MCN Healthcare: Policy Management and Compliance Tools

Home » Policy Library » Home Infusion Therapy Policy Procedure Manual

View Policies By Last Update

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.

One Year Online Subscription

$229.99

Changes Table of Contents - TJC, CHAP standards Copyright Disclaimer Approval/Signature Sheet Introduction

SECTION 01 - RIGHTS AND RESPONSIBILITIES OF THE INDIVIDUAL

Bill of Rights and Responsibilities Bill of Rights and Responsibilities Handout Client Consent, Rights and Responsibilities Home Healthcare Services Consent Consent for Home Care Services/Assignment of Insurance Benefits Form Treatment Consent, Assignment of Benefits, Agreement to Pay and Release of Information Agreement Form Elements Required for Informed Consent for Research Studies Clinical Determinations Interpreter Services Client Concern Form Staff Rights and Ethical Dilemmas in Client Care Resolution of Potential Conflict with Staff Members' Cultural/Ethical/Religious Belief System Request for Revised/Excused Duty Form

SECTION 02 - PROVISION OF CARE, TREATMENT AND SERVICES

Admission/Assessment

Policy for Admission Communication with the Agency at Admission Checklist for Initial Evaluation Checklist for Initial Evaluation Form Client Assessment Identified Malnutritional and Nutritional Needs Assessment

Client Care, Treatment and Services

Client Identification for Clinical Care and Treatment "Hand-Off" Communication Critical Tests and Result Reporting Coordination of Care Change of Care/Service - Client Notification Pharmacy Plan of Care Sample Pharmacy Plan of Care Form Plan of Treatment/485 Place Form CMS 485 here Pharmacy Client Care - Flow Diagram Pharmaceutical Services Physician Responsibilities for Home Care Clients Progress Notes Progress Notes Form Significant Changes to Report to the Physician Telephone Discussion Record Telephone Discussion Record Form Telephone Report Form Anaphylaxis Signs and Symptoms of Anaphylaxis Anaphylaxis Kit - Adults Anaphylaxis Kit for Pediatrics Anaphylaxis Kit Lot Number Log Anaphylaxis Protocol Treatment for Anaphylactic Reactions - Physician Order Sheet Cardiopulmonary Resuscitation (CPR)Clinical Laboratory Laboratory Flow Sheet Form Huber Needle Insertion for Implanted Vascular Access Devices Pain Management Policy Pain Management Therapy Pharmacy Plan of Care - Pain Intraspinal Pain Management Therapy Insertion of Peripherally Inserted Central Catheter (PICC)Peripherally Inserted Central Catheter (PICC) Consent Form PICC Insertion Progress Note Form PICC Line Dressing Change Flushing of PICC Client and Family Education Handout - Peripherally Inserted Central Catheters (PICC,Physician Order Sheet for Venous Access Device Pump Tubing Changes Selection of Infusion Pump Venipuncture Waived Testing List of Client Charges Form

Client/Family Education

Client Education Client Information Hypoglycemia/Hypotension Instruction Sheet Client/Caregiver Education - Storage, Handling and Administration of CSPs Client/Caregiver CSP Competence Assessment

Discharge/Transfer

Summary of Client Status Form Client Transfers/Discharges Policy for Discharge

SECTION 03 - MEDICATION MANAGEMENT

Medication Management Plan of Care

Security of Pharmacy Temperature Control for Pharmaceuticals Pharmacy Freezer Temperature Log Form Pharmacy Refrigerator Temperature Log Form Incubator Temperature Log Form IV Admixture Room Temperature Log Form Warehouse Temperature Log Form Policy for Controlled Substances Place U.S. Official Order Forms, Schedule I and II, DEA Supplier's Copy Here Perpetual Inventory Form for Controlled Substances Look-Alike, Sound-Alike Medication Management Physician's Order and Prescription Physician's Verbal Order Form Legibility of Medical Record Documentation Medication Profile Medication Profile Form Medication Recall Obtaining Drugs During an Emergency Obtaining Medications After Hours and On-Call Policy Medication Administration Drug Classification Form Drug Formulary Drug Formulary List Medication - First Dose IV Antibiotics - First Dose Medication Record Medication Record Form Controlled Substances in the Home Medication Inadvertent Incident Report Form Medication Error Analysis Tool Performance Improvement Analysis - Medication Inadvertent Incident Form Adverse Drug Reaction Reporting Adverse Drug Reaction Reporting Form Administration of Medications, Subcutaneous and Intramuscular Miscellaneous Injectable Medications Intravenous Medications Approved for Home Administration Ceftriaxone Sodium Injection - Client Handout Erythropoietin Pharmacy Plan of Care Form - Erythropoietin (EPO)Foscarnet Infusion of Foscarnet - Infusion in the Home Setting Pharmacy Plan of Care Form - Foscarnet Aminoglycoside and Vancomycin Guidelines for Drawing Aminoglycoside Levels Guidelines for Drawing Vancomycin Levels Pharmacy Plan of Care Form - Antibiotics Pharmacy Plan of Care Form - Vancomycin Pharmacy Plan of Care Form - Aminoglycoside Pentamidine Inhalation Guidelines for Pentamidine Inhalation Administration Pentamidine Intravenous Guidelines for Pentamidine Administered Intravenously Pentamidine Client Handout Pharmacy Plan of Care Form - Pentamidine Anti-Infective Therapy Amphotericin B Trimetrexate Pharmacy Plan of Care Form - Trimetrexate Infusion of Dobutamine for Outpatients Mitomycin-C (Mutamycin)Filgrastim (G-CSF) Use Pharmacy Plan of Care Form - Filgrastim (G-CSF)Heparin Therapy Pharmacy Plan of Care Form - Heparin Hydration Therapy Pharmacy Plan of Care Form - Hydration TPN Therapy Pharmacy Plan of Care Form - TPN Pharmacy Plan of Care Form - Amphotericin B Pharmacy Plan of Care Form - Deferoxamine Approved Chemotherapy Drugs for Administration in the Home Selection Criteria of Nurses for Chemotherapy Administration Chemotherapy Chemotherapeutic Drugs, Medication Dosage Calculation Chemotherapy Infusion Guidelines 5-Fluorouracil Pharmacy Plan of Care Form - 5-Fluorouracil Ganciclovir Administration Guidelines for Home Infusion of Ganciclovir Pharmacy Plan of Care Form - Ganciclovir Extravasation Management Management of Doxorubicin, Daunorubicin, Dactinomycin, Idarubicin, Amsacrine, Mitoxantrone Extravasation Extravasation Management of Mechlorethamine (Mustard, Nitrogen Mustard)Management of Dacarbazine (DTIC) Extravasation Management of Vincristine, Vinblastine, Vindesine Extravasation Chemotherapy - Vesicants Listing of Vesicants and Irritants Nursing Assessment of Extravasation Versus Other Reactions Extravasation Management Guidelines Specific Antidotes and Treatment for Vesicant Antineoplastic Agents

Investigational Drugs/Clinical Trials

New Therapies/Medications Investigational Drugs/Devices Essential Elements of a Clinical Trial Protocol Experimental Medical Treatment Physician Triplicate Reminder Letter Bill of Rights for Experimental Subjects Research Exempted Under HHS Regulations Preclinical Stage of the Antineoplastic Drug Development Process Clinical Stage of the Antineoplastic Drug Development Process Managing Investigational Drugs Acquired for Compassionate Treatment of Individual Patients Place NCI Managing Investigational Drugs Acquired for Compassionate Treatment of Individual Patients Form here NCI's Policy for Group C Drug Distribution Place NCI Group C Drug Distribution Form here Place NCI Clinical Drug Request Form here Place NCI Investigational Drug Accountability Record Form here Place NCI Return Investigational Agent Form here Place Transfer Investigational Agent Form here

SECTION 04 - INFECTION, PREVENTION AND CONTROL

Standard Precautions Hand Hygiene Hand Scrub Sterile Compounding - Staff Competency Critical Site Environment LAFWs or Barrier Isolators Infection Control Aseptic Technique Use of Multiple Dose Vials (MDVs)Exposure Control Plan Sharps Injury Protection Plan Sharps Injury Log Form

SECTION 05 - PERFORMANCE IMPROVEMENT

Performance Improvement Plan Infusion Therapy Services PI Monitoring and Evaluation Plan Infusion Therapy Services PI Trending Sheet Infusion Therapy Services PI Outcome Evaluation Infusion Therapy Services PI Volume Measures/Statistics Performance Improvement Incident Analysis Form Sentinel Event Conducting Root Cause Analysis Client Risk Management Reports Client Risk Management Report Form

SECTION 06 - LEADERSHIP

Scope of Care and Services Standards of Professional Practice Pharmacy License On-Call Policy for Agency Clients Prescription Transfer to Another Pharmacy

SECTION 07 - ENVIRONMENT OF CARE

Environmental Safety

Cytotoxic and Infectious Waste Disposal Management of Cytotoxic Spills Emergency Management Plan Emergency Management Plan - Drills Hazard Vulnerability Analysis Emergency Management - Hazard Vulnerability Analysis Worksheet Emergency Management Responses Bomb Threat Report Form Emergency, Safety and Disaster Management (for Home Care) - Teaching Outline Emergency/Disaster Management Evaluation Form

Equipment Management

Pump Inspection and Function Testing for Sabratek Infusion Pump Pump Inspection and Function Testing for Syringe Pumps Pump Inspection and Function Testing for Baxter 6200/6201 Pump Cleaning and Check Log Form CADD Pump Cleaning and Function Checklist Standard Pump Equipment Flow Sheet Standard Pole Equipment Flow Sheet Pump Tracking Log Form Equipment Testing, Tracking and Maintenance Maintenance of Vertical and Laminar Flow Hoods Clean Room Maintenance Log Form Hood Cleaning Log Form Hood/Filter Change Log Form Refrigerator Clean Log Form

SECTION 08 - HUMAN RESOURCES

Position Description/Performance Evaluation - Infusion Therapy Services Director Performance Evaluation - Age-Related Competency - Infusion Therapy Services Director Annual Competency Clinical Skills Assessment - Infusion Therapy Services Director Position Description/Performance Evaluation - Infusion Therapy Services Pharmacist Performance Evaluation - Age-Related Competency - Infusion Therapy Services Pharmacist Annual Competency Clinical Skills Assessment - Infusion Therapy Services Pharmacist Position Description/Performance Evaluation - Infusion Therapy Services Technician Performance Evaluation - Age-Related Competency - Infusion Therapy Services Technician Annual Competency Clinical Skills Assessment - Infusion Therapy Services Technician Position Description/Performance Evaluation - Infusion Therapy Services RN Performance Evaluation - Age-Related Competency - Infusion Therapy Services RN Annual Competency Clinical Skills Assessment - Infusion Therapy Services RN Infusion Therapy Clinical Staff - Competency Checklist Infusion Therapy Clinical Staff - Orientation Checklist Equal Opportunity Employment Licensure, Certification and Registration Verification and Control Systems New Employee Orientation Inservice and Continuing Education Continuing Education Attendance Record Form Inservice Attendance Record Form Employee Safety Employee Job-Related Injuries Annual Competency - Joint Commission National Patient Safety Goals and Universal Protocol Annual Competency - Universal Protocol for Preventing Wrong Site, Wrong Procedure and Wrong Person Surgery

SECTION 09 - INFORMATION MANAGEMENT

References Medical Records Unacceptable Abbreviation and Symbol List Acceptable Abbreviations List Employee Signature/Initial List