Provision of Care and Services

Table of Contents

Provision of Care and Services

POLICIES

Human Rights Assurance 2.1

Patient Admission Criteria/Scope of Services 2.2

Identifying and Reporting Possible Victims of Alleged/Suspected

Abuse or Neglect 2.3

RN Delegation 2.4

Initial Assessments/Comprehensive Assessments 2.5

Plan of Care 2.6

Professional Standards of Practice 2.7

Coordination of Patient Care 2.8

Duplication of Services 2.9

Skilled Nursing Services 2.10

Rehabilitation Services 2.11

Social Work Services 2.12

Blank 2.13

Blank 2.14

Other Healthcare Services 2.15

Equipment Management 2.16

Laboratory Testing: Blood Glucose Monitors 2.17

Laboratory Testing: PT/INR Monitors 2.18

After Hours Accessibility 2.19

Extended Care 2.20

Community Resources 2.21

Emergency Procedures 2.22

Visit Schedule / Missed Visits 2.23

Transfer/Discharge Criteria 2.24

Discharge Planning Criteria 2.25

Discharge Summary 2.26

Physician License Verification 2.27

Patient Information for Medication Management 2.28

Medication Storage 2.29

Emergency Medications and Supplies 2.30

Medication Profile 2.31

Medication Orders 2.32

Medication Preparation 2.33

Medication Labels 2.34

Medication Administration 2.35

First Dose 2.36

Treatment Modalities 2.37

Medication Monitoring 2.38

Adverse Drug Reactions 2.39

Medication Errors 2.40

High-Risk Medications 2.41

POLICIES (continued)

Investigational/Experimental Drugs 2.42

Evaluation of Medication Management System 2.43

Look-Alike/Sound-Alike Drugs 2.44

FORMS/ATTACHMENTS

Documentation of Face to Face Encounter 2.2A

RN Delegation Assignment Sheet 2.4A

Glucometer Competency Assessment 2.17A

PT/INR Monitor Competency Assessment 2.18A

Discharge Summary 2.26A

Physician License Verification 2.27A

Drug Classifications Approved for Home Administration 2.35A

Staff: Appropriate Use of 2 Patient Identifiers 2.35B

Professional Pediatric Home Care December 2012

Contents – Chapter 2

ACHC Standard HH1-1A.01

Human Rights Assurance

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Policy

The Agency states human rights assurance.

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Purpose

To establish guidelines for assurance of human rights.

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Reference

Health Facilities and Emergency Medical Services Division, 6 CCR 1011-1, Standards for Hospitals and Health Facilities, Chapter 26 – Home Care Agencies

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Procedure

1.  The Agency will not discriminate against recipients of services on the basis of race, color, religion, national origin, sex, sexual preference, physical or mental handicap, political belief, veteran status, age, diagnosis/infectious disease, ability to pay, or whether the patient has an advance directive.

2.  The Agency will not discriminate against any employee or applicant for employment on the basis of race, color, religion, national origin, sex, sexual preference, political belief, veteran status, age or physical or mental handicapped status.

3.  All employees and subcontractors employed by this Agency will conform to these policies of human rights assurances.

Professional Pediatric Home Care December 2012

2.1

ACHC Standard HH2-1A.01, HH5-13A.01, HH5-14A.01, HH5-15A.01

Patient Admission Criteria/Scope of Services

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Policy

Patients are accepted for care or services on the basis of a reasonable assurance that the needs of the patient can be met adequately by the Agency in the patient’s temporary or permanent home or place of residence. Patients will be accepted for care only if Agency can meet a patient’s identified needs.

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Purpose

To establish criteria for the admission of patients to the Agency and Agency Scope of Services.

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Reference

Health Facilities and Emergency Medical Services Division, 6 CCR 1011-1, Standards for Hospitals and Health Facilities, Chapter 26 – Home Care Agencies

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Related Documents

“Documentation of Face to Face Encounter” form

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Procedure

1. Criteria for admission are:

·  The patient must reside within the Agency’s service area:

o  50 mile radius from the Agency office, including areas of Adams, Arapahoe, Boulder, Broomfield, Denver, Elbert, Douglas, Weld and Jefferson counties.

·  Patients will be accepted for treatment if the patient’s needs can be met by the agency in the patient’s place of residence.

·  Criteria for acceptance may include:

o  The patient must be under the care of a physician. The patient’s physician must order and approve the provision of any service. A skilled service must be ordered.

o  The patient must desire home health services.

o  The patient must reside within the Agency’s geographical area.

o  The physical facilities and equipment in the patient’s home must be adequate for safe and effective care.

o  Services may be provided to patients insured by Medicare who have a primary need for skilled nursing, physical, and/or speech therapy on an intermittent basis and are homebound. (A patient is considered to be homebound if he/she has a condition that restricts his/her ability to leave his/her place of residence except with the aid of supportive devices; and the use of special transportation; and the assistance of another person; and if he/she has a condition which is such that leaving his/her home is medically contraindicated.)

o  Patient must demonstrate potential to progress toward goals.

o  Acceptance for home health services is realistically based on the patient’s willingness and ability to function in a non-institutional environment, and the willingness, ability, and availability of family/caregiver or significant individuals to participate in the care.

·  If Agency receives a referral of a patient who requires care or services that are not available at the time of referral, Agency shall advise the patient’s primary care provider, if applicable, and the patient or authorized representative of that fact. The patient will be referred to another agency, if appropriate. Referral forms will reflect this.

o  Agency shall only admit the patient if the primary care provider and the patient or patient’s representative agree the services can be delayed or discontinued.

2. The Agency primarily serves pediatric patients requiring the following care:

·  Skilled Nursing, Physical Therapy, Occupational Therapy, Speech Therapy, Medical Social Services.

·  All skilled services are provided under the orders of a licensed physician.

·  Service limitations:

o  The Agency does not provide the following services: geriatric or hospice services.

3.  A list of current charges for services is available to the public and referral sources upon request.

4.  When services are to be terminated, the patient will be notified verbally and in writing.

5.  Agency will not deny admission to people with communicable disease, including, but not limited to, HIV, MRSA, TB and Hepatitis B.

6. Care in the home will be available to all patients who can benefit regardless of race, color, religion, national origin, sex, sexual preference, physical or mental handicap, political belief, veteran status, age or whether the patient has an advance directive. Information to be gathered to determine eligibility includes:

·  Agency has resources to provide the services required by the patient.

·  Attitudes of the patient and family toward care at home are appropriate.

·  Qualified personnel to provide needed services are available.

·  Reasonable assurance that the needs of the patient can be met adequately by the Agency in the patient’s temporary or permanent home or place of residence exist.

·  Care can be provided safely and effectively in the patient’s home.

·  Adequate physical facilities in the patient’s residence for proper care exist.

·  Family or caregiver is available, able and willing to participate in the patient’s care when conditions warrant.

7. Patient referrals may be made by anyone including the family, physician, discharge planners, friends, relatives or the patient.

8. When a telephone referral is received by the Agency, a referral form is completed by qualified agency personnel (Administrator, Director of Clinical Services, Supervisor and Administrative Assistant/Scheduler). Referrals may also be received by fax, in person or in the mail. The referral form includes at least the following information:

·  Patient identification information, e.g., name, address, telephone number, date of birth, sex, social security number, insurance information (if applicable), emergency contact and telephone number.

·  Physician’s name, address and telephone number.

·  Referrals containing verbal orders must be given by the referring physician, by others approved by law to prescribe, or the individual directly designated to convey orders and will be referred to a designated staff member(s) for verification and documentation of verbal orders.

·  Referral source.

·  Primary and other diagnoses, if relevant to care.

·  Date of hospital discharge, if applicable.

·  Care to be provided, including frequency and duration.

·  Availability of a caregiver.

·  Any other information reported by the referral source.

·  The Agency provides 24 Hour on-Call Service after office hours and during weekends and holidays.

·  A Registered Nurse is on call after office hours and during weekends and holidays to coordinate referrals, answer patient/family questions and to provide supervision to staff providing care, treatment and/or services after hours.

·  To contact the Agency, interested parties can contact the office by telephone at 303-759-1342.

9. If required by the payor, a request for confirmation of the face-to-face encounter will be made of the referring party at the time of the referral. If necessary, the agency will provide the referral source with a face-to-face encounter form on which to document the encounter. The form will include:

·  The date that the encounter took place.

·  The primary condition for which home health services are needed, including the medical necessity that requires intermittent skilled nursing and/or skilled therapy services to be provided in the patient’s home.

·  Determination of a patient’s eligibility to receive Medicare home health services with their homebound status being clearly established and documented during the encounter as applicable.

·  Certifying physician signature and date signed.

If a qualifying face-to-face encounter has not occurred within 90 days prior to the start of care date, the admitting clinician will be instructed to provide the patient with verbal and written information regarding the face-to-face encounter requirements. The clinician will assist the patient, as needed, to schedule an appropriate appointment within the required time frame.

10. Each referral is evaluated by the Administrator, Director of Clinical Services and/or Supervisor to assess the level and type of service/care required and to determine whether the patient is eligible for admission based on the Agency criteria and availability of service/care to meet the patient’s needs.

11. One home evaluation visit may be made before deciding to accept the patient for home care services.

12. All initial evaluation visits are made by qualified Agency personnel.

13. During the initial visit, the admitting professional will:

·  Provide information relevant to services to be provided so that patient/caregiver can give informed consent.

·  Provide verbal and written information about the services covered under the HHA benefit, the scope of services that the HHA will provide, and specific limitations on those services prior to initiating service/care.

·  Obtain the patient’s signature on the consent for treatment and other required forms.

·  Verify the information on the referral form.

·  Explain and provide a copy of the Written Notice of Home Care Patient Rights, Patient Bill of Rights and obtain patient’s signature.

·  Explain the patient’s liability for payment of services. Give the patient in writing his/her expected payment responsibility.

·  Explain and provide a copy of the Agency Disclosure Notice, and obtain patient’s signature.

·  If patient has an advance directive, a copy will be obtained or the patient’s wishes will be documented.

·  Explain the visit procedures to the patient and the patient’s family, as applicable.

·  Provide a copy of the Agency’s scope of services, mission statement, office hours and how to access the on-call system.

·  Implement a comprehensive assessment of the patient, including safety and environmental assessment.

·  Obtain past medical information, as appropriate.

·  Develop and implement a plan of care based on the initial assessment, with input from the patient and family and discuss any reasonable risk associated with the proposed treatment or alternatives.

·  Discuss emergency management plan with the patient/caregiver.

·  If a home health care patient has not had a qualifying face-to-face encounter with their physician within 90 days prior to the start of care date, the admitting clinician will provide the patient with verbal and written information regarding the face-to-face encounter requirements. The clinician will provide the patient with the due date of the encounter and assist the patient, as needed, to schedule an appropriate appointment within the required time frame.

·  Determine patient and family primary language and assure that all paperwork is provided in a language that the patient or family can understand

14. A log of all referrals received is maintained by the Agency.

15. Service/care needs which cannot be met by the organization will be addressed by referring the patient to other organizations when appropriate. Patient records or referral or intake forms must indicate a referral was made to another organization or communication was provided to the physician or referral source when patient needs could not be met.

16. Patients that have no payor source or no ability to pay will be evaluated by agency management and appropriate referrals are made (if necessary) or a payment plan is negotiated and documented with patient and family or primary caregiver.

Professional Pediatric Home Care December 2012

2.2

DOCUMENTATION OF FACE-TO-FACE ENCOUNTER

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Patient Name and Identification (if not elsewhere on this page)

Certification Date

I certify that this patient is under my care and that I, or a nurse practitioner or physician’s assistant working with me, had a face-to-face encounter that meets the physician face-to-face encounter requirements with this patient on: (Insert date that visit occurred):

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Month Day Year

Medical Condition

The encounter with the patient was in whole, or in part, for the following medical condition, which is the primary reason for home health care (list medical condition):

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Services Needed

I certify that, based on my findings, the following services are medically necessary home health services (check all that apply): o Nursing o Physical Therapy o Speech Language Pathology

To provide the following care/treatments: (Required only when the physician completing the face to face encounter documentation is different than the physician completing the plan of care):

Clinical Findings

My clinical findings support the need for the above services because:

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