Sessions Statement
Please find below an updated position statement for defining and recording cardiac rehab sessions as agreed by the BACPR, NACR, and the NCP_CR Steering Group.
There are two parts to the statement - the first covering supervised outpatient CR and the second facilitated/structured self-managed CR.
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SESSIONS DEFINITION - BACPR/NACR
- This definition applies to supervised outpatient Cardiac Rehabilitation (CR) delivery only
In accordance with the BACPR Standards and Core Components the recording of CR sessions should take account of the core components of CR delivery. In practical terms this means that, for example, a structured exercise session followed by a structured education session, each targeting at least one key core component, would be recorded as two separate sessions on the NACR database.
A CR session should be provided by a member of your team (ie. not an onward referral to another service), and may be a group session, or a 1-1 session. Examples may be - an exercise session, or education around smoking cessation, psycho-social, dietary advice.
Examples:
- 1. One exercise session would incorporate a warm-up (5 to 15 mins), main exercise (20 to 40 mins) and cool down (5 to 10 mins). The exercise intensity should be tailored to patient ability (e.g. 40% to 70% of a patient’s measured fitness). The lower duration timings and intensity settings in each part of the exercise training session (stated above) relate to either low exercise capacity patients (such as more severe heart failure e.g. NHYA III) or a slower progression due to other complex needs of the patient.
- 2. One education session would incorporate the presentation of up to date education materials, in a group setting, focusing on a specific core component of cardiac rehabilitation (as per BACPR 2017). A single session would have key learning outcomes stated at the start around the selected core component. The duration would typically be around 30 to 40 minutes per core component with time given to allow patients to ask questions about that session and for the tutor to gain some sense that the learning outcomes had been achieved. This approach assumes that patients will also have ongoing education built into other aspects of their tailored CR intervention.
- This definition applies to facilitated and structured Self-Managed delivery e.g. home-based, web-based and hybrid programmes
For this type of CR delivery what should be recorded is the contacts by the CR team with the patient (sessions=contacts here). In accordance with the BACPR Standards and Core Components the recording of CR sessions/contacts should take account of the core components of CR delivery. In practical terms this means that a facilitated session/contact needs to include structured support in achieving agreed patient goals (based on prior assessment) for CR core component(s) i.e. exercise, diet, psychosocial etc.
In all aspects, the programme should be structured to achieve an optimal learning experience and align with each of the BACPR Core Components. These should be delivered by a competent healthcare professional, within the Core Component topic area, in accordance with BACPR education delivery guidance (BACPR 2017 section 3.1.2 Education).
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Where components are done outside the Core CR programme (ie. Early / Phase 1 or 2) then a similar criteria will apply: in that CR intervention related contacts (on the ward, or by telephone) will need to be done by a competent healthcare professional and take into account the Core Components.
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Assessment as part of a CR programme – A 'completed baseline assessment' prior to starting core rehab (assessment 1 NACR) when done by a member(s) of the CR team can be recorded as one session. Recording this as one CR session is independent of the number of appointments taken to complete the full assessment as per BACPR Standards and Core Components (BACPR 2017). For example if a patient was initially assessed for psychosocial status, diet and risk factors and then had a different appointment for their Functional Capacity Test (e.g. Bypass patients) this would collectively be counted as 'completing the full assessment' and considered as part of one CR session rather than a separate CR session.
These session definitions and recording principles should be applied to the post CR assessment (NACR assessment 2) in that a 'completed final assessment' (independent of the number of appointments) counts as one CR session.
These session definitions and recording principles should be applied to the post CR assessment (NACR assessment 2) in that a 'completed final assessment' (independent of the number of appointments) counts as one CR session.
The BACPR and NACR will review session definitions and related examples annually.
V1.2 BACPR/NACR June 2020
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