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Home Health Policy and Procedure Manual

Home Health Policy and Procedure Manual

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Home Health Policy and Procedure Manual is a manual containing many of our policy and procedure templates for the medical office, hospital, and other healthcare organizations. The policies cover: Joint Commission (JCAHO or TJC) • CMS • HIPAA • CDC • AAAHC and more.
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Changes

Home Health.7.changes Home Health.7.1.changes Most current changes

Table of Contents - TJC Standards, CMS Regulations Table of Contents - ACHC Standards, CMS Regulations Table of Contents - CHAP Standards, CMS Regulations Copyright Disclaimer Approval/Signature Sheet Introduction

SECTION 01 - EMERGENCY MANAGEMENT

Emergency Operations Plan Hazard Vulnerability Analysis (HVA)Emergency Management - Hazard Vulnerability Analysis Worksheet - Example Command Structure and Staffing Communications Processes During an Emergency/Disaster Emergency Management Call-Back Tree Sample Emergency Management Responder List Communications - Patients and Families Patient and Family Education Handout - Emergency Management Equipment and Supplies Utilities - Emergency Management Emergency Procedures for Utility System Failure/Disruption Managing Patients During an Emergency/Disaster Emergency Response Exercise - Exercises and Improvement Plans Bomb Incident Plan Detecting Suspicious Packages/Letters Bomb Threat Report Form Natural Disaster Management Plan Terrorism Response Plan

SECTION 03 - EQUIPMENT MANAGEMENT

Medical Equipment Used by Staff Infusion Pump Safety Durable Medical Equipment Equipment Delivery and Set-Up Safe Medical Devices - Home Health Medical Device Problem and Recall

SECTION 04 - HUMAN RESOURCES

Staffing - General Qualifications and Competency - HHA Licensure, Certification and Registration Verification and Control Systems Criminal Background Checks Criminal Background Check Release of Information Authorization Form - Sample Reference Checking Physician Licensure Verification Orientation Program Orientation - Certified Home Health Aide Services Performance Evaluations Employee Education Programs Continuing Education/Inservice Attendance Record Form Monitoring of CHHA and CNA Inservice Hours Position Description/Performance Evaluation - Home Health Administrator Annual Competency Clinical Skills Assessment - Home Health Administrator Position Description/Performance Evaluation - Home Health Patient Care Services Director Performance Evaluation - Population-Specific/Age-Related Competency - Home Health Patient Care Services Director Annual Competency Clinical Skills Assessment - Home Health Patient Care Services Director Position Description/Performance Evaluation - Home Health Intake Nurse Performance Evaluation - Population-Specific/Age-Related Competency - Home Health Intake Nurse Annual Competency Clinical Skills Assessment - Home Health Intake Nurse Position Description/Performance Evaluation - Home Health Clinical Supervisor Performance Evaluation - Population-Specific/Age-Related Competency - Home Health Clinical Supervisor Annual Competency Clinical Skills Assessment - Home Health Clinical Supervisor Position Description/Performance Evaluation - Home Health Case Manager Performance Evaluation - Population-Specific/Age-Related Competency - Home Health Case Manager Annual Competency Clinical Skills Assessment - Home Health Case Manager Position Description/Performance Evaluation - Home Health LPN/LVN Performance Evaluation - Population-Specific/Age-Related Competency - Home Health LPN/LVN Annual Competency Clinical Skills Assessment - Home Health LPN/LVN Position Description/Performance Evaluation - Home Health Physical Therapist Performance Evaluation - Population-Specific/Age-Related Competency - Home Health Physical Therapist Annual Competency Clinical Skills Assessment - Home Health Physical Therapist Position Description/Performance Evaluation - Home Health Occupational Therapist Performance Evaluation - Population-Specific/Age-Related Competency - Home Health Occupational Therapist Annual Competency Clinical Skills Assessment - Home Health Occupational Therapist Position Description/Performance Evaluation - Home Health Speech-Language Pathologist Performance Evaluation - Population-Specific/Age-Related Competency - Home Health Speech-Language Pathologist Annual Competency Clinical Skills Assessment - Home Health Speech-Language Pathologist Position Description/Performance Evaluation - Home Health Medical Social Worker Performance Evaluation - Population-Specific/Age-Related Competency - Home Health Medical Social Worker Annual Competency Clinical Skills Assessment - Home Health Medical Social Worker Position Description/Performance Evaluation - Home Health Aide Performance Evaluation - Population-Specific/Age-Related Competency - Home Health Aide Annual Competency Clinical Skills Assessment - Home Health Aide Annual Competency - Joint Commission National Patient Safety Goals - Home Health/Hospice Employment of Certified Home Health Aides/Nursing Assistants Home Health Aide Training Certified Home Health Aide - Competency Certified Home Health Aide Competency Evaluation Program Certified Home Health Aide Competency Checklist Form Certified Home Health Aide Supervision Supervision Checklist Form Equal Opportunity Employment Applications for Employment Attendance and Tardiness Change in Personal Information Classification of Employees Disciplinary Action Dress Regulations Employee Assistance Program Employee Communications Employee Handbook Employee Requests for Time Off Employment of Foreign Applicants Employment of the Disabled Employment of Relatives Exit Interviews Exit Interview Form - Sample Garnishment of Wages Holiday Policy Payroll Distribution/Time Verification Personnel Files - Contents and Originations Procurement of Employees Personnel Requisition Form - Sample Re-Employment Sick Leave Policy Termination of Employment Staff Recruitment, Retention and Education Vacation Policy Workers' Compensation

SECTION 05 - INFECTION PREVENTION AND CONTROL

Infection Prevention and Control Program - Home Health Infection Prevention and Control Plan - Home Health Infection Prevention and Control Committee Infection Report Form Infection Surveillance Sheet Patient Infection Control Log Form Summary of Monthly Infection Control Data Form Reporting Patient Infections Nationally Notifiable Infectious Diseases Standard Precautions Hand Hygiene - CDC Guidelines Hand Hygiene/Glove Use Observation Form Respiratory Hygiene/Cough Etiquette in Healthcare Settings Transmission-Based Precautions (Isolation Precautions)Asepsis Nursing Bag Techniques Personal Protective Equipment Personal Protective Equipment - Training Management of Multidrug-Resistant Organisms in Non-Hospital Healthcare Settings AIDS/HIV Positive Guidelines Guidelines for Prevention of Tuberculosis Transmission in the Home Tuberculosis Training Program Outlines Influenza Vaccination - Home Health Influenza Immunization Program for Healthcare Staff - Monthly Implementation Checklist Influenza Vaccination Program for Healthcare Staff HHA Plan and Response to a Potential or Actual Influenza Pandemic Outbreak Pandemic Risk Assessment Tool for Home Care Organizations CDC - Home Healthcare Services Pandemic Influenza Planning Checklist Exposure Control Plan Sharps Injury Protection Plan Sharps Injury Log Form Employee Exposure to Blood and Body Fluids - Sample Form Infectious Waste Management Plan

Employee Health

Employee Health Program Tuberculosis Screening Program Health Questionnaire for Positive Tuberculosis Skin Test Reactions Employee Health - Immunizations Hepatitis B Vaccine Program Informed Consent for Hepatitis B Vaccine Form Hepatitis B Vaccine Declination Form Workplace Injury, Illness or Fatality Reporting Employee Health - Employee Illnesses Employee Absence Report Form Exposure to HIV

SECTION 06 - INFORMATION MANAGEMENT

Information Management Plan - Home Health Interruptions to Electronic Health Information Confidentiality of Information - General Issues Confidentiality of Information - Electronic Health Records Electronic Signature Authorization/Confidentiality Form Confidentiality of the Medical Record Uses and Disclosures of Protected Health Information - General Rules Uses and Disclosures of Protected Health Information Subject to an Agreed-Upon Restriction Restriction Agreement - Release of Patient Protected Health Information Consent Form Release of Medical Information Release of Patient Information Consent Form Patient Medical Record Access Form Reporting OASIS Information Documentation and the Use of Abbreviations, Acronyms and Symbols Unacceptable Abbreviation and Symbol List Knowledge-Based Information Utilization of the Facsimile Machine Guidelines for the Use of Electronic Mail

SECTION 07 - LEADERSHIP

CMS Definitions Organization and Structure Governance - Board of Directors/Management Company Governance - Sole Proprietorship Professional Advisory Committee Organization Chart - Example Licensure Mission Statement Philosophy Non-Discrimination Policy Compliance with Federal, State and Local Laws Fiscal Planning Annual Operating Budget Communication Process Agency Supervision Supervision of Care, Treatment and Services Supervising Physician or Registered Nurse Guidelines for Medical Management and Physician's Responsibilities Scope of Services Professional Standards and Principles Staff Under Hourly or Per Visit Contracts Contracted Services Policies and Procedures Role of HHA Leadership in Performance Improvement Annual Agency Evaluation Code of Ethics Code of Ethics (Sample)Standards of Conduct Care and Service Rates Financial Incentives/Clinical Decision Making Billing Practices Marketing Practices Financial Records - Maintenance of Conflict of Interest Conflict of Interest Disclosure Letter - Sample Ethics Committee Culture of Safety and Quality Code of Conduct - Sample Disruptive and Inappropriate Behavior Examples of Survey Tools to Survey a Culture of Safety and Quality Your Organization's Culture of Safety and Quality Survey Survey Assessment Tools Staff Rights and Ethical Dilemmas in Patient Care Patient Safety Plan Components of a Patient Safety Program - Patient Safety Program Checklist Sentinel Event Corporate Compliance Plan The OIG Work Plan - 2013 - Home Health Change in Ownership

SECTION 08 - MEDICATION MANAGEMENT

Medication Management - Patient Information HHA Medication Reconciliation/Verification Form - Sample Medication Profile Form "A" - Sample Medication Profile Form "B" - Sample Medication Transfer Communication High Alert Medication Management Look-Alike, Sound-Alike Medication Management Selection of Medications Safe Storage of Medications in the Patient's Home Emergency Medications Prescribing/Ordering - General Practices Telephone/Verbal Orders Physician Telephone/Verbal Orders Form Contracted Pharmacy and On-Call Pharmacist Medication Orders and Administration Patient Self-Administration of Medication Influenza and Pneumococcal Vaccine Standing Orders Use of Investigational Treatments/Trials First Dose Home IV Antimicrobial Administration and Management of Anaphylaxis Medication Monitoring Controlled Drug Disposal Disposal of Controlled Substance Patches in the Home Reducing Medication Errors Medication Errors Medication Inadvertent Incident Report Form Performance Improvement Analysis - Medication Inadvertent Incident Form Adverse Drug Reaction Reporting Adverse Drug Reaction Reporting Form (Internal)Medication Management Program

SECTION 09 - PERFORMANCE IMPROVEMENT

Organizational Performance Improvement Plan Performance Measurement Problem Conclusion Action Plan Monitoring Conducting Root Cause Analysis A Framework for a Root Cause Analysis and Action Plan in Response to a Sentinel Event Root Cause Analysis Flowchart Incident Reports Incident Report Form Home Health PI Monitoring and Evaluation Plan Home Health PI Trending Sheet Home Health PI Outcome Evaluation Home Health PI Volume Measures/Statistics Home Health Service Questionnaire Form Incident Reporting Staff Questionnaire Form

SECTION 10 - PROVISION OF CARE, TREATMENT AND SERVICES

Admission/Assessments

Acceptance/Admission of Patients Intake Service Intake/Referral Form - Sample Plan of Care (Plan of Treatment)Orders for Service Form - Sample Initial Certification for Home Health Services - Face-to-Face Encounter Completion of the Comprehensive Assessment Assessment - Nursing Nursing Assessment Form Interdisciplinary Patient Assessments and Reassessments Fall Assessment and Prevention Pain Assessment, Reassessment and Management Pain Management Education Nutritional Assessment Nutritional Assessment Form Patient Abuse, Neglect or Exploitation - Training Program Patient Abuse, Neglect or Exploitation - Adult Patient Abuse, Neglect or Exploitation - Child Care Planning - Home Health Care Plan Implementation Coordination of Patient Services Skilled Nursing Plan of Care Form - Sample Nursing Progress Report Form - Sample Monthly Medical Update - Sample Form

Patient Care

Administration of Blood/Blood Components Blood/Blood Components - Transfusion Reactions Emergency Intervention End-of-Life Care Patient Identification Scheduling Patient Visits On-Call Coverage Photographing Pressure Ulcers/Suspected Physical Abuse Reporting of Critical Results of Tests and Diagnostic Procedures Resumption of Care Seizures - Nursing Management RN Supervisory Visits Licensed Practical/Vocational Nurse Supervision LPN/LVN Supervisory Visit Note Home Health Aide - Supervision Form

Patient/Family Education

Patient/Family Education Multidisciplinary Patient Education Patient/Family Education Record - Sample Form Personal Care Instructions Personal Care Instructions Form Patient Education - Anticoagulation Therapy - Home Health Patient Education - Medical Equipment Patient and Family Education Handout - Home Safety Patient and Family Education Handout - Hazardous Materials and Waste Disposal Patient and Family Education Handout - Infection Prevention and Control Patient and Family Education Handout - Use of Restraint Devices Patient and Family Education Handout - Oxygen Safety Rules Patient and Family Education Handout - Crutch Ambulation for Stairs - Weight Bearing as Tolerated (WBAT)Patient and Family Education Handout - Crutch Ambulation for Stairs - Non-Weight Bearing (NWB)Patient Instruction Sheet - Oxygen Cylinder Set-Up Patient Instruction Sheet - Oxygen Concentrator Patient Instruction Sheet - Canes and Quad Canes Hoja de Instruccion del Paciente - Los Bastones y Los Bastones de Cuadrangulo Patient Instruction Sheet - Walker Hoja de Instruccion del Paciente - Andador Patient Instruction Sheet - Bedside Commode Procedure Hoja de Instruccion del Paciente - Procedimiento de la Comoda del Lado de la Cama

Discharge/Transfer

Discharge/Transfer/Referral of Patients Discharge Summary Skilled Nursing Discharge Summary Form Discharge Summary Plan/Transfer Form Physician Discharge Summary Form Patient Discharge Instructions Form Discontinuance of Service Against Medical Advice Form

SECTION 11 - RECORD OF CARE, TREATMENT AND SERVICES

Medical Record Content Policy Entries in the Medical Record Physician Signature Requirements Corrections to the Paper Medical Record Access and Maintenance of the Electronic Health Record Late Entries to the Electronic Health Record Addendum to the Electronic Health Record Amendment to the Electronic Health Record Legibility of Medical Record Documentation Maintenance and Retention of Clinical Records Auditing of Medical Records Quarterly Clinical Record Review Home Health Medical Records Audit Form Home Health Documentation Form

SECTION 12 - RIGHTS AND RESPONSIBILITIES OF THE INDIVIDUAL

Notice of Rights Home Care Patient Rights and Responsibilities OASIS Privacy Act Statement Policy OASIS Statement of Patient Privacy Rights - English (CMS)OASIS Statement of Patient Privacy Rights - Spanish (CMS)OASIS Privacy Act Statement - English (CMS)OASIS Privacy Act Statement - Spanish (CMS)OASIS Notice About Privacy for Patients Who Do Not Have Medicare or Medicaid Coverage - English (CMS)OASIS Notice About Privacy for Patients Who Do Not Have Medicare or Medicaid Coverage - Spanish (CMS)Patient Information Packet Advance Directives Advance Directive Information Form Patient Information on Advance Directives Formats for Patient Directives Durable Power of Attorney for Healthcare Withholding or Withdrawal of Life-Sustaining Measures Declaration to Withdraw/Withhold Treatment Do Not Resuscitate/Do Not Intubate (DNR/DNI)Do Not Resuscitate and/or Do Not Intubate Request Form Patient Liability for Payment Privacy and Confidentiality of Information Staff Confidentiality Statement Form Release of Patient Identifiable OASIS Information Uses and Disclosures for Which an Authorization is Required Consent for Uses or Disclosures to Carry Out Treatment, Payment or Healthcare Operations Auxiliary Aids and Services for Persons with Disabilities Patient Informed Decision Making Authorization to Treat/Informed Consent Patient Consents and Authorizations - Sample Form Authorization/Agreement for Services - Sample Form Consent to Blood/Blood Product Transfusion(s) Form Recording/Filming Patients Authorization and Consent Form - Recordings, Films or Other Images, and Publication Patients with Special Communication Needs Patient Concerns/Grievances Patient Concerns/Grievance Process Flowchart About the Right to Express Grievances Patient Complaint Form

SECTION 13 - WAIVED TESTING

Waived Testing Glucose Monitor Operator Proficiency Record Form Glucose Monitor Quality Control Glucose Monitor Quality Control Log Fingerstick and Point of Care Blood Testing Devices Referring Specimens for Laboratory Testing