies
Sharon Kunzman EKG Quiz 5/5/2011
Glucometer return demo 6/15/2011
Waist circ return demo 7/20/2011
Crash cart scavenger hunt 8/9/2011 Cindi Oberhauser EKG Quiz
5/5/2011
Glucometer return demo 6/15/2011
Waist circ return demo 7/20/2011
Crash cart scavenger hunt 8/9/2011
Abbie Nelson EKG Quiz
5/5/2011
Glucometer return demo 6/15/2011
Waist circ return demo 7/20/2011 Crash cart scavenger hunt 8/9/2011
Staff
Competency
Automatic
Denial
DO
NOT:
Submit general emergency, safety drills and in‐services in the hospital facility, such as fire drills, infection control, safety inspections or health and safety reviews. Submit documentation outside the stated date range. Submit competencies not specific to cardiac or pulmonary rehab. Fail to submit a min. of two core competencies. Submit competencies that are not in the required table format AND do not match staff on Program Intake Form. Fail to respond to reviewer clarification questions within three business days.What
is
an
Individualized
Treatment
Plan?
Summary of the planned
care of the patient from
initial assessment to
discharge from the Cardiac
P l
or Pulmonary
Rehabilitation program.
For the purpose of
certification/recertificatio
n the ITP must be
developed and completed
for each patient in the
CR/PR program and must
include all components
.
Individual
Treatment
Plan
(ITP)
Requirements
Upload
COMPLETED
Cardiac or Pulmonary ITP that
is HIPAA compliant
ITP
t b
i l
d
t (It d
t
d t
ITP must be a
single
document . (It does not need to
be one page.)
ITP must be for an actual patient that has completed
all required components
Assessment and reassessment scores must be on the
ITP, do not submit assessment tools.
ITP must be completed in the data collection period
Must
Include
the
Following
Clearly
Labeled
Components
Education
Assessment EducationIntervention EducationReassessment EducationDischarge
Exercise Exercise Exercise Exercise Exercise
Assessment ExerciseIntervention ExerciseReassessment ExerciseDischarge Nutrition
Assessment NutritionIntervention NutritionReassessment NutritionDischarge Psychosocial
Assessment PsychosocialIntervention PsychosocialReassessment PsychosocialDischarge
Individual
Treatment
Plan
(ITP)
Automatic Denial
DO
NOT
Submit a blank ITP or one competed that was not an actual patient.
Submit an ITP that did not contain all of the 16 required
Submit an ITP that did not contain all of the 16 required components that are clearly labeled Submit multiple documents i.e. assessment tools, letters to physicians/patients., progress notes, etc. Submit check boxes only indicating done but no data given. Submit ITP that is dated outside the collection period Fail to respond to reviewer clarification questions within three (3) business days.
Assessment Psychosocial Intervention Psychosocial Evaluation Psychosocial Follow-up Psychosocial Assessment Nutrition Assessment Education Intervention Nutrition Evaluation Nutrition Follow-up Nutrition Evaluation Nutrition Follow-up Education Evaluation Education Intervention Education Assessment Education
Emergency
Preparedness
(Cardiac)
CARDIAC REHAB: For the purpose of AACVPR certification, the
following emergency equipment and supplies must be immediately
available to Cardiac Rehab and documentation maintained of
verification of readiness preformed every day the rehab program is
in operation. Calling 911/EMS alone to bring these
supplies/medications is not acceptable.
Defibrillator/AED Portable oxygen, tubing, mask/nasal cannula Intubation equipment and advanced airways Crash cart with emergency equipment and ACLS medications. pp / p
Emergency
Preparedness
(Pulmonary)
PULMONARY REHAB: For the purpose of AACVPR certification,
the following emergency equipment and supplies must be
immediately available to Pulmonary Rehabilitation unit and
documentation maintained of verification of readiness preformed
every day the rehab program is in operation. Calling 911/EMS alone
to bring these supplies/medications is not acceptable.
Defibrillator/AED Oxygen source and delivery apparatus Resuscitation mask (Ambu bag) Ability to monitor oxygen saturation (pulse oximeter) Bronchodilator medications Glucose g pp / p
Emergency
Preparedness
Requirements
One (1) month's documentation of daily verification of readiness for each day the program is in operation. An explanation should be provided for any missing dates during that month. For each equipment/supply listed, indicate where the item is l t d i l ti t th C di P l R h bilit ti located in relation to the Cardiac or Pulmonary Rehabilitation unit. Evidence of four (4) annual department medical emergency in‐ services specific to Cardiac or Pulmonary Rehabilitation held during the data collection period. Brief description of medical emergency in‐service Submitted in‐services may include mock code blues, review of crash cart/defibrillator, critique of an actual code, etc.Emergency
Preparedness
Automatic Denial
DO NOT: Fail to haveallrequired emergency supplies and equipment immediately available to the Cardiac or Pulmonary Rehabilitation unit. Fail to provide the location in relation to the rehab unit of each required equipment/supply. q q p / pp y Fail to submit one (1) month's documentation of verification of operational readiness with explanation of missing dates. Fail to submit dates and brief description of four (4) medical emergency in‐services. Submit general hospital emergency and safety drills and in‐ services such as fire drills, infection control, safety inspections, or health and safety reviews. Submit documentation out of the data collection period; Fail to respond to reviewer clarification questions within three (3) business days.
Date Brief description of medical emergency in‐service
Date Brief description of medical emergency in‐service
Medical Emergency In‐service
Date Brief description of medical emergency in‐service
Date Brief description of medical emergency in‐service
Policies
and
Procedure
Requirements
Documentation that policies and procedures specific
to Cardiac or Pulmonary Rehabilitation have been
i
d
ll b th
di l di
t
reviewed annually by the program medical director
and director/coordinator/manager during the
collection period.
Policies
and
Procedure
Automatic Denial
DO
NOT:
Fail to submit evidence that department policies are
reviewed
annually.
y
Fail to submit evidence that department policies are
reviewed by the medical director and program
director, coordinator, manager.
Fail to respond to reviewer clarification questions
within
three
(3)
business
days.
Submit documentation that is not in the collection
period.
Example
of
P&P
Signature
Page
REVIEW OF CARDIOPULMONARY REHAB POLICIES & PROCEDURES Policies & Procedures are to be reviewed annually. The Medical Director and the Cardiopulmonary Rehab Manager will share responsibilities for the review.Month/Year Reviewed Medical Director Manager ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________
Exercise
Prescription
The exercise prescription is individualized, approved by the physician for each CR/PR patient and it must contain all required elements; mode, frequency, duration, intensity and progression. In addition to required elements, O2 saturation and titration for pulmonary rehab patients only . The Ex Rx can be a component of the Individual Treatment Plan but it p must be submitted for both the ITP (page1) AND the exercise prescription (page 5). A written policy must be in place that details how an exercise prescription is developed and modified for each patient. The policy must contain all required element of the exercise prescription; mode, frequency, duration, intensity, progression plus oxygen saturation and titration for pulmonary rehabilitation.Exercise
Prescription
Requirement
Individual
Exercise
Prescription
(EX
RX)
Initial exercise prescription.
Physician signature approving the exercise prescription.
Includes mode duration frequency intensity and progression
Includes mode, duration, frequency, intensity and progression. O2 saturation and titration for PR patients only. Intensity targets must be within AACVPR and ACSM guidelines Progression must be more specific than “as tolerated” or “as dictated by absence of signs and symptoms” The document called the Exercise Prescription from a telemetry monitoring system , MUST include all required elements of the exercise prescription. Completed and for an actual patient . Completed during the data collection period
Exercise
Prescription
Requirement
Exercise
Prescription
Policy
Describes in detail how all required elements of the
exercise prescription listed above are developed and
modified.
Exercise
Prescription
Components
Mode: – Bike, Treadmill, Elliptical Intensity: – How hard (heart rate range, RPE, Mets) Intensity targets must be within AACVPR and ACSM published guidelines Duration:Duration: – How long Frequency: – How often Progression: ‐ How do you advance the patients. Need some type of methodology. “As tolerated” or “as per clinical signs and symptoms” is not accepted. Oxygen Saturation and Titration (Pulmonary only) ‐ Risk DeterminedLow Risk Moderate Risk High Risk
Progression
Pattern
Based
on
Risk
Stratification
and
LOS
Up to 60% of Maximum HR
Up to 80% of
Maximum HR Up to 70% of Maximum HR
Initial Duration
45 Minutes Initial Duration 35 minutes Initial Duration25 minutes
Duration/Intensity change every 3 sessions Duration/Intensity change every 6 sessions Duration/Intensity change every 9 sessions Weight training
Exercise
Prescription
Automatic Denial
DO
NOT
Fail to submit any of the required components of the
exercise prescription.
Submit blank or not for an actual patient in your
program.
Fail to have evidence of physician signature.
Fail to submit a policy that addresses all components
of the exercise prescription.
Submit daily exercise session sheets only.
Submit document outside of the data collection
period.
Fail to respond to reviewer clarification questions
within three business days.
Medical
Emergencies
For the purposes of AACVPR
certification/recertification, written
program
specific
policies/protocols for the following:
Cardiopulmonary Arrest
Angina
Acute Dyspnea
Tachycardia
Bradycardia
Hypertension
Hypotension
Hyperglycemia
Hypoglycemia
Medical
Emergencies
Requirement
A department specific policy addressing all of the medical emergency conditions. They can be in separate policies/protocols for each specific condition or in one combined policy. Policies specific to Cardiac or Pulmonary Rehabilitation.p y Medical emergency policies must be detailed beyond calling 911 Policies specific to the role of the Cardiac or Pulmonary Rehabilitation staff in managing the emergency situation. Medical emergency policies must address the treatment of the patient from onset of signs and symptoms until resolution of the emergency (transfer to ED, hospital admission, resolution of symptoms, discharge home, etc.Medical
Emergencies
Automatic Denial
DO
NOT:
Submit department policies addressing all of the
medical emergency conditions.
Submit policies that do not include specific details
related to staff involvement in treatment activities.
Submit policies that are ACLS
protocols/algorithms
only.
Fail to respond to reviewer clarification questions
within three business days
Outcome
Assessment
Outcome measures are tests to evaluate if a desired end is met. They can be used to evaluate individual patient progress, to determine overall effectiveness of the program.
Cardiac outcome categories:
–Clinical
–Behavioral
–Health
–Service
Pulmonary outcome categories:
–Functional status/exercise capacity
–Symptoms Measurement
–Quality of Life
Outcome
Assessment
Cardiac
Clinical Clinical outcomes measure objective clinical data, such as MET level, BMI, lipid levels, (6) six minute walk results, blood pressure, etc. Behavioral Behavioral outcomes measure the patient’s ability to make changes in life style: minutes of exercise, knowledge test, diet changes, number of cigarettes smoked Health Health outcome measure changes in health/quality of life status: Quality of Life survey (QOL) Service Service outcomes can measure: patient satisfaction, effectiveness of program, access or utilization of services, cost of careOutcome
Assessment
Pulmonary
Function Clinical outcomes measure objective clinical data, such as MET level, BMI, lipid levels, (6) six minute walk results, blood pressure, etc.Symptom managementdyspnea
Measurement for symptoms of dyspnea and fatigue such as Borg Measurement for symptoms of dyspnea and fatigue, such as Borg Dyspnea Scale, MRC Scale, UCSD SOBQ, CRQ, etc. Quality of Life Health outcome measure changes in health/quality of life status: Quality of Life survey (QOL) Service Service outcomes can measure: patient satisfaction, effectiveness of program, access or utilization of services, cost of care **See pulmonary outcomes toolkit or AACVPR Pulmonary Rehab Guidelines**
Cardiac
Outcomes
Requirement
Description of one clinical, behavioral, health and service outcome.
Outcome according to the AACVPR Outcomes Matrix
Document from the data collection period.
Description of the assessment tool used.
Report on a minimum of 30 patients (N). If less than 30 patients completed your program during the data collection period, submit data for completed your program during the data collection period, submit data for 100% of the patients who did complete. Pre program score. Post program score. Percent change, units of change or change towards goal between the pre‐ and post‐program scores. Conclusion , a summary of results of the outcome measurement on the pre‐and post program scores. Process or programming improvements made to CR program as a result of the outcome based on the conclusion.
Pulmonary
Outcomes
Requirement
Description of one outcome measure for each of the following; Function, Symptoms, Quality of Life and Service. Outcomes correspond with the Pulmonary Outcomes Tool Kit. Document from the data collection period. Description of the assessment tool used. Report on a minimum of 30 patients (N). If less than 30 patients completed your program during the data collection period, submit data for 100% of the patients who did complete. Pre program score. Post program score. Percent change, units of change or change towards goal between the pre‐and post‐program scores. Conclusion , a summary of results of the outcome measurement on the pre‐and post program scores. Process or programming improvements made to PR program as a result of the outcome based on the conclusion.Outcomes
Automatic Denial
DO
NOT:
Submit outcome measure that does not fall into the
Submit outcome measure that does not fall into the
appropriate category according to AACVPR outcomes
matrix or Pulmonary Tool Kit.(found on the AACVPR
web site).
Fail to meet sample size requirements.
Fail to submit any of the required elements.
Fail to respond to reviewer clarification questions
within three business days
.Service
Outcome
Required Elements –One Service outcome measured in your program during the collection period. –Description of the assessment Automatic Denial –Service measured not on AACVPR Outcomes Matrix –Not in collection period p tool used. –Summary of conclusions based on the outcome change found. –Description of process or programming improvements made to the CR/PR program as a result of the outcome. p –Failure to respond within three business days.Attestation
Statement
You must attest that all material and
information submitted with this application is
true and accurately represents program
true and accurately represents program
operations at this facility and would welcome
a site visit if randomly selected.
Submission
Here you can see a list of any pages that are incomplete. When all pages are complete, the submit
button appears.
Don’t forget to click “SUBMIT”!
Application
“Tips
For
Success”
Fill in the program roster with all staff prior to starting the application. Be sure that you have a primary and secondary contact person or you will not be able to go further on the application. All documentation will be requested with the initial application. No additional or newly created documentation will be allowed after the application is submitted.pp Only submit what is asked for. More is not always better. When documentation is required, there are two options for submitting that information; fax or upload. FAX:A fax cover sheet with the barcode, specific for that page, will be provided when you click on “fax information”. BE SURE that you do not use the same fax sheet for each page. The barcodes are page specific. If the document goes to the wrong page, you may not get credit for it. UPLOAD: Upload documents via an attachment when you can. The document is clearer and easier to review.
Application
“Tips
For
Success”
All submitted documentation must be HIPAA compliant
with all patient identifiable information blacked out or
removed, including patient name, date of birth, medical
record number, admission number, address, phone
number, spouse’s name, etc.
All
b i
d d
i
b
l
i
All submitted documentation must be actual patient
and/or program documentation. Blank sample forms
will not be accepted.
Submitted documentation should be neat and legible,
with correct spelling and grammar.
There are text boxes for required narratives. Keep it
brief and concise. There is a maximum number of
character allowed
.
Application
“Tips
For
Success”
The following automated message will be sent when the review of your application has started.
I have begun the review of your AACVPR Program Certification application. Please check your dashboard daily as you
b t t d lti l ti d i th t 2 3 k If
may be contacted multiple times during the next 23 weeks. If you
are asked to clarify, you need to respond to that request within three (3) business days. We recommend that you authorize a second person within your staff to also be able and available to
respond to these requests. Failure to do so could result in
automatic denial of your program.
An automated message will be sent when the initial review is completed.
Application
“Tips
For
Success”
If you have questions while completing the application
and can’t locate the answer, Certification Specialists are
available Monday through Friday during business hours
t
i t
li
t b
il li
h t
to assist applicants by email, live chat, or you can
contact the call center 312/321‐5146, option 1
Application fee for certification and recertification will
be set annually by the AACVPR Board of Directors
All application fees must be paid in full by the final
application submission deadline. The application will
not be reviewed without payment.
Application
“Tips
For
Success”
All applications must be received by the application
submission deadline. No extensions will be granted.
All applications must be submitted online via the AACVPR
Certification Center.
All communication between the applicant and reviewer will
be via the application dashboard.
Applicants must respond to reviewer questions regarding
their application within three (3) business days.
Printable versions of the current year’s application will be
available on the AACVPR website.
When a required table or form format is required there will
be a link in the application to obtain the form
APPROVALS
AND
DENIALS
The AACVPR Program Certification Committee shall
recommend approval or denial of the application to the
AACVPR Board of Directors.
Prior to the denial of a program, the inter‐rater reliability
testing process will be followed. It is utilized in the
certification process in order to assess the consistent
evaluations of the same application. This strengthens the
certification process and helps assure reliability of the review.
Individual programs recommended for denial
may
not
appeal.
The AACVPR Program Certification Committee reserves the
right to perform a site inspection if indicated.
Importance
of
Program
Certification
1.
Provide the best program possible for your patients
AACVPR certification demonstrates that your program is aligned with current guidelines for the appropriate and effective early outpatient care of patients with cardiac or pulmonary disease outpatient care of patients with cardiac or pulmonary disease.Importance
of
Program
Certification
2. Patient referral/enrollment
Physicians can refer patients to your certified program with confidence, knowing that you can be an extension of their care to the patient. Certification offers peace of mind to knowledgeable healthcare p g consumers. Certification can also help patients decide between your program and an uncertified program in the area. Patients and family members can feel confident in knowing that your staff has the experience and skills necessary to deal with the variety of issues that a life‐changing cardiac or pulmonary diagnosis can lead to.Importance
of
Program
Certification
3.
Recognition
Hospital administrators embrace program certification as a vehicle to demonstrate excellence for state department of health or TJC surveyors.Importance
of
Program
Certification
4.Reimbursement
Insurance companies recognize that performance measures in patient care are part of the essential standards required for AACVPR certification.Tips
for
Success
READ
the
entire
application
before
you
begin
the
process.
Be
prepared
BEFORE
you
apply.
Remember
that
this
is
a
CERTIFICATION
process,
not
a
MENTORING
process.
Take
advantage
of
all
the
available
RESOURCES.
The
application
and
requirements
may
CHANGE
every
year.