Practice Analysis of ABC Certified Mastectomy Fitters

January 2019

Appendix C

Linking Study
	Tasks		Knowledge and Tasks
	1. Patient Assessment	K/S 1	K/S 2	K/S 3	K/S 4	K/S 5	K/S 6
1	Review patient's prescription/referral	k11	k7	k1	k9	k23
2	Obtain relevant patient medical history, including previous use of post- mastectomy items, diagnosis, and activities of daily living (ADL)	k12	s33	s39
3	Discuss patient's expectations and goals	s33	s35	s36
4	Perform a diagnosis-specific functional clinical examination that includes observation of chest wall and evaluation of range of motion, manual dexterity, skin integrity, and shape/physical characteristics	k2	k3	k4	k5	s33	s34
5	Consult with other healthcare professionals and caregivers about patient's condition, as needed	k11	k20	k19
6	Refer patient, if appropriate, to other healthcare professionals (e.g., therapist, physician) for intervention beyond mastectomy fitter's scope of practice	k20	k14	k19
	2. Formulation of Treatment Plan
1	Use the assessment results to formulate a treatment plan, including goals and expected outcomes to increase patient comfort, enhance function, accommodate deformity (e.g., shoulder drop, scoliosis) and improve balance, symmetry and appearance	s34	k8	s35	s36
2	Consult with licensed healthcare prescriber to obtain supporting documentation and/or modify the original prescription, if necessary	k12	k14	k11	k32
3	Document the patient's need described in the treatment plan	k12	k32	s39	s36
4	Identify post-mastectomy items to support the treatment plan	s37	k21	k22
5	Communicate to patient and/or caregiver about the recommended treatment plan and timeline for completion	s38	k32	s33
6	Inform patient or responsible parties of their financial responsibilities as they pertain to the recommended treatment plan and/or any coverage limitations	k15	k32
	3. Implementation of Treatment Plan
1	Select and prepare appropriate post-mastectomy items to implement treatment plan	k21	s37	k28
2	Assess fit and comfort of post- mastectomy items and make any necessary adjustments	k24	k22	s38	s36
3	Ensure that post-mastectomy items are provided as prescribed	k32	s39	k12
4	Educate patient and/or caregiver about the use and care of post-mastectomy items (e.g., wearing schedules, cleaning), including benefits, possible risks, and warranty information	k25	k26	k28
5	Advise the patient and/or caregiver about their rights and responsibilities	k32	k18	k13
6	Document treatment using established record-keeping techniques to verify implementation of treatment plan	s39	k12	k32
7	Develop and communicate follow-up plan	s36	s37
	4. Follow-up
1	Obtain feedback from patient and/or caregiver about the outcome of the treatment plan (e.g., tolerance, comfort, ability to don and doff, proper usage and function)	s33	s34
2	Re-evaluate the patient through a follow-up clinical examination that may include review of changes to patient status, shape, and physical characteristics	s33	s34	s36
3	Identify need for changes relative to initial treatment goals and expectations by assessing fit of post-mastectomy items	s38	k22
4	Modify or adjust post-mastectomy items based on assessment and/or patient/caregiver feedback	k22	s38
5	Educate patient and/or caregiver on proper use of post-mastectomy items relative to modifications/adjustments	k21	k25	s36
6	Document follow-up care, including any changes in treatment plan	k12	s39
	5. Practice Management
1	Comply with federal and state regulations for the delivery of items within the Certified Mastectomy Fitter Scope of Practice (e.g., CMS, Medicaid, OSHA, HIPAA)	k32	s39	k16	k15
2	Comply with policies and procedures regarding universal precautions and infection control	k32	k17
3	Comply with documentation requirements (e.g., document retention, verification that post-mastectomy items were delivered and billed as prescribed)	k12	s39	k32

Contents

Practice Analysis of ABC Certified Mastectomy Fitters

Appendix C