Valve Exercise Program Template
- Valve Exercising Sop
- Valve Exercise Program Template
- Valve Exercising Program Checklist
- Water Valve Exercise Program Template
- Awwa Valve Exercise Program
- Valve Maintenance Program And Forms
The Program Administrator will provide all employees who voluntarily choose to wear either a filtering face-piece or elastomeric style respirator with the information contained in Appendix D of the standard (see below). Valves: Examine for residue or dirt, cracks or tears in valve material. (i.e., through hands-on exercises, written. The AWWA recommends all water utilities initiate a valve exercise program that requires all valves to be inspected and operated on a regular basis. With thousands and thousands of valves, a valve exercising and valve surveying program can be intimidating. Non-ESH Forms. Online Facilities Service Request; pdf Salvage Form To be used with ESH Radiological Survey. If Salvage is Radioactive, use with Radioactive Material Declaration Form More information at SCM Property Control: Surplus; ESH General Forms Project ESH Review Process. PDF ESH Project Review Procedure.
Abstract
Aerobic exercise and resistance training have been proven to be beneficial for patients with heart failure. Current reimbursement guidelines exclude these patients from our traditional cardiac rehabilitation program, so at Newton Wellesley Hospital a clinic model was developed for the disease management and exercise of heart failure patients.
INTRODUCTION
Newton Wellesley Hospital (NWH) is a 289 bed teaching hospital located about 15 miles west of Boston, Massachusetts. Our Cardiovascular Health Center offers 6 Phase II cardiac rehabilitation classes, serving patients after myocardial infarction, coronary bypass surgery, valve surgery, and angina. In addition, we run a disease management program for patients with heart failure (HF). Referrals come from inpatient admissions for acute onset HF and referrals from cardiologists and primary care physicians. This HF clinic is a nurse practitioner (NP) based clinic that offers disease management, education, exercise, and long term follow-up. There are dieticians and physical therapists involved in the education and exercise components of the program. The program uses a multidisciplinary model, which affords us the opportunity to incorporate each team member's expertise into a comprehensive patient care plan that positively impacts outcomes.
The CHF program began in 1996 by a NP and a physical therapist. The practitioners recognized the exclusion of HF patients from traditional cardiac rehabilitation programs and a more flexible, fluid, clinic model was developed. At the beginning of the program there were only 5 patients enrolled at a time, building gradually, with an estimated 500 patients participating to date. The current enrollment includes 64 patients for the exercise class, which is offered twice per week. Patients range in age from 52–92 years, 33 males and 31 females. The diagnosis of diastolic HF accounts for approximately 70% of the current group of patients, with the remainder diagnosed with systolic HF. At NWH we have an “identify and connect” program that alerts the NPs to any patient admitted with a diagnosis of HF. Based on their status and preference, patients are enrolled to nursing only visits or nursing visits with exercise. Patients are also referred by their cardiologist directly to the clinic from NWH and outlying hospitals.
By referencing the existing grading rule base, simplify the grading process. Free gerber accumark v8 cracked. By grading for the multiple samples to speed up the process. With AccuMark software, template designer to interactively or automatically generated from measurement specification template. AccuMark software not only accelerate the typesetting process and save material, it can also reduce labor costs.
Upon entrance into the program patients undergo an evaluation by the NP, assessing current physical status and medical regiment, with particular attention to signs and symptoms of HF and weight gain. Brain naturetic peptide (BNP) level is followed closely, as well as renal function, in the titration and selection of medications. At each visit the patients are reassessed by an NP, or nurse, for vital signs, weight, breath sounds, edema, and symptoms. If a patient has gained more than 3 pounds (1.4 kg) since the prior sessions, the patient is not permitted to exercise.
Prior to entering the exercise program, patients are evaluated by a physical therapist. This evaluation includes a musculoskeletal screening, 6 minute walk test with telemetry monitoring, balance screening, and self-report of prior and current exercise routines. Following the results of the six-minute walk test (6MWT), a target heart rate range is determined, at 50% to 70% of 220-age[,,, Patients are educated in the use of the Borg 6–20 rating of perceived exertion scale, with instruction to work at a level of 11–13, or moderate exercise[,,,
Exercise prescription is then determined, following the American Heart Association and the American College of Sports Medicine guidelines.5 Intensity is recommended to be within the target heart rate range and/or perceived exertion rating of 11–13 (moderate level). Duration is targeted at 30 to 40 minutes of aerobic exercise, beginning with the amount the patient is able to perform at the time. Frequency is recommended to be 5 to 7 days per week. Patients are monitored with telemetry for the first 3 exercise sessions, and then continue without telemetry unless there are rhythm or ectopy concerns. Patients are monitored for heart rate and blood pressure throughout the exercise sessions, and after 5 minutes of recovery. Oxygen saturation is measured as well. The examination and management of patients in the HF clinic is outlined in Figure Figure11.
Examination and management of patients in the heart failure clinic.
Modes of exercise include treadmills, upright and recumbent bikes, elliptical machines, and NuStep™ machines. The NuStep™ is a seated stepping and upper extremity exercise machine. It is well tolerated by patients with common comorbidities such as back pain, balance difficulties, and lower extremity weakness; this is one of the preferred machines by our patients. Considerations are taken into account for orthopedic impairments, pain, balance abnormalities, and personal preferences. Patients are encouraged to experiment with various machines for variety and carryover to health clubs or senior center exercise rooms, as well as for determining the best machine to purchase for home[,7Download aliens vs predator 3 tpb games. When appropriate, patients are referred for individual physical therapy services, for example balance training, which can be coordinated on the same visit day as the clinic.
Exercise is progressed as tolerated, with very deconditioned patients beginning with 5 minutes of exercise, followed by a rest period, continuing in intervals. More fit individuals begin with 30 minutes continuous exercise the first session, with warm-up and cool-down as well. Light resistance exercise is added when appropriate, taught individually with an emphasis on simple exercises that can be reproduced at home. Stretching is recommended and instructed for the working muscle groups. The HF program runs for 12 months throughout which patients can move from one phase to another if their medical status changes (Figure (Figure22).
The 3 phases of the heart failure clinic.
The diagnosis of HF is not recognized by Medicare as a Cardiac Rehabilitation diagnosis; thus, patients are billed only for the nursing visits. One of the primary goals of the program is to prevent readmissions for HF. Our 30 day all cause readmission rate at NWH was recently estimated at 15% with 7.5% for acute HF. National estimates in the same time period were 24% all cause and 17% acute HF readmissions. As health policy evolves and reimbursement may be spread over the course of an illness, rather than service based, this model may prove to be very cost effective for HF patients.
SUMMARY
In summary, we have developed a disease management program that incorporates physical therapist directed exercise training for our HF patients. This allows us to serve this population despite their falling outside the traditional cardiac rehabilitation model. Our patients benefit from the more frequent nursing assessments, training effects, and social interactions that the clinic provides. As one patient reported, “The program has increased my mobility, endurance, capacity, and tolerance. It has taught me how to care for myself.”
REFERENCES
Valve Exercising Sop
Valve Exercise Program Template
Abstract
Aerobic exercise and resistance training have been proven to be beneficial for patients with heart failure. Current reimbursement guidelines exclude these patients from our traditional cardiac rehabilitation program, so at Newton Wellesley Hospital a clinic model was developed for the disease management and exercise of heart failure patients.
Valve Exercising Program Checklist
INTRODUCTION
Newton Wellesley Hospital (NWH) is a 289 bed teaching hospital located about 15 miles west of Boston, Massachusetts. Our Cardiovascular Health Center offers 6 Phase II cardiac rehabilitation classes, serving patients after myocardial infarction, coronary bypass surgery, valve surgery, and angina. In addition, we run a disease management program for patients with heart failure (HF). Referrals come from inpatient admissions for acute onset HF and referrals from cardiologists and primary care physicians. This HF clinic is a nurse practitioner (NP) based clinic that offers disease management, education, exercise, and long term follow-up. There are dieticians and physical therapists involved in the education and exercise components of the program. The program uses a multidisciplinary model, which affords us the opportunity to incorporate each team member's expertise into a comprehensive patient care plan that positively impacts outcomes.
The CHF program began in 1996 by a NP and a physical therapist. The practitioners recognized the exclusion of HF patients from traditional cardiac rehabilitation programs and a more flexible, fluid, clinic model was developed. At the beginning of the program there were only 5 patients enrolled at a time, building gradually, with an estimated 500 patients participating to date. The current enrollment includes 64 patients for the exercise class, which is offered twice per week. Patients range in age from 52–92 years, 33 males and 31 females. The diagnosis of diastolic HF accounts for approximately 70% of the current group of patients, with the remainder diagnosed with systolic HF. At NWH we have an “identify and connect” program that alerts the NPs to any patient admitted with a diagnosis of HF. Based on their status and preference, patients are enrolled to nursing only visits or nursing visits with exercise. Patients are also referred by their cardiologist directly to the clinic from NWH and outlying hospitals.
Upon entrance into the program patients undergo an evaluation by the NP, assessing current physical status and medical regiment, with particular attention to signs and symptoms of HF and weight gain. Brain naturetic peptide (BNP) level is followed closely, as well as renal function, in the titration and selection of medications. At each visit the patients are reassessed by an NP, or nurse, for vital signs, weight, breath sounds, edema, and symptoms. If a patient has gained more than 3 pounds (1.4 kg) since the prior sessions, the patient is not permitted to exercise.
Prior to entering the exercise program, patients are evaluated by a physical therapist. This evaluation includes a musculoskeletal screening, 6 minute walk test with telemetry monitoring, balance screening, and self-report of prior and current exercise routines. Following the results of the six-minute walk test (6MWT), a target heart rate range is determined, at 50% to 70% of 220-age[,,, Patients are educated in the use of the Borg 6–20 rating of perceived exertion scale, with instruction to work at a level of 11–13, or moderate exercise[,,,
Exercise prescription is then determined, following the American Heart Association and the American College of Sports Medicine guidelines.5 Intensity is recommended to be within the target heart rate range and/or perceived exertion rating of 11–13 (moderate level). Duration is targeted at 30 to 40 minutes of aerobic exercise, beginning with the amount the patient is able to perform at the time. Frequency is recommended to be 5 to 7 days per week. Patients are monitored with telemetry for the first 3 exercise sessions, and then continue without telemetry unless there are rhythm or ectopy concerns. Patients are monitored for heart rate and blood pressure throughout the exercise sessions, and after 5 minutes of recovery. Oxygen saturation is measured as well. The examination and management of patients in the HF clinic is outlined in Figure Figure11.
Examination and management of patients in the heart failure clinic.
Modes of exercise include treadmills, upright and recumbent bikes, elliptical machines, and NuStep™ machines. The NuStep™ is a seated stepping and upper extremity exercise machine. It is well tolerated by patients with common comorbidities such as back pain, balance difficulties, and lower extremity weakness; this is one of the preferred machines by our patients. Considerations are taken into account for orthopedic impairments, pain, balance abnormalities, and personal preferences. Patients are encouraged to experiment with various machines for variety and carryover to health clubs or senior center exercise rooms, as well as for determining the best machine to purchase for home[,7 When appropriate, patients are referred for individual physical therapy services, for example balance training, which can be coordinated on the same visit day as the clinic.
Exercise is progressed as tolerated, with very deconditioned patients beginning with 5 minutes of exercise, followed by a rest period, continuing in intervals. More fit individuals begin with 30 minutes continuous exercise the first session, with warm-up and cool-down as well. Light resistance exercise is added when appropriate, taught individually with an emphasis on simple exercises that can be reproduced at home. Stretching is recommended and instructed for the working muscle groups. The HF program runs for 12 months throughout which patients can move from one phase to another if their medical status changes (Figure (Figure22).
The 3 phases of the heart failure clinic.
The diagnosis of HF is not recognized by Medicare as a Cardiac Rehabilitation diagnosis; thus, patients are billed only for the nursing visits. One of the primary goals of the program is to prevent readmissions for HF. Our 30 day all cause readmission rate at NWH was recently estimated at 15% with 7.5% for acute HF. National estimates in the same time period were 24% all cause and 17% acute HF readmissions. As health policy evolves and reimbursement may be spread over the course of an illness, rather than service based, this model may prove to be very cost effective for HF patients.
SUMMARY
In summary, we have developed a disease management program that incorporates physical therapist directed exercise training for our HF patients. This allows us to serve this population despite their falling outside the traditional cardiac rehabilitation model. Our patients benefit from the more frequent nursing assessments, training effects, and social interactions that the clinic provides. As one patient reported, “The program has increased my mobility, endurance, capacity, and tolerance. It has taught me how to care for myself.”