Policy Manual sample

MDT Home Health Care Agency, Inc. PERFORMANCE EVALUATION (Only for Employee with Deficiencies) Employee/Contractor Name: _______________________________________________ TITLE OF POSITION: RN LPN PT OT ST MSW HHA/CNA (Circle) TITLE OF IMMEDIATE SUPERVISOR: Director of Nursing, Clinical Manager EVALUATION:1. Excellent 2. Very Good 3. Average 4. Below Average 5. Poor N/A 1 2 3 4 5 NA 1. Conducts the admission of the patient to the Agency by: A. Obtaining a medical history, particularly as it relates to the present condition, from the patient and/or family member(s) B. Conducting a physical examination of the patient, including vital signs, physical assessment, mental status, appetite and type of diet, etc. C. Evaluating the patient, family member(s) and home situation to determine what health teaching will be required D. Evaluating the patient's environment to determine what assistance will be available from family members in caring for the patient E. Evaluating the patient's condition and home situation to determine if the services of a home health aide will be required and the frequency of this service F. Interpreting nursing and other services of the Agency to patients and families as a part of planning for care G. Developing and implementing the patient care plan _____________________________________________________________________ 1 2 3 4 5 NA 2. Provides skilled care as outlined in the patient care plan to include the following: A. Clinical services, treatments and preventative procedures requiring substantial specialized skill and ordered by the physician B. Initiating preventative and rehabilitative procedures as appropriate for the patient's care and safety C. Observing signs and symptoms and reporting to the physician reactions to treatments, including drugs, and changes in the patient's physical or emotional condition D. Teaching, supervising and counseling the patient and caregivers regarding the care needs and other related problems of the patient at home 1 2 3 4 5 NA 3. Is responsible for the care given by the home health aide to patients in her care by: A. Supervising and evaluating the care given by the home health aide and/or PTA/COTA as needed and at a minimum of once every 30 days B. Submitting to the appropriate department/individual a written evaluations of the home health aides and/or PTA/COTA who are providing service to the patients in his/her geographical area C. Participating in periodic conferences with the home health aide, and/or PTA/COTA supervisor concerning the aide's performance D. Charts those services rendered to the patient by the field staff, changes noted in the patient's condition and/or family and home situation, makes revisions in the patient care plan as needed, records supervisory visits conducted with the home health aide, and/or PTA/COTA evaluates patient care and progress and closes charts of discharged patients _____________________________________________________________ 1 2 3 4 5 NA 4. Prepares and presents patient's record to the Clinical Record Review Committee as indicated ___________________________________________________________ 1 2 3 4 5 NA 5. Evaluates the effectiveness of her nursing service to the individual and family ___________________________________________________________________ 1 2 3 4 5 NA Home Health Agency. - - Personnel/Operations Policies B-20