Success and Survival in Pulmonary Rehab

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1 Success and Survival in Pulmonary Rehab 35 Years and Still Growing Valerie McLeod, RRT Manager, Pulmonary Rehabilitation McLaren Flint, MI

2 Disclosure Information I have no disclosures. While some brands will be displayed, this is not intended to be an endorsement of any given product but rather an example for program development purposes.

3 Objectives Attendees will gain an understanding of the benefits and outcomes of pulmonary rehab and the role it plays in reducing repeat admissions Attendees will be able to recognize when it is appropriate to refer a patient for pulmonary rehab Attendees will learn approaches to make their programs viable to administrators and visible to the community

4

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6 Pulmonary Health & Rehabilitation Services Organizational Chart Hospital Administration / Board of Trustees Pulmonary Rehab Services Medical Director Registered Respiratory Therapists Core Staff Registered Respiratory Therapists Contributing Staff Dietician Pharmacist Psychologist Student & Volunteer Staff Student Interns Patient Volunteers Support Staff Administrative Assistant

7 Humble Beginnings Started at McLaren in 1978 No Guidelines, No Outcomes Researched articles in CHEST, JCR, ACCP Went on my own to AACVPR in Chicago 1980 Focus: Implement now, perfect later Program start date: July 1980 Staff of one with one treadmill

8 1980

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14 Luck is a matter of preparation meeting opportunity. Lucius Annaeus Seneca Roman Stoic Philosopher 3 BC AD 65

15 Key Components for Success Staff with a passion for the work

16

17 Key Components for Success Staff with a passion for the work Medical Director support Administration support Adequate space and staffing Value Added Services Patient Ambassadors Necessary Elements

18 Necessary Elements Exercise equipment and oxygen resources

19 Oxygen storage

20

21 Necessary Elements Exercise equipment and oxygen resources Creating Essential forms Charge Master, Referral Forms, Job Descriptions & Competencies Establishing educational materials (PEP) Understanding CMS requirements Marketing the new service Value Added Services Professional Networking

22 Program Format Initial Interview & Assessment 6 minute walk, Educational Videos, Establish ITP Patient Education 14 Individual Topics (one per session) Group Classes (once a month) Overview of Lung Disease, RRT Pulmonary Medications, Pharmacist Nutritional Needs of the Lung Patient, Dietician Understanding your Emotions with Lung Disease, Psychologist

23 Then Now

24 Program Format Exercise Sessions 2 3 times per week 90 minute sessions, 24 sessions total NuStep 10 minutes SCIFIT 10 minutes arms & legs OR arms only Treadmill 5 10 minutes Chest Expansion Exercises Strength Training (not done initially)

25

26 Keeping Patients Start to Finish Set attendance expectations Helping patients resume PR after exacerbations Establish continued communication with patients who have been put ON HOLD for whatever reason Develop a call spreadsheet RTs share responsibility to contact patients during slower gym times Support patients with quit-attempts to stop smoking

27 Value Added Services Smoking Cessation PFT Testing Spousal Exercise Program

28

29 Pulmonary Function Testing

30

31 Marketing Your Program Hospital Web Page In-services Physician Communication Brochures / Hospital Newsletters Resources for Networking Community Events

32

33 Marketing Your Program In-services RT department Residents & Physicians on staff Home Care Nurses Case managers

34 Diagnoses Appropriate for Pulmonary Rehabilitation Obstructive Diseases COPD (including alpha-1 antitrypsin deficiency) Persistent Asthma Bronchiectasis Cystic Fibrosis Bronchiolitis obliterans Other Conditions Lung Cancer Primary pulmonary hypertension Before and after thoracic surgery Before and after lung transplantation Restrictive Diseases Interstitial Diseases Interstitial Fibrosis Occupational or environmental lung disease Sarcoidosis Chest wall diseases Kyphoscoliosis Neuromuscular diseases Post-polio syndrome Before and after lung volume reduction surgery

35 2011 U.S. Readmission Data Diagnosis Number of index admissions Readmissions within 30 days Pneumonia 931, % Mood disorders 894, % Osteoarthritis 865, % Congestive heart failure 818, % Septicemia 794, % Cardiac dysrhythmias 686, % (#8) COPD 626, %

36 McLaren COPD Readmit Rate

37 Capturing Inpatient Referrals Direct Order generated from COPD standing orders Communication with Case Managers Collaboration with Home Health Nursing upon discharge

38

39

40 Marketing Your Program Communicating with Referring Physician Letter stating their patient has started PR 30 day & 60 day Progress Reports BP, SpO2, BG, HR Discharge summary & Referral Thank You

41

42 Marketing Welcome Letter

43

44 Mucus charts

45

46 Post Program Report

47 Marketing Your Program Networking Resources Transplant Centers Gift of Life Recognition Community Events Local Media Holiday Events

48

49 The Gift of Life flag honoring donors and their families for their courage to choose life.

50 Bobby Crim 10 mile road race

51 Celebrate Your Patients

52

53

54 We make a living by what we get, we make a life by what we give. Sir Winston Churchill

55

56 In memory of Mr. Ray McNally Pulmonary Rehab veteran for over 10 years Where there is a will, there is a way

57

58

59 Benefits of Pulmonary Rehab Increased energy, strength, and stamina Decreased shortness of breath Decreased anxiety and improved self reliance Increased participation in daily activities in the home and community Better understanding of inhalers and oxygen Reduced need for Emergency room visits or hospitalizations Personalized plan to help patients maintain general health and wellness despite lung damage

60 Exercise does not take time out of your life, it puts life into your time. - Linda Maxwell

61 Contact Information (810)

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