Exercise Prescription & Programming

I was wondering how everyone does the PAD SET initial intake? Do you require that an RN physically assess the patient? If the CEP takes sole responsibility of that, are there any guidelines as to what should be assessed for these patients initially?
Thank you!

Hello Lori,

Our intake for PAD Rehab is as follows. . .

The nurse will meet with the patient first to assess their feet and to teach the patient how to do it themselves from that point on. They will need to do this before and after class each day. The nurse will also assess medications and health history.

The RCEP will assess the patient next following the AACVPR PAD toolkit which consists of a graded Treadmill test. An Exercise Prescription is created based on the results of the Treadmill test and the PAD Algorithm is followed throughout classes. Hope this helps!

Angela Lanier, MS RCEP

Thank you so much Angela! Yes that does help. My concern is that our CR management wants to change the intake (we currently do our intake just as you described). They claim it is not necessary to have an RN assessment. I was just wondering if anyone knows if AACVPR requires an RN to assess the patient? I do not feel a CEP is trained to do a "nursing assessment" and wondered if one was necessary or what the "initial assessment" needs to entail?
Thank you again!

Hello all. I have been running a PAD program since late 2006. There has never been a RN part of the program and there have not been any adverse outcomes because of it.

There is not a specific need for RN evaluation prior to starting a program and an appropriately trained CEP is totally capable of administering and initial evaluation.

It would be a program specific issue in how they would want to do this.
A CEP that has been trained well to work with PAD patients can do a great job.

Thanks so much! Appreciate your feedback!

CMS is absolutely silent on the composition of staff for SET PAD just as they are for CR and PR. Mark Patterson is 100% correct, an appropriately trained CEP is more than capable of conducting an initial evaluation for any of the above programs.

Thank you so much Robert! If possible it would be so helpful to know exactly what you put in your assessment. If anyone would be willing or has a minute to contact me I would truly appreciate it! Thank you again!!
LSaiia@yahoo.com

Hi Lori

We do group orientations at our hospital. Any SET PAD pts we have attend the same orientation as our Ph2 CR pts. During group orientation, pts complete the Dartmouth CO-OP, PHQ-9, and Rate Your Plate surveys. SET PAD pts also get a Walking Impairment Questionnaire (WIQ). All of our pts get home grown surveys on perceived barriers to exercise and medication compliance.

During their first scheduled exercise session, the CEP (we only have one RN, and she's per diem) will go over any orthopedic limitations, medication reconciliation, and determine the speed and grade on the treadmill that elicits 2+ claudication within about 8 minutes or so. The CEP spends a lot of time teaching the SET PAD pts the modified Gardner protocol that we try to use as much as we can. That first day is 1:1 for most of the session, so we try to limit our schedule to one new pt per class. Our SET PAD pts attend the same educational lectures as our Ph2 CR pts and are given that schedule at their first exercise session.

We went back and forth as to whether or not the SET PAD pts should be ECG monitored the first few sessions due to concerns about occult CAD in this population, but ultimately decided we'd do that on a case by case basis as warranted by signs and symptoms.

Hope this helps.

Thanks so much! That definitely helps!