Mastectomy Fitter Course Scope of Practice Facilities and

Mastectomy Fitter Course Scope of Practice, Facilities, and Practice Management Mastectomy Fitter Course

Objectives 1. Discuss professional ethics and the scope of practice as it relates to mastectomy fitters as well as other related health care professions. 2. Describe practice management procedures and policies including safety, federal and state rules and regulations as well as documentation, reimbursement, and inventory control protocols. 3. Discuss the available educational materials, evidenced based practice, and continuing education in regards to mastectomy. Mastectomy Fitter Course

Scope of Practice

What is a Certified Mastectomy Fitter? A health care professional who is specifically educated and trained in the provision of breast prostheses and post-mastectomy services. 8 Pursuant to a physician’s order, a mastectomy fitter measures a patient and properly fits, dispenses and adjusts external breast prostheses, bras and related supplies. Trained and certified mastectomy fitters are integral to the physical and emotional wellbeing of patients, providing instruction and training on how to properly use and maintain postmastectomy devices. 22 Mastectomy Fitter Course

What is the Need for Mastectomy Fitters? During the delicate time of treatment, breast cancer patients can be overwhelmed with information and options. The mastectomy fitter is there to provide educated support regarding breast prosthesis options, fitting, and follow up. Mastectomy Fitter Course

The Mastectomy Fitter Niche For a wonderful article regarding the “niche” that is mastectomy fitter, please read the following 2013 O&P Edge Article, “Post. Mastectomy Fitters Find Their Niche in the Breast Cancer Community” by Linda M. Hellow. Article Link: POST-MASTECTOMY FITTERS FIND THEIR NICHE IN THE BREAST CANCER COMMUNITY Mastectomy Fitter Course

Certification • ABC • BOC Link to ABC Website Link to BOC website on Mastectomy Fitter certification Mastectomy Fitter Course

ABC • CFm • Successful completion of an approved entry level educational program • 500 hours documentation of mastectomy patient care • Successful completion of certification exam • Submitted application and fees Mastectomy Fitter Course

BOC • CMF • Successful completion of an approved entrylevel education program • 500 hours documentation of mastectomy patient care • Successful completion of certification exam • Submitted application and fees Mastectomy Fitter Course

Scope of Practice - BOC According to BOC, Mastectomy fitting is the practice of addressing medical conditions of the upper extremities and post-mastectomy surgical outcomes. Mastectomy Fitter Course

Scope of Practice - ABC • An ABC certified fitter-mastectomy is a health care professional who is specifically educated and trained in the provision of breast prostheses and post-mastectomy items and services. This includes patient assessment, formulation of a treatment plan, implementation of the treatment plan, follow-up and practice management. • The ABC certified fitter-mastectomy is bound by the ABC Code of Professional Responsibility which is enforced by a Professional Discipline program. The certified fitter-mastectomy is obligated to support and conform to professional responsibilities that promote and assure the overall welfare of the patient and the integrity of the profession. The time limited certification expires without compliance with the Mandatory Continuing Education program. Link to Source of Information Mastectomy Fitter Course

Maintaining your Certification ABC BOC • Obtain a minimum of 10 CEUs every 5 years. CPEs every 5 years. – 8 Category 1 (min) – 2 Category 2 (max) Mastectomy Fitter Course

Licensure/State Regulations Currently, Alabama is the only state also requiring licensure. Mastectomy Fitter Course

Other O&P Professions • • Orthotist Prosthetist Orthotic Fitter Pedorthist O&P Technician Therapeutic Shoe Fitter Orthotic Fitter Assistant Mastectomy Fitter Course

Table: Professions and Descriptions Profession. Description. O&P Technician. Provides fabrication for O&P devices. No patient contact. Orthotic Fitter Assistant. Prefabricated soft orthoses. Trusses. Prefab. Compression Garments. No Fractures. No modification. Orthotic Fitter. Prefabricated orthoses. Trusses. Prefab & Custom Compression Garments. Prefab & Custom Molded Therapeutic shoes. No Fractures. Minor Modification. Therapeutic Shoe Fitter. Non-Custom Therapeutic shoes. Non-Custom multi-density inserts. Pedorthist. Prefab or Custom orthoses distal to the Malleoli. Non-dynamic prosthetic fillers of the forefoot. Prefab & Custom Molded Therapeutic shoes. May make modifications. Orthotist / Prosthetist. All Custom and Prefabricated Orthoses and their modification and adjustments. Prostheses. Mastectomy Fitter Course

Practice Management

Regulatory Bodies • ABC Facility Accreditation Link to ABC website • BOC Facility Accreditation Link to BOC website • OSHA- Occupations Safety and Health Organization- part of the Dept. Of Labor Link to OSHA website • CMS- Centers for Medicare & Medicaid Services Link to CMS website Mastectomy Fitter Course

Safety • OSHA- Occupational Safety and Health Administration Link to OSHA website • CDC- Centers for Disease Control Link to CDC website • WHO- World Health Organization Link to WHO website Mastectomy Fitter Course

Disease Transmission While mastectomy fitting may not be as invasive or high risk as other medical scenarios, it is important to understand that there are risks. Specifically those surrounding the potential to spread infectious diseases, including: – Blood-borne pathogens- example: HIV, Hepatitis C – Other “Contact” Pathogens- example: C. Diff, MRSA – Airborne Pathogens- example: Influenza, Tuberculosis Mastectomy Fitter Course

Transmission It is important to note that not all infectious diseases are transmitted through direct contact with the patient. Indirect contact, such as a measuring tape on one patient’s skin used on another patient, or even airborne transmission, such as coughing and sneezing, can transmit disease. Many mastectomy patients may still have compromised immune systems due to treatment. Mastectomy Fitter Course

Work Practice Controls for Safety Policies that employees follow to prevent the transmission of disease – Universal/Standard Precautions – Hand Hygiene Protocols – Environmental Cleaning Protocols Mastectomy Fitter Course

Universal/Standard Precautions Universal Precautions, set in place by OSHA, are outdated. CDC and WHO both now recommend Standard Precautions for all patients. Minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where healthcare is delivered. 1. 2. 3. 4. 5. Hand Hygiene PPE- “Personal Protective Equipment”- Gloves, Gowns, Masks Safe Injection Practices (does not apply to mastectomy fitting) Safe Handling of Potentially Contaminated Equipment/Surfaces Respiratory Hygiene/Cough Etiquette Mastectomy Fitter Course

When Not to Fit • Do Not fit mastectomy patients with broken skin on chest wall and/or if the surgery site is not healed. In these cases provide consultations only and refer back to physician if necessary. • Always wear gloves and follow hand hygiene. – Protect the patient from you and you from the patient (transmission is both ways). Mastectomy Fitter Course

Hand Hygiene Hands are the main pathways of germ transmission during health care. • Hand washing (40 to 60 seconds): – wet hands and apply soap – rub all surfaces – rinse hands and dry thoroughly with a single use towel – use towel to turn off faucet • Hand rubbing (20 to 30 seconds): – apply enough product to cover all areas of the hands – rub hands until dry Mastectomy Fitter Course

Environmental Cleaning • • • Doorknobs Chairs/Railings Tape Measures Pens Patient Beds Mastectomy Fitter Course • EPA-Registered cleaning agents • C. Diff- Bleach dilution

Cough Etiquette • 1 st point of contact-reception areas • Signs at entrances • Provide tissues, masks, hand hygiene, and no touch waste receptacles • Spatial separation of persons with symptoms Link to Source of Information Mastectomy Fitter Course

Vaccines • • Hepatitis A Hepatitis B Influenza TB Test Annually Mastectomy Fitter Course

Practice Safety Policies • Practice Managers should have policies in place for employees including: – Disease Transmission Prevention Policies • Standard Precautions • Environmental Cleaning – Safety Education Training Policies • CPR/AED/First Aid • Infectious Disease Courses – Accident/Exposure Reporting Policies • CDC/DOH Mastectomy Fitter Course

HIPAA Health Insurance Portability and Accountability Act of 1996 • Provides federal protections for individually identifiable health information – Privacy Rule specifies who can access protected health information “PHI” – Security Rule specifies safeguards Link to Source of Information Mastectomy Fitter Course

HIPAA, 2 “Individually identifiable health information” is information, including demographic data, that relates to: • The individual’s past, present or future physical or mental health or condition, • The provision of health care to the individual, or • The past, present, or future payment for the provision of health care to the individual, • and that identifies the individual or for which there is a reasonable basis to believe can be used to identify the individual. Mastectomy Fitter Course

HIPAA, 3 Documentation – Agreement to use PHI during the course of treatment – Privacy Policy – Authorization to use PHI other than the course of treatment (if needed) Mastectomy Fitter Course

HIPAA, 4 How to protect PHI – Cover or remove sign-in sheets so patient names are not displayed – Be conscious of conversations and who can hear them, even through thin walls – Keep patient records separated from areas nonauthorized persons can access – Have written privacy policies and procedures and designate a “privacy official” and “contact official” Mastectomy Fitter Course

HIPAA, 5 • Privacy Official and/or Contact Official must: – Develop and implement written privacy policies and procedures – Keep track of all workforce training on its privacy policies and procedures – Receive and keep track of complaints – Mitigate any harmful effects that may have been caused by disclosure of PHI – Safeguard Data both technical and physical (shredding, encryption, locks, keys, passcodes, etc. ) Mastectomy Fitter Course

ABC/BOC Facility Accreditation While ABC or BOC Facility Accreditation may not be required by law, they sets standards and expectations for the O&P field and assist facilities in identifying inefficiencies and areas of improvement. Mastectomy Fitter Course

Facility Accreditation • All licenses, certificates, and permits must be displayed • Documented policies, procedures, mission statement, etc. • Complies with CMS Supplier Standards, Regulations, and Medicare Contractor policies • Establishes file auditing and monitoring for both clinical and financial records • Has an emergency evacuation plan and conducts a drill at least annually For a complete list of the requirements for the different facility accreditations, please visit their respective websites: Link to BOC website Link to ABC website Mastectomy Fitter Course

CMS Compliance Centers for Medicare & Medicaid Services • Enroll/Apply for a Medicare Provider/Supplier Number • CMS- DMEPOS Accreditation Link to Source of Information Mastectomy Fitter Course

Insurance Contracts • Consider contracts with other insurance providers besides CMS. • Many patients may have private insurance and want to go somewhere “in network. ” Mastectomy Fitter Course

Facilities Management

Types of Mastectomy Facilities According to a 2011 ABC Survey – 31% of CFms work at an O&P facility – 51% work in a retail setting such as a medical supply store, pharmacy, or post-mastectomy boutique Mastectomy Fitter Course

The Fitting Room Your office and fitting room are often your patient’s first impression. Appearance can be everything. • Environment – Private – Quiet – Attractive – Comfortable – Clean – Temperature controlled Mastectomy Fitter Course

The Fitting Room, continued • Each room should be equipped with the following: – Seating with armrests for patient safety – Full length mirror – Measuring tape – Robes (disposable are preferred) – Papers for documentation/ordering/notes – Hand sanitizer, tissues – Non Latex Gloves Mastectomy Fitter Course

Inventory Risk Management “Inventory control risks affect all companies regardless of how much inventory the company carries. A small business typically has a large amount of its cash tied up in inventory. With such a large financial investment in his business, the small businessperson must make every effort to reduce the risks associated with carrying inventory. ” -Kenneth Hamlett, Demand Media Link to Source of Information Mastectomy Fitter Course

Inventory Risk Management Factors • Theft – Have basic security measures in place • Lost Inventory – Inventory tracking system – Stock Room Labeling – Policies to put back items from inventory immediately after seeing a patient, etc. • Damage – Proper storage to prevent damage • Life Cycle – Recognizing when a product is being discontinued or becoming obsolete • Shelf Life – Proper date labeling of product to monitor shelf life Mastectomy Fitter Course

Inventory • Tailor inventory to your type of facility • Have various manufacturers • Have multiple sizes and more than one of popular sizes • Have a system for reordering inventory when it is used, and keeping track of orders, shipping, and current stock • Consider stocking other items such as headwear, swimwear, lotions and cleansers, etc. Mastectomy Fitter Course

Marketing

Know Your Referral Sources • • • Breast Surgeons/Clinical Oncologists Plastic Surgeons OB/GYNs Radiologists Support Groups Mastectomy Fitter Course

Marketing Materials Business Cards Prescription Pads Patient Education Pamphlets “In Service” Education about mastectomy products/services • Website • Newspaper/“Yellow Pages” • Other DMEPOS offices- exchange referrals as many O&P or • • DME offices do not provide mastectomy products Mastectomy Fitter Course

Patient Referral Works Both Ways During your patient evaluations and follow ups, you may discover health concerns that are out of your scope of practice. By referring your patients to the appropriate health care provider, you are not only better serving your patient population, but are also building relationships with current and future referral sources. Examples Include: • Noticing Edema- Referral back to Physician and/or Lymphedema Therapist • Patient c/o back pain- Referral back to Physician and/or Orthotist (once patient has Rx) • Patient c/o depression/anxiety- Referral back to Physician, Psychiatry, or support group Mastectomy Fitter Course

Patient Referral Works Both Ways, 2 1. Patient referred to outside health care provider. 2. Patient benefits from increased quality of care. 3. Relationship and trust built between you and outside health care provider. 4. Outside health care provider refers mastectomy patients back to you. 5. Your patient population increases. 6. Back to #1: Patient referred to outside health care provider. Mastectomy Fitter Course

Do Not Forget to thank referral sources and follow up with physicians! Mastectomy Fitter Course

Education and Ethics

Education • Knowing educational sources is beneficial for both you as a fitter and for your patients. Mastectomy Fitter Course

Fitter Education Resources • • CEUs are required by both ABC and BOC to maintain certification: Online CEUs- Link to O&P Education site Manufacturer courses Organizational Meetings Calendar of Courses – Link to O&P Education calendar Mastectomy Fitter Course

Patient Education Resources Mayo Clinic National Institute of Health- NIH Breast Cancer Org – Link to Breast Cancer website National Breast Cancer Foundations, Inc. – Link to National Breast Cancer Foundation website • American Cancer Society Support Group Search – Link to Cancer. Org website for support group programs • • Mastectomy Fitter Course

Evidenced-Based Practice Cancer treatment as well as the field of O&P is changing and growing rapidly. It is both important and ethical to keep up with the research and education surrounding breast cancer and its treatment. Be aware of biases in the current articles and research! I encourage you to read the following article pointing out the lack of evidenced-based research in our field: External Breast Prostheses: Misinformation and False Beliefs. Link to Medscape website. Mastectomy Fitter Course

Evidence-Based Practice, 2 • Besides keeping up with the current research and trends, consider giving back and promoting prosthetic mastectomy treatment. Do your own research, conduct surveys, document case studies, get involved with other medical professionals who may be doing research in a related area. • Through objective data and documentation we can continue to improve the standards and help increase our patients’ quality of care! Mastectomy Fitter Course

Ethics • Ethics applies to all aspects of a mastectomy fitters practice. • Billing – Do not take advantage of insurance companies or patients. • Documenting – Document everything, not just what will benefit you or your practice. Medical Documents are legal documents! • Patient Interaction – Your goal should always be for the best patient outcome. Mastectomy Fitter Course

Summary Please feel free to review this Power. Point and its references as many times as you feel necessary. Please take the quiz related to this portion of the course and then continue on with the next presentation. Mastectomy Fitter Course

References 1. Netter, F. H. Atlas of Human Anatomy. 5 th Edition. Saunders/Elsevier. 2011. 2. Mayo Clinic. Mastectomy. 2011. Retrieved from website on December 17 th 2013. Link to Mayo Clinic website. 3. National Breast Cancer Foundation, Inc. Link to National Breast Cancer website. 4. Breast Cancer. org Link to Breast Cancer website. 5. Trulife. Link to Trulife website. 6. Amoena. Link to Amoena website. 7. American Breast Care. Link to American Breast Care website. 8. The American Board for Certification in Orthotics, Prosthetics & Pedorthics. Link to ABC website. 9. Medline. Plus. U. S. National Library of Medicine. Breast Cancer. Retrieved from website on December 18 th 2013. Link to Medline. Plus website. 10. Centers for Disease Control and Prevention. Breast Cancer. Retrieved from website on December 18 th 2013. Link to CDC website. 11. American Cancer Society. Link to American Cancer Society. 12. National Library of Medicine. ADAM Medical Encyclopedia. 2013. Retrieved from website on January 2 nd 2014. Link to National Library of Medicine website.

References, 2 13. Pictures of Mastectomy. Dr. Oz. Retrieved from website on January 10 th, 2014. Link to Dr. Oz website. 14. Breast Cancer Surgical Treatment Complications and Lymphedema. Women’s Health and Education Center. Retrieved from website on January 11 th, 2014. Link to Women’s Health and Education Center. 15. Prevalence and Psychosocial Factors of Anxiety and Depression in Breast Cancer Patients. 2007. Retrieved from website January 3 rd, 2014. Link to National Center for Biotechnology Information (NCBI) website. 16. Psychological and Sexual Disorders in Long-Term Breast Cancer Survivors. Retrieved from website on January 17 th, 2014. Link to Dove Press website. 17. External Breast Prostheses: Misinformation and False Beliefs. Retrieved from Website on January 17 th, 2014. Link to Medscape website. 18. Body Posture of Women After breast Cancer Treatment. 2010. Retrieved from Website on January 17 th, 2014. Link to NCBI website. 19. Body Image After Prophylactic Bilateral Mastectomy: An Integrative Literature Review. 2006. Link to NCBI website. 20. Sex After Surgery: Intimacy After Mastectomy. 2008. Retrieved from website on January 17 th 2014. Link to Health Central website. 21. Post-Mastectomy FAQs. Link to Oand. PCare website. 22. BOC Board of Certification/Accreditation. Link to BOC USA.

Scope of Practice, Facilities, and Practice Management This workforce product was funded by a grant awarded by the U. S. Department of Labor’s Employment and Training Administration. The product was created by the grantee and does not necessarily reflect the official position of the U. S. Department of Labor. The U. S. Department of Labor makes no guarantees, warranties, or assurances of any kind, express or implied, with respect to such information, including any information on linked sites and including, but not limited to, accuracy of the information or its completeness, timeliness, usefulness, adequacy, continued availability, or ownership. Produced 2016. HOPE Careers Consortium is a partnership of five institutions of higher education that is building exciting new programs that will provide valuable career education and training in the Orthotics, Prosthetics, and Pedorthics (O&P) sector. The five institutions are: Baker College—Flint, Michigan; Century College—White Bear Lake, Minnesota; Oklahoma State University Institute of Technology—Okmulgee, Oklahoma; Spokane Falls Community College—Spokane, Washington; and St. Petersburg College—St. Petersburg, Florida. Although the authoring institution of this educational resource has made every effort to ensure that the information presented is correct, the institution assumes no liability to any party for any loss, damage, or disruption caused by errors or omissions. Except where otherwise noted, this work by St. Petersburg College is licensed under the Creative Commons Attribution 4. 0 International License. To view a copy of this license, click on the following link: Creative Commons Licenses 4. 0.