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Developing an Effective ITP and Plan of Care

Posted on June 08, 2017   |   
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 Pulmonary rehabilitation

This PRAXIS Nexus post contains the highlights from the webinar "Developing an Effective ITP and Plan of Care During Pulmonary Rehabilitation." This event's main speaker was Gerilynn Connors, RRT, BS, MFAACVPR, FAARC, who works as Clinical Manager Pulmonary Rehabilitation at Virginia's INOVA Health System. In this post, she outlines the essential components of the Individualized Treatment Plan (ITP) and her approach to the assessment that is the foundation of the plan.


Three Components of an Effective ITP 

The ITP must be reviewed and signed by a physician every 30 days. The law also clearly outlines the following parameters; including the following will ensure we adhere to the law and obtain maximum reimbursement for services provided.

  1. Diagnosis
  2. Type, amount, frequency and duration of the items and services offered under the plan
  3. Goals set for the individual under the plan

What are the essential assessments to be done on all patients? The effectiveness of the ITP is all about assessment!

  • Respiratory assessment
  • Psychosocial components – a written assessment of the individual’s mental and emotional functioning as it relates to the individual’s rehabilitation or respiratory condition
  • Smoking history and intervention – beyond pack years: Fagerstrom test for nicotine dependence and a smoking cessation treatment plan (e.g., PR smoking cessation program, ALA Quit Line, BreatheFree2 Program)
  • Airway clearance assessment (e.g., cough, devices and exercise) –and what type of instruction matches the airway clearance devices that are the best fit for this patient
  • Exercise assessment – refers to this article. Use all of the data available for the 6-minute; go beyond distance and oxygen saturation (e.g., percent predicted on distance, miles per hour can be calculated and used as a possible exercise starting goal). Also a functional exercise assessment (e.g., upper and lower body strength, sit to stand). Recommends referring to standards from ATS/ERS 2013 Key Concepts & Advances in PR and using the BODE Index.
  •  Pulmonary rehabilitation
  • Sleep apnea – assess via Epworth Sleepiness Scale and referring if indicated to see how to best treat this patient (uses sleep apnea educational materials found here).
  • Medications – assess and understand how we will educate patient; support them in asking questions of referring physician as there may be newer medications appropriate for the patient (e.g., roflumilast, LABA/LAMA, off-label azithromycin); refers to ABCD Gold assessment tool.
  • Oxygen – assess and give guidance to patient on options for oxygen delivery systems; get recommendations to their referring physician. Also monitor patient’s oxygen if they are using a portable oxygen concentrator. For 6-minute walk test, do not use patient’s oxygen system; however, at treatment session, use to gauge if their system is sufficient in keeping their oxygen saturation adequate. For patients with pulmonary hypertension, pulmonary rehabilitation is essential. Refer to ESC/ERS Guidelines and https://phassociation.org/ as great resources for both respiratory professionals and patients.

Let us know your thoughts and questions on these elements of the ITP! What assessments do you find helpful in your work with respiratory patients? What questions do you have about developing the most effective treatment plans for your patients with COPD?

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