AACVPR Cardiac Rehabilitation Program Certification

AACVPRCardiac RehabilitationProgram CertificationAnne M Gavic, MPA, RCEPPresident Elect,, AACVPRManager, Cardiopulmonary RehabilitationNorthwest Community Hospital

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AACVPRAmerican Association ofCardiovascular and Pulmonary RehabFounded in 1985, the American Association ofC diCardiovascularl andd PulmonaryP lRehabilitationR h bilit tiis dedicated to our mission of reducingy, mortalityy and disabilityy frommorbidity,cardiovascular and pulmonary diseasethrough education, prevention, rehabilitation,research and disease management.management Centralto the core mission is improvement in qualityof life for patients and their families.

CertificationRegistryAACVPR 20112011-12 Strategic GoalsGoal #1: Improve Use and Viability of Cardiac and PulmonaryRehabilitation and Prevention ServicesGoal #2: Enhance and Support the Quality of Cardiac and PulmonaryRehabilitation and Prevention ServicesGoal #3: To Support Strategic Goals 1 and 2Grow and Retain MembershipPerformanceMeasures

AACVPRPublications and ResourcesPUBLICATIONS: Core Competencies for Cardiac Rehabilitation / Secondary PreventionProfessionals: 2010 UpdateAACVPR / ACC / AHA 2007 Performance Measures on Cardiac Rehabilitation forReferral to and Delivery of Cardiac Rehabilitation/ Secondary PreventionServicesCore Components of Cardiac Rehabilitation / Secondary Prevention Programs:2007 UpdateMedical Directors Responsibilities for Outpatient Cardiac Rehabilitation /Secondary Prevention Programs - 2005Outcomes Evaluation in Cardiac Rehabilitation / Secondary PreventionPrograms – 2004

The Vision for Program Certification 19901990’ss–––Widespread acceptance of cardiac rehabilitationIncreased number of programs openingWidespread variability in program processes and quality State experience in certification–––Driven by reimbursementProcess templatepexistedRequest for national oversite 1995 - Clinical Practice Guidelines for CardiacR h bilit tiRehabilitation– Revealed significant benefit from Cardiac Rehab Functional / Clinical / Behavioral / Psychosocial– Benefits dependent on multidisciplinary / multifaceted program

1995 - AACVPRProgram Certification Task Force Investigate Program Certification – goals and benefitsDefine “quality”quality and “standardization”standardizationRecommend foundation of certificationDevelop process and content

1998AACVPR CertificationC tifi tiProcessPBeganBThe AACVPR Cardiac Rehabilitation ProgramC tifi tiCertificationprocess:The only peerpeer-reviewedreviewed accreditation processdesigned to review individual programs for adherenceto standards and guidelines developed and publishedby the AACVPR and other professional societies.societies

Grounded in Research andGuidelines AACVPR Guidelines for Cardiac Rehabilitation, 4th editionAACVPR Core Competencies for CR Professionals, 2010Clinical Practice Guidelines for Cardiac Rehabilitation and SecondaryPrevention, 1995AACVPR / ACC / AHA 2007 Performance Measures on CardiacRehabilitationAACVPR Consensus Statement: Outcomes Evaluation in CR/ SecondaryPrevention Programs, 2004AACVPR CR Resource ManualAACVPR Position Paper: Medical Director Responsibilities for OutpatientCR / Secondary Prevention Programs 2005AHA / ACCF Secondary Prevention and Risk Reduction Therapy forPatients with Coronary and Other Atherosclerotic Cardiovascular Disease:2011 UpdateACSM Guidelines for Graded Exercise Testing and PrescriptionACSM Resource Manual for Guidelines for Exercise Testing andPrescription

Goals of Program Certification Align programs with evidence- based medicine and standards of careImprove clinical practice and quality of carePromote standard outcome measurementsAdvance the Multidisciplinary processP o ide evidenceProvidee iden e of CR staff competencyompetenFavorably influence reimbursementEstablish “bestbest practice”practice programming

The Review ProcessFor “early outpatient” (Phase II) programsVoluntaryMust have 1 AACVPR Member on staffProgram operational 1 yearE h separateEacht facilityf ilit mustt applyl individuallyi di id llPeer ReviewOnsite Review OptionCertification Recommended by the ReviewCommittee and Granted by Board of Directors Valid for 3 years Certification and Recertification applications arenow identical. Application fee for certification and recertificationwillill beb sett annuallyll byb theth AACVPR BBoardd offDirectors

Application “TipsTips For SuccessSuccess” All applications submitted online via the AACVPR Certification Center by the application submission deadlineAll documentation requested with the initial application. Noadditional or newly created documentation will be allowedafter the application is submitted.When documentation is required, there are two options forsubmitting that information; fax or upload.uploadAll submitted documentation must be HIPAA compliant (allpatient identifiable information blacked out or removed)All documentationdt timustt beb actualt l patientti t and/ord/ programdocumentation. Blank sample forms will not be accepted.Applicants must respond to reviewer questions regardingtheir application within three (3) business days.

A li tiApplicationandd ReviewR iCalendarC l d December 1, 2011: Certification period application open Februaryy 29,, 2012: Certification periodpapplicationppcloses March 1 – June 30, 2012: Application review period JulyJ l 1–31,1 31 20122012: AACVPR BBoardd off DirectorsDitreviewsiand approves recommendations for certification

The ApplicationInstructionsProgram Intake FormProgram RosterPageage 1 StaStaff CoCompetenciespete c esPage 2 Individualized Treatment PlanPage 3 Emergency PreparednessPage 4 Policies & ProceduresPage 5 Exercise PrescriptionPage 6 Medical EmergenciesPage 7 Clinical Outcome AssessmentPage 8 Behavioral Outcome AssessmentPage 9 Health Outcome AssessmentPPage10 ServiceS i OOutcometAssessmentAt

Personnel InformationStaff Name, Degree,PositionMedicalMdi l Director(s)Di t ( )Antony Kusek MDCurrentLicensure/certification(BLS, ACLS, ACSM,ANCC)Roles/Responsibilities atFacility (RN, EP, RT,PT, part time, full time,PRN, contract)AACVPR/AffiliateMember Y/NACLS, BLS, NALSPart time Medical DirAACVPR (Y)(Y)Clinical Professional Staff Reporting to the Cardiac or Pulmonary Rehab DirectorAngie Swantek RNACLS, BLSFull timeAACVPR(Y)Janet Feik RnACLS, BLSFull timeAACVPR(Y)Sharon Kunzman LPNACLS, BLSFull timeAACVPR(Y)Cindi Oberhauser LPNACLS, BLSFull timeAACVPR(Y)Abbie Nelson EPBLSFull timeAACVPR(Y)Ancillary Staff/Clinical Staff not reporting to the Cardiac or Pulmonary DirectorAff(Y)Aff(Y)Aff(Y)Aff(Y)Aff(Y)Aff

Staff Competency AACVPR defines competency asskills, knowledge and criticalskillsthinking required to operateeffectively in a Cardiac program. provide evidence of annualassessment of competencyspecific to CR for allclinical/professional staff Ways to assess competencyCheck off stations,Test/quizzes,Return demonstration, Articlereview with post test

Required Table Format for StaffCompetenciesName of EmployeeCompetency with DateCompetency with Date Competency with DateCompetency withDateAngie SwantekEKG Quiz 5/5/2011Glucometer returndemo6/15/2011Waist circ return demo7/20/2011Crash cart scavengerhunt8/9/2011Janet FeikEKG Quiz 5/5/2011Glucometer returndemo6/15/2011Waist circ return demo7/20/2011Crash cart scavengerhunt8/9/2011Sharon KunzmanEKG Quiz 5/5/2011Glucometer returndemo6/15/2011Waist circ return demo7/20/2011Crash cart scavengerhunt8/9/2011Cindi OberhauserEKG Quiz 5/5/2011Glucometer returndemo6/15/2011Waist circ return demo7/20/2011Crash cart scavengerhunt8/9/2011Abbie NelsonEKG Quiz5/5/2011Glucometer returndemo6/15/2011Waist circ returndemo7/20/2011Crash cartscavenger hunt8/9/2011

What is anIndividualized Treatment Plan? Summary of the planned carefor a patient from initialassessment to discharge fromthe Cardiac Rehabilitationprogram.program Assessment,, Goals,,Intervention, Reassessment, TheTh ITP mustt bbe ddevelopedldand completed for each patientin the CR/PR program andmust include all components.

Must Include the Following ClearlyL b l d assessmentExerciseDi assessmentPsychosocialDischarge

Individual Treatment Plan (ITP)Requirements UploadU l d COMPLETED CardiacC di or PPulmonarylITP ththatt iis HIPAA compliantITP must be a singleg document . ((It does not need to be onepage.)ITP must be for an actual patient that has completed allrequired componentsAssessment and reassessment scores must be on the ITP, donot submit assessment tools.ITP must be completed in the data collection period

Emergency PreparednessCARDIAC REHAB:For the purpose of AACVPR certification the following emergency equipment and supplies must be immediately availableto your unit verification of readiness performed and documented every day the program is inoperation. Calling 911/EMS alone to bring these supplies/medications is not acceptable Defibrillator/AED O2,O2 tubing,tubing mask/nasalcannula Intubation equipment andadvanced airways Crash cart with emergencyequipment and ACLSmedications.

Emergency PreparednessRRequirementsi One (1) month's documentation of daily verification of readiness for each dayy the programgis in operation. An explanation should beprovided for any missing dates during that month.For each equipment/supply listed, indicate where the item is locatedin relation to the Cardiac or Pulmonaryy Rehabilitation unit.Evidence of four (4) annual department medical emergency inservices specific to Cardiac or Pulmonary Rehabilitation held duringthe data collection period.pBrief description of medical emergency in-serviceSubmitted in-services may include mock code blues, review of crashcart/defibrillator critique of an actual codecart/defibrillator,code, etcetc.

Medical Emergency InIn‐serviceserviceD tDateB i fdBriefdescriptioni ti off medicaldi l emergency in‐serviceiiDateBrief description of medical emergency in‐serviceDateBrief description of medical emergency inin‐serviceserviceDateBrief description of medical emergency in‐service

Policies and ProcedureRequirementsDocumentation that policies and procedures specific to Cardiac orPulmonary Rehabilitation have been reviewed annually by theprogram medical director and director/coordinator/manager during thecollection period.

Exercise PrescriptionpSubmit a ppatient exercise pprescriptionpwhich is– individualized– approved by the physician for this patient– Contains all required elements( mode, frequency, duration, intensity andprogression)Submit a written policy that details– how an exercise pprescriptionpis developedpandmodified for each patient.– all required elements of the exerciseprescription; mode, frequency, duration,intensity, progression

Exercise PrescriptionRequirementIndividual Exercise Prescription (EX RX) Initial exercise prescription.prescription Physician signature approving the exercise prescription. Includes mode, duration, frequency, intensity and progression. O2 saturation and titration for PR patients onlyprogressiononly.Intensity targets must be within AACVPR and ACSMguidelinesProgression must be more specific than “as tolerated” or “asdictated by absence of signs and symptoms”Completed and for an actual patient .Completed during the data collection period

Exercise PrescriptionComponents Mode:M d – Bike, Treadmill, EllipticalIntensity:y– How hard (heart rate range, RPE, Mets) Intensity targets mustbe within AACVPR and ACSM published guidelinesDuration:– How longFrequency:– HowHoftenfProgression:- How do yyou advance the patients.pDescribe the typeyp ofmethodology.“As tolerated” or “as per clinical signs and symptoms” isnot accepted.p‐

Medical Emergencies For the purposes of AACVPRcertification/recertification, written program specificpolicies/protocols for the following: Cardiopulmonary ArrestAnginaAcute DyspneaT perglycemiaHypoglycemia