RE: Re: Hot Pack Covers / Pulse Oximetry

June 23, 2012

Steve:

Here's a copy of a June 26, 2009 posting on the APTA's Home Health Section

(HHS-APTA) listserv regarding JCAHO's position on pulse oximetry.

CMS/Medicare is silent on this matter, and it has no bearing on Medicare

payment... It's only a JCAHO concern, and thus of the home health agency as

well if it is JCAHO accredited. You might want to contact APTA's Department of

Practice directly for clarifications.

APTA notified the Home Health Section this morning that they received the

following from Dr. Wise of the Joint Commission on Accreditation of

Healthcare Organizations ( " The Joint Commission " , formerly " JCAHO " ) on June

1, 2009 regarding pulse oximetry orders in home care:

" After review of the material you sent and discussion with our Standards

Interpretation Group, I determined that a physical therapist does not

require the order of a physician to use pulse oximeter unless that order is

required by state law/ practice act or prohibited by the responsible

healthcare organization. Per Joint Commission standards this position is

true for all settings " .

Home Health Section members and leadership provided critical initiative,

information, and cooperation to APTA on this issue. Thanks to members from

both the Section and the APTA for patience and examples from clinical

practice.

As this is not a written standard, if now or in the future, your

organization or agency is cited by The Joint Commission for not having a

pulse oximetry order, please get in touch with APTA's Department of Practice

as they can provide the needed support on this issue.

Robin Childers, CAE

Executive Director

Home Health Section- APTA

PO Box 4553 . Missoula, MT 59806-4553

www.homehealthsection.org<http://www.homehealthsection.org>

Hope this is of help.

[cid:image001.jpg@...]

Jean-Michel Geoffriau, PT | Director of Rehabilitation | Sta-Home Health &

Hospice | JGEOFFRIAU@...

406 Briarwood Drive, Bldg. 200 | , MS 39206 | Office: | Fax:

| Mobile:

From: PTManager [mailto:PTManager ] On Behalf Of

Steve Passmore

Sent: Friday, June 22, 2012 10:33 PM

To: PTManager

Subject: RE: Re: Hot Pack Covers

Not to sound sarcastic. but maybe JCAHO needs to start and Evidenced Based

Approach. Coming up with rules with no data is just contrary to

conventional practice and common sense. It's one thing to suspect and

investigate (or even a temporary rule) but this practice has been in effect

since loooooong ago and has never been called into question. Next step is

wearing protective suit to even touch a patient (yes I suspect someone is

writing a rule on that one now).

On a separate issue, I just purchased a pulse oximeter so I could have the

option to check the O2 level with some fatigued patients on a home health

eval/re-check. I was told by the Home Health Agency that I could not record

this in the medical record without a physician order. Medicare considers

this an " invasive procedure " even though I was using the finger clip method.

We have an order for vitals and I thought this would be covered in that

section. I realize this is not something that is needed often in a typical

population but I was surprised with the classification. Has anyone else had

this as an issue? Would I jeopardize payment by recording this?

Steve Passmore PT, MS (soon to be DPT)

Healthy Recruiting Tools

<mailto:spass@...<mailto:spass%40healthyrecruiting.com>>

spass@...<mailto:spass%40healthyrecruiting.com>

Phone:

Fax:

" What We Did For You Yesterday Is History. What Can We Do For You Today "

Recruiting Tools: Cold Calls ~ List Enhancement ~ Direct Mailers ~ Card

Design ~ Recruiting Software

From: PTManager <mailto:PTManager%40yahoogroups.com>

[mailto:PTManager <mailto:PTManager%40yahoogroups.com>] On Behalf

Of Effie_Elliott@...<mailto:Effie_Elliott%40Bayhealth.org>

Sent: Friday, June 22, 2012 1:16 PM

To: PTManager <mailto:PTManager%40yahoogroups.com>

Subject: Re: Hot Pack Covers

Kirk -

I just came across your post about hot pack covers in PT Manager.

Ironically, we just had an internal mock JC tracer survey, and were told

by a survey team member from Infection Prevention that we could not re-use

our hot pack covers and that having 6 - 8 layers of toweling between the

hot pack and the patient did not prevent " germs " from seeping through to

come in contact with the patient's skin!

We are hard put to come up with a solution. I have been a PT for a

looooooooooooong time and have never known of a patient becoming infected

from a hot pack treatment appropriately applied.

The question also came up about how and when are the hot pack covers

laundered.

Let me know if you have come up with any creative solutions, or if there

is anyone who has recently gone through a JC survey and experienced a

challenge to the hot pack covers!

Thanks,

Effie

Effie Elliott, PT, DPT

Director, Rehabilitation Services

Bayhealth Medical Center

(or 7096) Office Number

Pager Number

Fax Number

effie_elliott@...<mailto:effie_elliott%40bayhealth.org>

<mailto:effie_elliott%40bayhealth.org>

" Next to doing a good job yourself, the greatest joy is in having someone

else do a first-class job under your direction. " Feather,

American author & publisher

June 24, 2012

Different question, same topic. If you find that O2 saturation is too low, are

you then obligated to initiate treatment for this? In other words do you need

to have access to portable O2 at the very least? And if so, do any of you have a

policy on this and can you initiate such treatment without MD orders.

van Well, PT

Henry Ford Health System

Detroit, MI

Sent from my 'new' iPad

On Jun 23, 2012, at 12:37, " Geoffriau, Jean-Michel "

wrote:

> Steve:

>

> Here's a copy of a June 26, 2009 posting on the APTA's Home Health Section

(HHS-APTA) listserv regarding JCAHO's position on pulse oximetry.

> CMS/Medicare is silent on this matter, and it has no bearing on Medicare

payment... It's only a JCAHO concern, and thus of the home health agency as well

if it is JCAHO accredited. You might want to contact APTA's Department of

Practice directly for clarifications.

>

> APTA notified the Home Health Section this morning that they received the

> following from Dr. Wise of the Joint Commission on Accreditation of

> Healthcare Organizations ( " The Joint Commission " , formerly " JCAHO " ) on June

> 1, 2009 regarding pulse oximetry orders in home care:

>

> " After review of the material you sent and discussion with our Standards

> Interpretation Group, I determined that a physical therapist does not

> require the order of a physician to use pulse oximeter unless that order is

> required by state law/ practice act or prohibited by the responsible

> healthcare organization. Per Joint Commission standards this position is

> true for all settings " .

>

> Home Health Section members and leadership provided critical initiative,

> information, and cooperation to APTA on this issue. Thanks to members from

> both the Section and the APTA for patience and examples from clinical

> practice.

>

> As this is not a written standard, if now or in the future, your

> organization or agency is cited by The Joint Commission for not having a

> pulse oximetry order, please get in touch with APTA's Department of Practice

> as they can provide the needed support on this issue.

>

> Robin Childers, CAE

> Executive Director

> Home Health Section- APTA

> PO Box 4553 . Missoula, MT 59806-4553

>

> www.homehealthsection.org<http://www.homehealthsection.org>

>

> Hope this is of help.

>

> [cid:image001.jpg@...]

> Jean-Michel Geoffriau, PT | Director of Rehabilitation | Sta-Home Health &

Hospice | JGEOFFRIAU@...

> 406 Briarwood Drive, Bldg. 200 | , MS 39206 | Office: |

Fax: | Mobile:

>

> From: PTManager [mailto:PTManager ] On Behalf

Of Steve Passmore

> Sent: Friday, June 22, 2012 10:33 PM

> To: PTManager

> Subject: RE: Re: Hot Pack Covers

>

> Not to sound sarcastic. but maybe JCAHO needs to start and Evidenced Based

> Approach. Coming up with rules with no data is just contrary to

> conventional practice and common sense. It's one thing to suspect and

> investigate (or even a temporary rule) but this practice has been in effect

> since loooooong ago and has never been called into question. Next step is

> wearing protective suit to even touch a patient (yes I suspect someone is

> writing a rule on that one now).

>

> On a separate issue, I just purchased a pulse oximeter so I could have the

> option to check the O2 level with some fatigued patients on a home health

> eval/re-check. I was told by the Home Health Agency that I could not record

> this in the medical record without a physician order. Medicare considers

> this an " invasive procedure " even though I was using the finger clip method.

> We have an order for vitals and I thought this would be covered in that

> section. I realize this is not something that is needed often in a typical

> population but I was surprised with the classification. Has anyone else had

> this as an issue? Would I jeopardize payment by recording this?

>

> Steve Passmore PT, MS (soon to be DPT)

>

> Healthy Recruiting Tools

>

> <mailto:spass@...<mailto:spass%40healthyrecruiting.com>>

spass@...<mailto:spass%40healthyrecruiting.com>

>

> Phone:

>

> Fax:

>

> " What We Did For You Yesterday Is History. What Can We Do For You Today "

>

> Recruiting Tools: Cold Calls ~ List Enhancement ~ Direct Mailers ~ Card

> Design ~ Recruiting Software

>

> From: PTManager <mailto:PTManager%40yahoogroups.com>

[mailto:PTManager <mailto:PTManager%40yahoogroups.com>] On Behalf

> Of Effie_Elliott@...<mailto:Effie_Elliott%40Bayhealth.org>

> Sent: Friday, June 22, 2012 1:16 PM

> To: PTManager <mailto:PTManager%40yahoogroups.com>

> Subject: Re: Hot Pack Covers

>

> Kirk -

> I just came across your post about hot pack covers in PT Manager.

> Ironically, we just had an internal mock JC tracer survey, and were told

> by a survey team member from Infection Prevention that we could not re-use

> our hot pack covers and that having 6 - 8 layers of toweling between the

> hot pack and the patient did not prevent " germs " from seeping through to

> come in contact with the patient's skin!

> We are hard put to come up with a solution. I have been a PT for a

> looooooooooooong time and have never known of a patient becoming infected

> from a hot pack treatment appropriately applied.

> The question also came up about how and when are the hot pack covers

> laundered.

> Let me know if you have come up with any creative solutions, or if there

> is anyone who has recently gone through a JC survey and experienced a

> challenge to the hot pack covers!

> Thanks,

> Effie

>

> Effie Elliott, PT, DPT

> Director, Rehabilitation Services

> Bayhealth Medical Center

> (or 7096) Office Number

> Pager Number

> Fax Number

> effie_elliott@...<mailto:effie_elliott%40bayhealth.org>

<mailto:effie_elliott%40bayhealth.org>

>

> " Next to doing a good job yourself, the greatest joy is in having someone

> else do a first-class job under your direction. " Feather,

> American author & publisher

>

June 24, 2012

The only obligation is to report the abnormal findings to the physician who will

decide how to proceed, hopefully with your input. In most states, oxygen

therapy falls under the same regulations as medications, so it should not be

initiated apart from physician orders.

[cid:image001.jpg@...]

Jean-Michel Geoffriau, PT | Director of Rehabilitation | Sta-Home Health &

Hospice | JGEOFFRIAU@...

406 Briarwood Drive, Bldg. 200 | , MS 39206 | Office: | Fax:

| Mobile:

From: PTManager [mailto:PTManager ] On Behalf Of

van Well

Sent: Sunday, June 24, 2012 6:29 AM

To: PTManager

Subject: Re: Re: Hot Pack Covers / Pulse Oximetry

Different question, same topic. If you find that O2 saturation is too low, are

you then obligated to initiate treatment for this? In other words do you need to

have access to portable O2 at the very least? And if so, do any of you have a

policy on this and can you initiate such treatment without MD orders.

van Well, PT

Henry Ford Health System

Detroit, MI

Sent from my 'new' iPad

On Jun 23, 2012, at 12:37, " Geoffriau, Jean-Michel "

<jgeoffriau@...<mailto:jgeoffriau%40sta-home.com>> wrote:

> Steve:

>

> Here's a copy of a June 26, 2009 posting on the APTA's Home Health Section

(HHS-APTA) listserv regarding JCAHO's position on pulse oximetry.

> CMS/Medicare is silent on this matter, and it has no bearing on Medicare

payment... It's only a JCAHO concern, and thus of the home health agency as well

if it is JCAHO accredited. You might want to contact APTA's Department of

Practice directly for clarifications.

>

> APTA notified the Home Health Section this morning that they received the

> following from Dr. Wise of the Joint Commission on Accreditation of

> Healthcare Organizations ( " The Joint Commission " , formerly " JCAHO " ) on June

> 1, 2009 regarding pulse oximetry orders in home care:

>

> " After review of the material you sent and discussion with our Standards

> Interpretation Group, I determined that a physical therapist does not

> require the order of a physician to use pulse oximeter unless that order is

> required by state law/ practice act or prohibited by the responsible

> healthcare organization. Per Joint Commission standards this position is

> true for all settings " .

>

> Home Health Section members and leadership provided critical initiative,

> information, and cooperation to APTA on this issue. Thanks to members from

> both the Section and the APTA for patience and examples from clinical

> practice.

>

> As this is not a written standard, if now or in the future, your

> organization or agency is cited by The Joint Commission for not having a

> pulse oximetry order, please get in touch with APTA's Department of Practice

> as they can provide the needed support on this issue.

>

> Robin Childers, CAE

> Executive Director

> Home Health Section- APTA

> PO Box 4553 . Missoula, MT 59806-4553

>

> www.homehealthsection.org<http://www.homehealthsection.org>

>

> Hope this is of help.

>

> [cid:image001.jpg@...<mailto:image001.jpg%4001CCAFFA.A2BD9500>]

> Jean-Michel Geoffriau, PT | Director of Rehabilitation | Sta-Home Health &

Hospice |

JGEOFFRIAU@...<mailto:JGEOFFRIAU%40sta-home.com><mailto:JGEOFFRIAU@sta-\

home.com<mailto:JGEOFFRIAU%40sta-home.com>>