Policy Manual sample

MDT Home Health Care Agency, Inc. including OASIS if applicable ! Guiding and instructing the patient in therapeutic self-care activities that are directed toward improving independence and mental and physical functioning such as dressing, bathing and cooking. ! Establishing household management routines. ! Teaching family members to assist in maintaining the program after establishment of same. RESPIRATORY THERAPY • Gives treatment to patient as prescribed by a physician, physician assistant, or advanced registered nurse practitioner, acting within their scope of practice to relieve and/or improve patient’s condition, which can be safely provided in the home and to assist the physician, physician assistant, or advanced registered nurse practitioner in evaluating patients, develop plan of care, through the use of diagnostic testing related to the cardiopulmonary system. • Makes initial and periodic evaluation of patient’s respiratory therapy needs, including outcomes of care, and discharge planning. • Communicate in writing and/or verbally with the referring physician, physician assistant, or advanced registered nurse practitioner, acting within their scope of practice and / or other Home Health Care Agency personnel to obtain and give pertinent information on the patient’s progress and/or plan of care desviation. • Record content of each visit made to the patient. Provides information for development of re- certifications. Instruct the patient and caregiver in care and use of respiratory therapy devices; instruct/consult other health team personnel including, when appropriate, home health aides and caregivers in certain phases of respiratory therapy in which they may assist the patient; and instruct the patient and caregiver on the patient's total respiratory therapy program. Monitoring respiratory equipment for safety and appropriateness. • Attend Paramedical service meetings, in service programs, and other required Agency meetings. • Has full understanding and is in compliance with Home Health Care Agency rules and regulations and job description. Participate in in-services program, and discharge planning. MEDICAL SOCIAL WORKER Identifies and understands the social and emotional factors underlying patient's illness and communicate these factors to the Health Care Team. Assists patients and their families in understanding and accepting the treatment necessary to maximize medical benefits. Arrangement of additional services to outside agencies an needed. *Assessing psychosocial status *Developing the plan of care in consultation with the physician and other care team members * Assisting other teammembers in understanding the social and emotional factors related to the health problems * Working with family as needed * Utilizing and providing client/family with appropriate community resources as needed * Planning for discharg, Consultation and coordination of services with other disciplines CONTINUITY OF CARE In addition to the services previously described, our agency contributes to continuity of care through the use of the R.N. staff. Registered Professional Nurses act an liaison between hospital personnel, physicians, patient and agency. Upon request, the R.N. Super-visor initiates a comprehensive plan of care for patients referred. These services include: Home Health Agency Bylaws H-5