Home Infusion Therapy Policy and Procedure Manual
Home Infusion Therapy 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.
SECTION 01 - RIGHTS AND RESPONSIBILITIES OF THE INDIVIDUAL
1001 - Bill of Rights and Responsibilities1002 - Bill of Rights and Responsibilities Handout1003 - Client Consent, Rights and Responsibilities1004 - Home Healthcare Services Consent1005 - Consent for Home Care Services/Assignment of Insurance Benefits Form1006 - Treatment Consent, Assignment of Benefits, Agreement to Pay and Release of Information Agreement Form1007 - Elements Required for Informed Consent for Research Studies1008 - Clinical Determinations1009 - Interpreter Services1010 - Client Concern Form1011 - Staff Rights and Ethical Dilemmas in Client Care1012 - Resolution of Potential Conflict with Staff Members' Cultural/Ethical/Religious Belief System1013 - Request for Revised/Excused Duty Form
SECTION 02 - PROVISION OF CARE, TREATMENT AND SERVICES
Admission/Assessment
Client Care, Treatment and Services
2101 - Client Identification for Clinical Care and Treatment2102 - "Hand-Off" Communication2103 - Critical Tests and Result Reporting2104 - Coordination of Care2105 - Change of Care/Service - Client Notification2106 - Pharmacy Plan of Care2107 - Sample Pharmacy Plan of Care Form2108 - Plan of Treatment/4852109 - Place Form CMS 485 here2110 - Pharmacy Client Care - Flow Diagram2111 - Pharmaceutical Services2112 - Physician Responsibilities for Home Care Clients2113 - Progress Notes2114 - Progress Notes Form2115 - Significant Changes to Report to the Physician2116 - Telephone Discussion Record2117 - Telephone Discussion Record Form2118 - Telephone Report Form2119 - Anaphylaxis2120 - Signs and Symptoms of Anaphylaxis2121 - Anaphylaxis Kit - Adults2122 - Anaphylaxis Kit for Pediatrics2123 - Anaphylaxis Kit Lot Number Log2124 - Anaphylaxis Protocol2125 - Treatment for Anaphylactic Reactions - Physician Order Sheet2126 - Cardiopulmonary Resuscitation (CPR)2127 - Clinical Laboratory2128 - Laboratory Flow Sheet Form2129 - Huber Needle Insertion for Implanted Vascular Access Devices2130 - Pain Management Policy2131 - Pain Management Therapy2132 - Pharmacy Plan of Care - Pain2133 - Intraspinal Pain Management Therapy2134 - Insertion of Peripherally Inserted Central Catheter (PICC)2135 - Peripherally Inserted Central Catheter (PICC) Consent Form2136 - PICC Insertion Progress Note Form2137 - PICC Line Dressing Change2138 - Flushing of PICC2139 - Client and Family Education Handout - Peripherally Inserted Central Catheters (PICC)2140 - Physician Order Sheet for Venous Access Device2141 - Pump Tubing Changes2142 - Selection of Infusion Pump2143 - Venipuncture2144 - Waived Testing2145 - List of Client Charges Form
Client/Family Education
SECTION 03 - MEDICATION MANAGEMENT
Medication Management Plan of Care
3001 - Security of Pharmacy3002 - Temperature Control for Pharmaceuticals3003 - Pharmacy Freezer Temperature Log Form3004 - Pharmacy Refrigerator Temperature Log Form3005 - Incubator Temperature Log Form3006 - IV Admixture Room Temperature Log Form3007 - Warehouse Temperature Log Form3008 - Policy for Controlled Substances3009 - Place U.S. Official Order Forms, Schedule I and II, DEA Supplier's Copy Here3010 - Perpetual Inventory Form for Controlled Substances3011 - Look-Alike, Sound-Alike Medication Management3012 - Physician's Order and Prescription3013 - Physician's Verbal Order Form3014 - Legibility of Medical Record Documentation3015 - Medication Profile3016 - Medication Profile Form3017 - Medication Recall3018 - Obtaining Drugs During an Emergency3019 - Obtaining Medications After Hours and On-Call Policy3020 - Medication Administration3021 - Drug Classification Form3022 - Drug Formulary3023 - Drug Formulary List3024 - Medication - First Dose3025 - IV Antibiotics - First Dose3026 - Medication Record3027 - Medication Record Form3028 - Controlled Substances in the Home3029 - Medication Inadvertent Incident Report Form3030 - Medication Error Analysis Tool3031 - Performance Improvement Analysis - Medication Inadvertent Incident Form3032 - Adverse Drug Reaction Reporting3033 - Adverse Drug Reaction Reporting Form3034 - Administration of Medications, Subcutaneous and Intramuscular3035 - Miscellaneous Injectable Medications3036 - Intravenous Medications Approved for Home Administration3037 - Ceftriaxone Sodium Injection - Client Handout3038 - Erythropoietin3039 - Pharmacy Plan of Care Form - Erythropoietin (EPO)3040 - Foscarnet3041 - Infusion of Foscarnet - Infusion in the Home Setting3042 - Pharmacy Plan of Care Form - Foscarnet3043 - Aminoglycoside and Vancomycin3044 - Guidelines for Drawing Aminoglycoside Levels3045 - Guidelines for Drawing Vancomycin Levels3046 - Pharmacy Plan of Care Form - Antibiotics3047 - Pharmacy Plan of Care Form - Vancomycin3048 - Pharmacy Plan of Care Form - Aminoglycoside3049 - Pentamidine Inhalation3050 - Guidelines for Pentamidine Inhalation Administration3051 - Pentamidine Intravenous3052 - Guidelines for Pentamidine Administered Intravenously3053 - Pentamidine Client Handout3054 - Pharmacy Plan of Care Form - Pentamidine3055 - Anti-Infective Therapy3056 - Amphotericin B3057 - Trimetrexate3058 - Pharmacy Plan of Care Form - Trimetrexate3059 - Infusion of Dobutamine for Outpatients3060 - Mitomycin-C (Mutamycin)3061 - Filgrastim (G-CSF) Use3062 - Pharmacy Plan of Care Form - Filgrastim (G-CSF)3063 - Heparin Therapy3064 - Pharmacy Plan of Care Form - Heparin3065 - Hydration Therapy3066 - Pharmacy Plan of Care Form - Hydration3067 - TPN Therapy3068 - Pharmacy Plan of Care Form - TPN3069 - Pharmacy Plan of Care Form - Amphotericin B3070 - Pharmacy Plan of Care Form - Deferoxamine3071 - Approved Chemotherapy Drugs for Administration in the Home3072 - Selection Criteria of Nurses for Chemotherapy Administration3073 - Chemotherapy3074 - Chemotherapeutic Drugs, Medication Dosage Calculation3075 - Chemotherapy Infusion Guidelines3076 - 5-Fluorouracil3077 - Pharmacy Plan of Care Form - 5-Fluorouracil3078 - Ganciclovir3079 - Administration Guidelines for Home Infusion of Ganciclovir3080 - Pharmacy Plan of Care Form - Ganciclovir3081 - Extravasation Management3082 - Management of Doxorubicin, Daunorubicin, Dactinomycin, Idarubicin, Amsacrine, Mitoxantrone Extravasation3083 - Extravasation Management of Mechlorethamine (Mustard, Nitrogen Mustard)3084 - Management of Dacarbazine (DTIC) Extravasation3085 - Management of Vincristine, Vinblastine, Vindesine Extravasation3086 - Chemotherapy - Vesicants3087 - Listing of Vesicants and Irritants3088 - Nursing Assessment of Extravasation Versus Other Reactions3089 - Extravasation Management Guidelines3090 - Specific Antidotes and Treatment for Vesicant Antineoplastic Agents
Investigational Drugs/Clinical Trials
3101 - New Therapies/Medications3102 - Investigational Drugs/Devices3103 - Essential Elements of a Clinical Trial Protocol3104 - Experimental Medical Treatment3105 - Physician Triplicate Reminder Letter3106 - Bill of Rights for Experimental Subjects3107 - Research Exempted Under HHS Regulations3108 - Preclinical Stage of the Antineoplastic Drug Development Process3109 - Clinical Stage of the Antineoplastic Drug Development Process3110 - Managing Investigational Drugs Acquired for Compassionate Treatment of Individual Patients3111 - Place NCI Managing Investigational Drugs Acquired for Compassionate Treatment of Individual Patients Form here3112 - NCI's Policy for Group C Drug Distribution3113 - Place NCI Group C Drug Distribution Form here3114 - Place NCI Clinical Drug Request Form here3115 - Place NCI Investigational Drug Accountability Record Form here3116 - Place NCI Return Investigational Agent Form here3117 - Place Transfer Investigational Agent Form here
Admixing, Compounding, Preparation, Dispensing
3201 - Compounding Record Forms3202 - Record of Compounding3203 - Manipulation of Vials, Ampules and IV Fluid Containers3204 - Drug Compounding3205 - CSP Microbial Contamination Risk Levels3206 - Quality Assurance Procedures3207 - Cleaning and Disinfection of the Sterile Compounding Areas - Pharmacy Responsibilities3208 - Cleaning of the Clean Room and Anteroom - Environmental Services Responsibilities3209 - Compounding of TPN - General3210 - 3-in-1 TPN Compounding3211 - Sheet for TPN Mixing3212 - Chemotherapy Handling3213 - Automated Compounding Devices (ACDs)3214 - Medications in a Prefilled Infusion System3215 - Labeling3216 - Lot Number Log Form3217 - Documentation of Packing List3218 - Packaging Finished Products3219 - Finished Product Document Form3220 - Transportation of Medications, Equipment and Supplies3221 - Delivery and Pick Up of Products3222 - Pick-Up List Form3223 - Daily Delivery Worksheet Form
SECTION 04 - INFECTION, PREVENTION AND CONTROL
4001 - Standard Precautions4002 - Hand Hygiene4003 - Hand Scrub4004 - Sterile Compounding - Staff Competency4005 - Critical Site Environment4006 - LAFWs or Barrier Isolators4007 - Infection Control4008 - Aseptic Technique4009 - Use of Multiple Dose Vials (MDVs)4010 - Exposure Control Plan4011 - Sharps Injury Protection Plan4012 - Sharps Injury Log Form
SECTION 05 - PERFORMANCE IMPROVEMENT
5001 - Performance Improvement Plan5002 - Infusion Therapy Services PI Monitoring and Evaluation Plan5003 - Infusion Therapy Services PI Trending Sheet5004 - Infusion Therapy Services PI Outcome Evaluation5005 - Infusion Therapy Services PI Volume Measures/Statistics5006 - Performance Improvement Incident Analysis Form5007 - Sentinel Event5008 - Conducting Root Cause Analysis5009 - Client Risk Management Reports5010 - Client Risk Management Report Form
SECTION 06 - LEADERSHIP
SECTION 07 - ENVIRONMENT OF CARE
Environmental Safety
7001 - Cytotoxic and Infectious Waste Disposal7002 - Management of Cytotoxic Spills7003 - Emergency Management Plan7004 - Emergency Management Plan - Drills7005 - Hazard Vulnerability Analysis7006 - Emergency Management - Hazard Vulnerability Analysis Worksheet7007 - Emergency Management Responses7008 - Bomb Threat Report Form7009 - Emergency, Safety and Disaster Management (for Home Care) - Teaching Outline7010 - Emergency/Disaster Management Evaluation Form
Equipment Management
7101 - Pump Inspection and Function Testing for Sabratek Infusion Pump7102 - Pump Inspection and Function Testing for Syringe Pumps7103 - Pump Inspection and Function Testing for Baxter 6200/62017104 - Pump Cleaning and Check Log Form7105 - CADD Pump Cleaning and Function Checklist7106 - Standard Pump Equipment Flow Sheet7107 - Standard Pole Equipment Flow Sheet7108 - Pump Tracking Log Form7109 - Equipment Testing, Tracking and Maintenance7110 - Maintenance of Vertical and Laminar Flow Hoods7111 - Clean Room Maintenance Log Form7112 - Hood Cleaning Log Form7113 - Hood/Filter Change Log Form7114 - Refrigerator Clean Log Form
SECTION 08 - HUMAN RESOURCES
8001 - Position Description/Performance Evaluation - Infusion Therapy Services Director8002 - Performance Evaluation - Age-Related Competency - Infusion Therapy Services Director8003 - Annual Competency Clinical Skills Assessment - Infusion Therapy Services Director8004 - Position Description/Performance Evaluation - Infusion Therapy Services Pharmacist8005 - Performance Evaluation - Age-Related Competency - Infusion Therapy Services Pharmacist8006 - Annual Competency Clinical Skills Assessment - Infusion Therapy Services Pharmacist8007 - Position Description/Performance Evaluation - Infusion Therapy Services Technician8008 - Performance Evaluation - Age-Related Competency - Infusion Therapy Services Technician8009 - Annual Competency Clinical Skills Assessment - Infusion Therapy Services Technician8010 - Position Description/Performance Evaluation - Infusion Therapy Services RN8011 - Performance Evaluation - Age-Related Competency - Infusion Therapy Services RN8012 - Annual Competency Clinical Skills Assessment - Infusion Therapy Services RN8013 - Infusion Therapy Clinical Staff - Competency Checklist8014 - Infusion Therapy Clinical Staff - Orientation Checklist8015 - Equal Opportunity Employment8016 - Licensure, Certification and Registration Verification and Control Systems8017 - New Employee Orientation8018 - Inservice and Continuing Education8019 - Continuing Education Attendance Record Form8020 - Inservice Attendance Record Form8021 - Employee Safety8022 - Employee Job-Related Injuries8023 - Annual Competency - Joint Commission National Patient Safety Goals and Universal Protocol8024 - Annual Competency - Universal Protocol for Preventing Wrong Site, Wrong Procedure and Wrong Person Surgery
SECTION 09 - INFORMATION MANAGEMENT