Quality Assurance and Performance Improvement

Contents

About The Author

Acknowledgement

Author’s Insight

Key Factors:

Administrative

Business Development Department (Marketing)

Quality Assessment & Performance Improvement (Qapi)

Introduction

Definitions

Policy

Purpose

Responsibilities

Determination Of Compliance

Objectives Of The Program

Special Instructions

Agency Philosophy

Agency Goals

Daily Stand Up Conference / Qapi Data Collection

Clinical Record Review

Policy

Purpose

Special Instruction

Admission Policy

Services Provided

Policy

Client Assessment

Policy

Purpose

Special Instructions

Provision Of 24-Hour Rn Availability

Policy

Purpose

Special Instructions

Supervision Of Services

Policy

Purpose

Special Instructions

Abuse Prevention Plan

Types Of Abuse

Policy

Purpose

Special Instructions

Special Considerations

Clinical

Plan Of Care

Purpose

Special Instructions

Physician Orders

Policy

Purpose

Special Instructions

Medical Supervision

Policy

Purpose

Selection Of A Physician

Special Instructions

Emergent Care

Policy

Purpose

Special Instructions

Clinical Documentation

Policy

Procedure

Special Instructions

Documentation Turnaround Policy For Clinical Staff

Medicare Documentation Guide And Cheat Sheet

Medication Profile

Policy

Purpose

Special Instructions

Table 1:

Some Non Crushable Medications

Reasons

Home Health Aide Flow Sheet And Documentation

Policy

Purpose

Special Instructions

Home Health Aide Care Plan

Policy

Purpose

Special Instructions

Home Health Aide: Assignment

Policy

Purpose

Special Instructions

Home Health Aide Documentation

Policy

Purpose

Special Instructions

Communication With Limited-English-Proficient Persons

Policy

Purpose

Special Instructions

The Process Of Communication In Business

Teaching Clients/Caregivers

Policy

Purpose

Special Instructions

Safety Management

Policy

Special Instructions

Needle Stick Safety And Prevention Policy And Procedure

Purpose:

Policy:

Mistreatment / Abuse / Neglect / Misappropriation

Client Incident Reporting

Policy

Purpose

Special Instructions

Laboratory Testing

Policy

Purpose

Special Instructions

Client Discharge Process

Policy

Purpose

Special Instructions

Discharge Summary

Policy

Purpose

Special Instructions

Client Transfer

Policy

Purpose

Special Instructions

Personnel Recruitment Process

Policy

Special Instructions

License Registration Or Certification Requirements

Policy

Home Health Aide Competency Evaluation Policy

Purpose

Special Instructions

Employee Health Screening

Policy

Purpose

Special Instructions

Performance Review

Policy

Purpose

Special Instructions

Cardiopulmonary Resuscitation (Cpr) Training

Policy

Purpose

Special Instructions

Employee Orientation

Policy

Special Instructions

Employee Training

Policy

Purpose

Special Instructions

License Registration Or Certification Requirements

Policy

Home Health Aide Competency Evaluation

Policy

Purpose

Special Instructions

Form 3

Reference Check (Pre-Employment)

Form 4: Confidential Reference

Form 5: Confidential Reference

Form 6: Applicant Performance Evaluation

Superior:

Above Average:

Fully Competent:

Developmental:

Provisional/Unsatisfactory:

Form 7: Health Statement

Form 8: Performance Appraisal Report

Form 9: Employee Evaluation (Optional)

Form 10: Service Evaluation Questionnaire

Form 11: Peer Review

Nurses Orientation

Mission And Value Statement

Implementation

Focus

Cost Control

Form 12: Patient/Family Grievance Form

Form 13: Grievance/Complaint Investigation Report

Competency Evaluation And Test For Registered Nurse

Competency Evaluation And Test For Licensed Practical (Vocational) Nurse

Additional Resources

Nebulizers

Hand Washing

Ppe (Personal Protective Equipment)

Gloves

Environmental Measures

Transmission-Based Precautions

Contact Precautions

Surveillance

Securing/Positioning Of Indwelling Catheter

Cdc Migration Of Bacteria Outside Catheter

Glucometers-Cdc Recommendations

Gloves During Glucometer Check

Gloves During Subcutaneous Injections

Gt-Check Placement

Female Perineal Care

Male Perineal Care

Uti Confusion

Foley Catheters

Tb Ppd Vials

Insulin

Lantus

Advair Diskus

Serevent Diskus

Miacalcin Nasal Spray

Eye Drops

Intravascular Catheters

Bruit & Thrill For Shunts

Heparin Parin Flush

Normal Saline Open Vials

Xalatan Ophthalmic Solution

Pressure Ulcers

Background

Pathophysiology

History

Physical

Causes

Surgical Care

Consultations

Form 13: Qapi Form

Form 14: Quality Indicator

Form 15: Staff Retention

Diagram 1: The Anene Service & Care Management Circle

References

ABOUT THE AUTHOR 

The author is a Registered Nurse, and has a Bachelor’s Degree in Business Administration and a Master’s Degree in Labor and Industrial Relations. The author is currently the CEO at Glowtorch Enterprises, Inc, a healthcare organization parent company and was a surveyor for Long Term Care Facilities. The author is also the CEO at Anene, Inc. a healthcare consulting company based in Arlington, Texas.

Prior to these positions, the author served as a member of the City of Arlington, Texas Hospital Authority Board for two terms (four years). The author has several years of experience in hospital (Medical/Surgical) and Rehabilitation nursing.

The author’s other positions and experiences include, but not limited to: Home Health Administrator, Nursing Home Director, and Nurse Consultant for several Long-Term Care Facilities and Home Health Agencies.

The author has extensive experience in Long-Term and Home Health Care on the provider side and Long-Term regulatory side respectively, and he is a published author of the book titled Home Health Aide Training Manual and Handbook. The book is available online at iuniverse.com, Amazon.com, Barnes and Nobles.com, Book-A-Million.com, Borders.com and many retail outlets. The book is further listed with the two largest distributors in the United States-Ingram and Baker, and Taylor. The book is also available for purchase directly from the author by calling 817-271-7370.

ACKNOWLEDGEMENT 

This book is dedicated to my late parents, Mr. Samuel N. Anene and Mrs. Bridget N. Anene.

Author’s Insight 

Having been in the home health industry for the past thirty five years, and later half of those years as an owner of and consultant for home health agencies, I have seen several agencies come and go. Some of those that have survived had truly worked at it and those that faded away may not have had the tenacity to remain or survey the ill wind.

Suffice me to say that if the sole purpose of any aspiring or prospective home health agency proprietor is to make money then the individual may be in the wrong business. Just like most other businesses owning a home health agency requires, passion, management skills, organizational skills, people skills, supervisory skills, and financial/accounting skills. Knowledge in health care is an advantage. A prospective owner may not have any or all of the aforementioned skills, however, the individual must have the resources to employ professionals that possess these skills and knowledge.

Starting a home health agency is probably one of the few businesses that require the least amount of capital. The individual may decide to start initially from home with very little or no over head. Consultation fees are relatively inexpensive compared to other businesses. The government nevertheless is in the process of changing this view point as large sums of money is being required from prospective home health owners as evidence of financial solvency.

As patients become sicker than usual and as baby boomers begin to get into the circle of those classified as patients requiring home health care (by choice) Home Health Agencies must be prepared with additional skills and knowledge to care for these individuals who are very likely to present with more complicated and complex health issues. Agencies that do not prepare to take care of patients with complicated and sometimes complex cases may not fare very well in today’s home health care market. It will no longer be enough to admit only patients who have diagnosis of congestive heart failure (CHF), Hypertension (HTN) or minor wound dressing changes. It will no longer be enough to send a nurse to a patient’s home to take blood pressure reading, give the patient medications, write up nurses’ notes and turn them in and get paid. Meaningful assessment, skilled observation, intervention, meaningful teaching of the family and patient regarding disease process or processes and alternative measures to maintain the patient at an improved level of health will be required of all agencies and will be the yard stick for measuring performance.

The patients and family members are going to demand quality care and the home health agencies must be ready to provide quality care.

Key factors: 

I strongly advise individuals who are in the process of starting a home health agency to:

1.   Consider a good location as very many cities especially large cities in California, Texas, Florida and New York are flooded with home health agencies. Most recent review of the Texas Department of Aging and Disability Services (DADS) website as of October 2009 there were approximately four thousand eight hundred and sixty four (4,864) active home health agencies in Texas.

2.   Establish solid referral basis

3.   Have a financial institution ready to work with the agency in hard times or have enough money saved up to fall back on.

4.   Have qualified staff available including competent Accountant, and skilled health care professional s

5.   Have a competitive pay scale

6.   Establish a well grounded technical support

7.   Establish resources for training and education

8.   Well informed nurse consultant

9.   Hire an experienced business development specialist (Marketing)

10.   Hire an experienced biller and coder

11.   Above all establish systems of operation

12.   Bear in mind that Home Healthcare is labor intensive business

13.   Understand that over head costs may be astronomical if not well managed

ADMINISTRATIVE 

Business Development Department (MARKETING) 

Home health agencies are becoming aggressive marketers of their business because marketing is very important for the sustenance of any home health agency. Operating an agency without an aggressive and effective marketing plan will be self defeating. The marketing efforts of any home health agency will be directed at ensuring that the most cost effective methods are applied and that the marketer understands the scope of the agency and the totality of the agency’s capabilities in terms of skills and personnel.

In marketing a home health agency the marketer must be equipped with adequate information about the agency regarding what sets the