Policy Manual sample

MDT Home Health Care Agency, Inc. * Patient’s requests conflict with the Plan of Care. This might apply if the patient is asking the staff to work more hours than authorized. * Staffs violating any of the Conditions of Participation. In addition to reporting the above events, the staff must also report and provide in writing a 15 day notice to the case manager as well as the patient. This provides the case manager time to secure services for the patient. If circumstances exist that places the staff at risk, the case manager must be notified. The case manager can determine if a 15 day notice can be waived, however the staff must report the issues to the case manager immediately. In addition, if the 15 day notice is rescinded by the staff, the case manager needs to be informed. If the staff fails to notify the case manager, the case manager is unaware and will continue to work on securing an alternate staff. Remember, any time the staff discharges a patient from his/her care, the staff must write a discharge summary. This summary should be submitted to the case manager, DON, Clinical Manager, physician, and maintained in the patient’s chart, is also required to notify the DON, Clinical Manager of any change in staff’s address and / or contact information. This must be done within 30 days of the change. This is done not only for billing purposes – to ensure the staff’s reimbursement is going to the right place, but also to ensure the case manager / patient can reach the staff. In addition, the staff is required to participate in Case Conference. Case Conferences are set up by direct in the office, phone contact and then the staff is notified via the phone, text or e-mails. If the staff has not updated his/her phone and address, the staff may not receive the notification and may possibly be out of compliance. Reporting accurate information in a timely manner to the Case Manager is vital in ensuring the health and safety of the patient. There will be patients who do not want the information listed above to be reported to the Agency. Patient’s have many reasons for not wishing to share information. Sometimes it is fear based. Fear of going into an extended care facility or assisted living, fear of family discovering that the patient is not doing as well as they thought or fear of losing independence. There are also patients who may be engaging in illegal activities such as illegal drugs, or misusing prescribed medications. There are also patient’s who are simply private people who do not wish to share information. The staff may be asked by the patient who has fallen; “please don’t tell your case manager, Agency”. Requests such as these place the staff in a difficult position. The staff wants to maintain the trust of the patient but the staff knows that he/she is bound by the staff agreement to report such occurrences. The best course of action for the staff would be to talk to the patient about why he/she doesn’t want this reported. The staff may be able to relieve the patient’s fears or explore some of the concerns the patient has regarding informing the case manager of the occurrence. The staff should be truthful with the patient and inform the patient that he/she has to report the occurrence to the case manager/Agency. If the staff honors the patient’s request not to report an occurrence to the case manager, the staff has violated the Conditions of Participation as well as professional boundaries. The staff must maintain objectivity and comply with reporting mandates. The patient may be unhappy with the staff and it is possible that the patient will decide to replace the staff. As this may be an unfavorable outcome for the staff, failing to report an occurrence may have a far worse outcome for the staff, which can include Cease and Desist / Notice of Deficiencies, referrals to the professional licensing board, such as the Florida Nursing Board and even Adjudication (removal of staff license). Reporting concerns and issues enables the Case Manager to identify whether or not a health and safety issue exists and enables him/her to implement safety / prevention plans, increase or decrease services as needed, or identify other providers within the community that may be able to assist / meet the patient’s needs. Let us refer back for a moment to the example of the patient asking the staff not to report a fall. If this patient sustained a fall because he/she had an unsteady gait and the staff notified the case manager, the case manager could then authorize physical therapy to work on improving the gait or obtain assistive / adaptive devices. Now imagine the staff did not report the fall. The patient continues to ambulate with an unsteady gait. The next fall occurs and the patient hits his/her head on the sink and sustains a life threatening head injury and then dies. The nurse failed to maintain professional boundaries, and by doing so, failed to protect the patient. The nurse may have prevented this death by simply reporting a fall. In addition to reporting such events to the case manager, it is also necessary for licensed staff to report such events to the patient’s physician and if applicable law enforcement and county protective agencies such as child or adult protection services. If the staff is an LPN, the LPN must also report such events to his/her RN supervisor. Impermissible Actions and Behaviors: The Conditions of Participation outline actions and behaviors that are not permitted by the Agency’s Staff to participate in during the hours of service delivery to the patient. These include but are not Home Health Agency. - - Personnel/Operations Policies B-165