**VHA PROSTHETIC CLINICAL MANAGEMENT PROGRAM (PCMP)**

**CLINICAL PRACTICE RECOMMENDATIONS**

**FOR AUDIBLE PRESCRIPTION READING DEVICES**

I. **POLICY**

The purpose of this document is to assist practitioners in clinical
decision making,

standardize and improve the quality of patient care, and promote

veterans\' functional independence in relation to audible prescription
reading

devices (APRD).

II\. **BACKGROUND**

VHA\'s Prosthetic and Sensory Aids Service Strategic Healthcare Group
was

directed by the Under Secretary for Health to establish a Prosthetic
Clinical

Management Program (PCMP). The objectives are to coordinate the

development of clinical practice recommendations for prosthetic devices
and

contracting opportunities to assure technology uniformity\' and ease of
access

to prosthetic prescriptions and patient care that will lead to valid
outcome

measures and analysis for research purposes. A workgroup with input from
selected clinicians and con\~iumers was formed to develop clinical
practice recommendations for the use, training and issuance of APRD.
These devices are designed to provide auditory feedback forpatients with
visual, cognitive, and/or reading/language barriers.

A veteran who can benefit from the APRD should be idel1tified by the
primary

health care team, appropriate specialty health care provider, or Visual

Impairment Services Team (VIST) Coordinator. The prirnary health care

team should coordinate and initiate the assessment and evaluation.
Training

will be provided by nurse educators or their designee. There must be

documentation about the justification for, and evidence of, appropriate
patient

training in the uses of these devices to meet VHA outcorne measures.

III\. **CLINICAL PRACTICE RECOMMENDATIONS**

A. General Recommendations

1\. Had a stated goal(s) that required the use of an APRD.

2\. Expressed an interest in using the device to a(;complish the
goal(s).

3\. Demonstrated the ability to independently and safely use the device

to effectively meet the stated goal(s).

a\. Prior to issuing a specific APRD, the veteran should have

the opportunity to evaluate other appropriate visual and non- ..

visual devices to accomplish the stated goal(s).

b\. The device must prove to be the most efficient and effective

means of meeting the goal.

c\. Prior to enrollment in the APRD progranl, evaluations will be

conducted by appropriate consultative clinical services

identified by the primary health care team that may impact

successful training with the device (Attachment).

B. Specific Recommendations

The general purpose of these devices is to improve the independent and

safe use of prescription medications by veterans \'Nith visual and other

functional or cognitive impairments to better manage medical health care

conditions.

1\. General guidelines for consideration shoul(j be:

a\. Ability to use and operate appropriate functions of the

device.

b\. Ability to hear, and demonstrate comprehension of the

recorded message.

c\. All veterans must have initial instruc:tion and training with

these devices.

C. VHA Outcomes Measures

1\. Veteran-specific abilities:

At the conclusion of training, the veteran must be able to demonstrate

the ability to independently and safely operate the APRD to achieve

the stated goal(s). VHA outcome measures for the use of this device

by veterans may include the ability to:

a\. Identify, operate and effectively utilize the basic features of

the device to follow auditory instructions.

b\. Clean, care for, maintain and trouble-shoot the device.

c\. Understand the potential uses of the (device, and when the

device will be ineffectual or inappropriateness.

d\. Safely and efficiently utilize the device for its intended use.

e\. Demonstrate a level of safety and skill with the device.

2\. Rehabilitation-specific capabilities:

At the conclusion of training, the veteran must be able to

demonstrate improved quality of life through the development of

skills and capabilities needed for the independent and safe use of

prescription medications to better manage medical health care

conditions. VHA outcomes measures may include the following

areas, as applicable:

a\. Living skills

b\. Communication skills

c\. Activities of Daily Living

d\. Independent Living

e\. Adjustment to blindness and/or significant visual,

cognitive or other functional impairment

NOTE: The VHA Outcome Measures are arrived at through both objective and
subjective

means. Current research dictates the particular measurement tools or
measures utilized.

Jonathan B. Perlin, MD, PhD, MSHA, FACP

Acting Under Secretary for Health

ATTACHMENT

CONSULTATIVE CLINICAL SERVICES

Consultative clinical services that may be requested by the primary
health care

team prior to Audible Prescription Reading Devices (APRD) program
enrollment

of veterans may include, but are not limited to:

1\. Audiology

2\. Geriatrics

3\. GRECC

4\. Mental Health

5\. Neurology

6\. Neuropsychology

7\. Optometry

8\. Ophthalmology

9\. Psychology

10\. Psychiatry

11\. Pharmacy