Making the Most of the Guide to Minnesota Class F Home

Transcription

1 Making the Most of the Guide to Minnesota Class F Home Care Provider Rules Susan Christianson SDC Consulting Mhdmanor@cableone.net /15/2010 1

2 Guide to Minnesota Class F Home Care Provider Rules Guide to Minnesota Class F Home Care Provider Rules, a comprehensive and interactive resource including forms, policies, and procedures designed to educate users about selected home care rules Developed in conjunction with Susan Christianson, Sdc Consulting, LLC, as a "start-to-finish" system for ensuring regulatory success, the three-ring binder includes forms, policies and procedures Electronic copies of the forms are included on a CD. The Guide also includes a comprehensive appendix with relevant statutes, rules, and guidelines. Member Price: $ Prospective Member Price: $ /15/2010 2

3 Guide s purpose Home Care Guide is based on the MN Class F Rules & Regulations Functions from the initial referral to the point of discharge from your home care program Covers Employees, checklists and requirements of training & delegated tasks Great teaching tool for staff, clients & families Helps build and create your own home care policy & procedure CD Rom- templates of the entire guide for you to simply add your own programs structure and definition I created this manual and home care system so that everyone could learn the exact language of the law and have it readily accessible. Home care program surveys will become more simplified as everyone knows the exact laws, their language and how and why you are applying them. I recommend that facilities make a TABLE of CONTENTS of the laws and the pages where you have used them. When a surveyor asks where you have applied a certain law and how, you can go to the exact form! 2/15/2010 3

4 Forms for Entry Table of contents Initial referral RN evaluation & assessment Vulnerable adult assessment & plan Home care orientation for clients Service plan RN supervisory visits, modifications to service plan flow sheet & charting Medication administration reference face sheet 2/15/2010 4

5 Miscellaneous Forms Needed Client information sheet Clinic referral form Master signature list Socialization grid Home care incident report Medication and physician orders, medication reference sheet Mdi Medication i error report form Loss or spillage of schedule II medication log Disposition of medications 2/15/2010 5

6 Policy & Procedure Forms Home care orientation for clients Nursing & supervisory visits Instructions for medication administration record Home Care Complaint Policy & Procedure Home Care Complaint form Mdi Medication &Treatment torders policy Central Storage of Medication Competency evaluations for medication administration or delegated nursing 2/15/2010 6

7 Policy & Procedure Forms Policy on client records Training & competency evaluation for UP s Orientation to home care requirements Personnel checklist of compliance upon hiring In-service training of UP s Oi Orientation tti to Home Care Requirements Job descriptions- who supervises? Core training done for UP s and training done specific to your client s needs and those in your home care program. 2/15/2010 7

8 Unlicensed Personnel (UP)/Home Care Employee Forms Competency evaluation forms Medication administration by UP s Personnel checklist: TB screening, infection control, orientation to home care requirements, HIPPA, competency evaluations, job description, Nursing services which may be delegated to UP s Information to determine delegation to UP s 2/15/2010 8

9 Discharge Forms Assistance upon discontinuation of services Disposition of medications upon discharge 2/15/2010 9

10 Appendix Public Documents Class F Home Care- Minnesota Statutes 144A to 144A Minnesota Home Care Rules Chapter 4668 Vulnerable Adults Act MDH Class F Guide to Survey Process MDH Entrance Conference Guidelines MDH Determination Process for 144G Minnesota Home Care Bill of Rights Housing with Services - Minnesota Statutes 144D Care Providers of Minnesota ss Guide to Minnesota s s 2006 Assisted Living Law 2/15/

11 Example of Two Forms HOME CARE ORIENTATION FOR CLIENTS CENTRAL STORAGE OF MEDICATION See Appendix for examples of actual forms 2/15/

12 HOME CARE ORIENTATION FOR CLIENTS Each form has a cover sheet with an overview of the form s purpose and the relevant Home Care Rules. Great teaching tool for staff, residents and their family. These are the exact standards of the law and these are how you are fulfilling it. 2/15/

13 HOME CARE ORIENTATION FOR CLIENTS General Information on specific Rules 2/15/

14 HOME CARE ORIENTATION FOR CLIENTS Bullet One - Assessment & Evaluation: Subp. 1- language of law; what is it saying? How are you answering this? #1- No later than TWO weeks after initiation of services, an RN MUST complete individualized evaluation. Bullet Two Reevaluation: MUST establish up-to-date service plan for providing services. Bullet Five: The first supervision or monitoring will be provided within 14 days after initiation by an RN and then at least every 62 days thereafter, or more frequently as indicated. Ok, there s your minimum. Are you doing this? Are you doing more than this? Add it as your policy. 2/15/

15 HOME CARE ORIENTATION FOR CLIENTS Skip to Bullet Eight - Contingency Plan: do you have one? Here is the language in part: client s service plan MUST include a contingency plan of action that includes the actions taken when services cannot be provided, the method for the client to contact a representative of the provider, name and number of the person to contact in an emergency, method for the provider to contact the client etc. Again, step by step you complete this. 2/15/

16 HOME CARE ORIENTATION FOR CLIENTS The form is walking you through the law step by step. You can then take the language of the law and make it your policy & procedure. This way you KNOW you are compliant. REMEMBER: these are the minimums that you must do. You can go above these. Also, this guide has NOTHING to do with the operation of your housing facility. 2/15/

17 CENTRAL STORAGE OF MEDICATION Watch the progression of the steps. See how your policy is easily built? As reviewing each form, walk through each layer and build! 2/15/

18 CENTRAL STORAGE OF MEDICATION For a client for whom meds will be centrally stored, an RN MUST ONE: conduct a nursing assessment of client s functional status, TWO: the need for central storage and THREE: development of a service plan for the provision of that service according to clients needs and preferences. All that in the first statement. Control of medications: AN RN OR PHARMACIST MUST ESTABLISH AND MAINTAIN A SYSTEM THAT ADDRESSES: 1) control of medications, 2)handling of medications, 3) medication containers, 4) medication records and finally 5) the disposition of medications Subp. 3A 2/15/

19 CENTRAL STORAGE OF MEDICATION Staff will provide medication reminders, assistance with self administration, medication administration or a combination of these services based on the RN assessment.. Are you able to do all of those things? Which do you provide? Veteran s- different procedure. Others that require a different procedure? UP s must transmit within the hour to the RN for implementation of changes and within 24 hours receive that medication. Storage of legend drugs. 2/15/

20 CENTRAL STORAGE OF MEDICATION Storage of over the counter medications i Policy on RN s review of PRN usage. At least WEEKLY, state in your policy. Have RN note this on medication record. Procedure for notifying an RN when there is a problem with administration. 2/15/

21 CENTRAL STORAGE OF MEDICATION Storage of Schedule II drugs. permanently affixed to the physical building or cart for storage. 2/15/

22 Any Questions? Feel a little overwhelmed? DON T!!! This empowers you to begin to truly know and understand the law and the Class F Home care process. Take it step by step. Take each form and go through it slowly. Use the CD and build the form. The outlines are there for you. Keep the exact law and number if you want on the form. I do. Show residents & employees this is WHY you do things the way you do! Use the resources in the back of the manual. Take the Guide to the survey process once you have completed your policy & procedure and actually use the law listed and find where you have applied it. EASY REFERENCE AGAIN FOR SURVEYS! Create a Master book of all your forms. When surveyors walk in- you have everything you need that you are implementing. 2/15/

23 Good Luck! You CAN do this. I am available if you ever have any questions or concerns regarding gthe Guide to Minnesota Class F Home Care Provider Rules. Care Providers is ALWAYS available to dig deep and assist itin answering Member questions Utilize your resources! Thank you for your interest in this product. 2/15/

24 Appendix HOME CARE ORIENTATION FOR CLIENTS CENTRAL STORAGE OF MEDICATION 2/15/

25 HOME CARE ORIENTATION FOR CLIENTS This form serves as a checklist of information and issues that a home care agency should discuss with each home care client upon the initiation of services. It is important not only that clients understand the Home Care Bill of Rights (see the acknowledgments on the final page) but also the scope of what services you will be providing. For example, many home care clients do not receive cares from a Registered Nurse on a routine, daily basis, and a discussion of the delegation and supervision issues can be helpful. Many of the paragraphs that follow are quotations or paraphrasing from the Minnesota Home Care Rules in other words, not necessarily in plain English. We suggest you use these to prompt yourself, more-so than as a script. Rules to Review: (Not an exhaustive list.) MN Rule Evaluation and Service Plans. MN Rule Nursing Services. Sample MN Rule Delegated Nursing Services. MN Rule Periodic Supervision of Unlicensed Personnel. 5 HOME CARE ORIENTATION FOR CLIENTS.doc 2006, 2007 Sdc Consulting, LLC

26 HOME CARE ORIENTATION FOR CLIENTS Subpart 1. Evaluation; documentation. No later than two weeks after the initiation of class F home care services to a client, a registered nurse must complete an individualized evaluation of the client's needs and must establish, with the client or the client's responsible person, a suitable and up-to-date service plan for providing class F home care services in accordance with accepted standards of practice for professional nursing. The service plan must be in writing and include a signature or other authentication by the class F home care provider licensee and by the client or the client's responsible person documenting agreement on the services to be provided Subpart 2. Reevaluation. A registered nurse must review and revise a client's evaluation and service plan at least annually or more frequently when there is a change in the client's condition that requires a change in services Delegated Nursing Services. Subpart 2. Nursing assessment and service plan. Before initiating delegated nursing services for a client, a registered nurse must conduct a nursing assessment of the client's functional status and need for nursing services and must develop a service plan for providing the services according to the client's needs and preferences. The service plan must include the frequency of supervision of the task and of the person providing the service for the client according to part The service plan for delegated nursing services must be maintained as part of the service plan required under part PERIODIC SUPERVISION OF UNLICENSED PERSONNEL. Subpart 2. Services that require supervision by a registered nurse. A. After the orientation required under part , subpart 5, a registered nurse must supervise, or a licensed practical nurse under the direction of a registered nurse must monitor, unlicensed persons who perform class F home care services that require supervision by a registered nurse at the housing with services establishment, to verify that the work is being performed adequately, identify problems, and assess the appropriateness of the care to the client's needs. Supervision or monitoring must be provided no less often than the following schedule: (1) within 14 days after initiation of class F home care services that require supervision by a registered nurse; and (2) at least every 62 days thereafter, or more frequently if indicated by a nursing assessment and the client's individualized service plan. Sample B. If the unlicensed person is monitored by a licensed practical nurse, the client must be supervised by a registered nurse at the housing with services establishment at least every other visit and the licensed practical nurse must be under the direction of a registered nurse, according to Minnesota Statutes, sections to HOME CARE ORIENTATION FOR CLIENTS.doc 2006, 2007 Sdc Consulting, LLC 1

27 HOME CARE ORIENTATION FOR CLIENTS Licensee: Address: Office phone: Fax: After hours call to reach staff and they can reach the manager on duty. Client Name: Room Number: Responsible Person (if any): Relationship: Address: Telephone: (Home) (Work) (Fax) Assessment and Evaluation. No later than two weeks after the initiation of class F home care services to a resident, an RN must complete an individualized evaluation of the resident's needs and must establish with the resident, or the resident's responsible person, a suitable and up-to-date service plan for providing services in accordance with accepted standards of practice for professional nursing. [The agency will separately review the actual service plan with the client.] Subpart 1. Reevaluation: An RN must review and revise the evaluation and service plan at least annually or more frequently when there is a change in the resident's condition that requires a change in services Subpart 2. Delegated Nursing Services; Nursing Assessment and Service Plan. Before initiating delegated nursing services for a client, a registered nurse must conduct a nursing assessment of the client's functional status and need for nursing services and must develop a service plan for providing the services according to the client's needs and preferences. The service plan must include the frequency of supervision of the task and of the person providing the service for the client according to part The service plan for delegated nursing services must be maintained as part of the service plan required under part Subp. 2. Sample Supervision of Unlicensed Personnel: An RN must supervise, or an LPN under the direction of an RN must monitor, an unlicensed person who performs class F home care services that require supervision to verify that the work is being performed adequately, identify problems and assess the appropriateness of the care to the client's needs Subp. 2. Supervision Schedule: The first supervision or monitoring will be provided within 14 days after initiation of services that require supervision by an RN and then at least every 62 days thereafter, or more frequently if indicated. Currently the RN will supervise residents under the assistive living home care program every 62 days on-site. This will either be in each resident's room or in the Home Health Care room, whichever provides the most privacy for the resident Subp HOME CARE ORIENTATION FOR CLIENTS.doc 2006, 2007 Sdc Consulting, LLC 2

28 HOME CARE ORIENTATION FOR CLIENTS Description of Services: Please see the Service Plan personalized grid (attached). That grid will provide: 1) a description of the [AGENCY NAME HERE] class F home care service or services to be provided and the frequency of each service, according to the individualized evaluation required to be done by the RN, 2) It will identify the categories of persons that will provide these services or cares, 3) the schedule or frequency of sessions of supervision or monitoring as required by law, and 4) the fees for each service. The plan for contingency action for essential and nonessential services is listed below. (Please review.) , Subpart 4(A)-(D). I understand that I will be responsible for: coinsurance deductible private pay none - County program involved: Contingency plan: The client s Service Plan must include a plan for contingency action that includes (1) the actions to be taken by the class F home care provider licensee, client, and the responsible person if scheduled services cannot be provided, (2) the method for the client or responsible person to contact a representative of the class F home care provider licensee whenever staff are providing services, (3) the name and telephone number of the person to contact in an emergency or significant adverse change in the client s condition, (4) the method for the class F provider to contact a responsible person of the client, if any, and (5) the circumstances in which emergency medical services are not to be summoned, consistent with MN Statutes, chapters 145B and 145C, and declarations made by the client under those chapters. These items are addressed in the separate Service Plan document (attached) , Subpart 4(E). Essential Services: If, for medical or safety reasons, a service to be provided must be completed at the scheduled time and [AGENCY NAME HERE] is unable, for any reason, to keep the scheduled appointment, [AGENCY NAME HERE] will re-staff the service for that day or make reasonable arrangements with the resident or their responsible party to complete the service through other means , Subpart 6. Nonessential services: Sample o If [AGENCY NAME HERE] is unable, for any reason, to keep a scheduled appointment for a service that is not essential for medical or safety reasons, [AGENCY NAME HERE] must A. follow the procedure established in the service plan; B. provide a replacement person; or C. notify the client that the appointment will not be kept and schedule a new appointment or arrange for some other reasonable alternative. [The preceding sentence quotes the rule; you could modify it to match your agency s actual practice.] , Subpart 6. o If the client or responsible person must cancel services, reasonable notification must be made to the staff at [AGENCY NAME HERE]. Rearrangement of any client nonessen- 5 HOME CARE ORIENTATION FOR CLIENTS.doc 2006, 2007 Sdc Consulting, LLC 3

29 HOME CARE ORIENTATION FOR CLIENTS tial service is always discussed prior to any decreasing of staff (i.e.: holidays). A client or their responsible person may contact [AGENCY NAME HERE] by telephone at [AGENCY NAME HERE] regarding any questions or concerns they may have whenever staff is providing services or service alterations need to be made , Subpart 6. Advanced Directive: Information Provided Client has Adv. Directive Living Will Mental Health Declaration copy in file, directives are (if known): Full Code Other ACKNOWLEDGMENTS: [The following are examples only. Modify this list to include whatever documents and forms you include as part of the initiation of home care services. This list is not intended to match perfectly the contents of this Form or to refer by name to other forms included in this resource.] I have received a copy of the home care bill of rights. I have received a copy of the written complaint procedure. I have been informed that information regarding home care services may be shared with my physician, insurers, and staff as appropriate and in accordance with all the HIPPA rules and regulations. I have received information about Advanced Directives and discontinuation of life sustaining treatment. I have received a copy of the policy concerning discontinuation of services. I have received a copy of the Abuse Prevention plan I have received a copy of the Policy on Client Records I have received a copy of the Policy on Central Storage of Medications Sample Signature of client or responsible person Date [AGENCY NAME HERE]: Signature and Title of Staff Completing Form Date Signature of RN Date 5 HOME CARE ORIENTATION FOR CLIENTS.doc 2006, 2007 Sdc Consulting, LLC 4

30 CENTRAL STORAGE OF MEDICATION This form establishes policies concerning central storage of medications, including control and distribution of medications, procedures for recording medications and the system used, storage of legend drugs and over the counter drugs, refrigeration of certain medications, and procedures for notifying an RN when there is a problem with the administration of a medication. The Minnesota Home Care Rules contain detailed provisions about these topics, and the paragraphs of this policy track the rule. Rules to Review: (Not an exhaustive list.) MN Rule Central Storage of Medications Sample 23 CENTRAL STORAGE OF MEDICATION.doc 2006, 2007 Sdc Consulting, LLC

31 CENTRAL STORAGE OF MEDICATION For a client for whom medications will be centrally stored, an RN must conduct a nursing assessment of the client's functional status and the need for central medication storage, and develop a service plan for the provision of that service according to the client's needs and preferences. The service plan must include the frequency of supervision of the task and of the person providing the service for the client according to part The service plan for central storage of medication must be maintained as part of the service plan required under part , subp. 2. CONTROL OF MEDICATIONS An RN or pharmacist must establish and maintain a system that addresses the control of medications, handling of medications, medication containers, medication records and the disposition of the medications , subp. 3.A. The following paragraphs constitute the system that [AGENCY NAME HERE] has established and will maintain: 1. [AGENCY NAME HERE] staff will provide medication reminders, assistance with selfadministration of medication, medication administration, or a combination of these services based upon the RN assessment of the client and the client's preferences at the time that home care services are determined to be needed , subp. 3.B.(1). 2. [AGENCY NAME HERE] provides suitable storage facilities for medications on site. This is a locked room that has a locked medication cabinet within the room. All medications that are under observation by unlicensed personnel, the RN and/or pharmacy are placed into this location and cabinet for safekeeping. Any Schedule II controlled substances maintained within the facility will be kept in a separate locked cabinet, which is permanently affixed to the building. (See #11 below.) Only authorized nursing personnel have access to keys to the locked room and cabinet , subp. 3.B.(2); subp. 8. Sample 3. Distribution of medications. Determined by each client s doctor. The medications are either setup by the pharmacy of the client's choice or by the RN for the facility, whichever is more convenient for the client. The clients chosen pharmacy and/or the RN maintain the medication administration records (MAR), which the unlicensed personnel must follow , subp. 3.B.(2). 4. Procedure for recording medication is based upon the dosage box system ( , subp. 3.B.(3)). A. The orders are transcribed onto the medication administration record either by the RN or the pharmacy. B. There is a medication description label of each pill located on the back of each client s weekly dosage box which is filled by the pharmacy. The pharmacy places this on each of their client's boxes for review by the unlicensed personnel if needed in determining 23 CENTRAL STORAGE OF MEDICATION.doc 2006, 2007 Sdc Consulting, LLC 1

32 CENTRAL STORAGE OF MEDICATION which pills are currently ordered or if any are missing. Clients that use the veteran s administration and a separate agency to fill their medications are unable to have separate labels on the back of their medication boxes. All questions and concerns regarding a veteran clients medication administration should immediately contact the 24-hour on-call staff by that agency. For the client utilizing the pharmacy program, the unlicensed personnel can then review the label on the dosage box, the medications record and then call the pharmacy with their questions or concerns. Each pharmacy has agreed to be available for contact 24 hours. See the home care room for specific telephone numbers and contacts. The RN or pharmacy assures that any special instructions such as "give with food" are included on the MAR. The MAR will also include the names, strengths, a brief pill description and the dosages of the individual medications, along with the day and time that each dosage box medications are given. Those clients that obtain their medication from the Veterans Administration are filled by an RN from a certified Medicare agency. All information regarding medication is on the medication record. The medication record is completed and maintained by the agency s RN. The RN assures that any special instructions such as "give with food" are included on the medication record. The same rules above pertaining to the medication record apply. Any discrepancy in giving pills is immediately directed to the RN at the agency by the unlicensed personnel prior to administering the medication. The medications for the Veterans are kept in their own Tupperware box, locked in the central storage cabinet and labeled with the Veteran's name and are in the original container with the prescription and information for review if needed. C. The RN and/or the pharmacy will set up the dosage boxes on a biweekly or as-needed basis. If a client at any time has a change in the medication prescribed, the order is either called in directly by the client's doctor to the pharmacy or the paperwork is given to the unlicensed personnel on duty by the client upon return from their appointment. The unlicensed personnel, within the hour, transmits the order to the RN for implementation of the changes according to [AGENCY NAME HERE] policy on medication and treatment orders protocol, and within 24 hours of receipt. Sample D. The unlicensed personnel are trained by the RN for medication administration and competency prior to any administration to clients. The procedures are distinctly spelled out in the [AGENCY NAME HERE] medication administration policy and reviewed with each unlicensed personnel at least annually or as needed per clients need. 5. Storage of legend drugs. [AGENCY NAME HERE] provides central storage of legend drugs for a client. A legend drug must be kept in its original pre-filled pharmacy dosage box container bearing the original prescription label with drug, strength and quantity of drug, expiration date of a time-dated drug, directions for use, client's name, prescriber s name, date of issue, and the name and address of the licensed pharmacy that issued the medication , subp. 3.B.(4), subp 5. Cross-Client Use Prohibited: No legend drug supply for one client may be used or saved for the use of another client , subp CENTRAL STORAGE OF MEDICATION.doc 2006, 2007 Sdc Consulting, LLC 2

33 CENTRAL STORAGE OF MEDICATION 6. Storage of over the counter medication: Over the counter medications are treated just like prescriptions in that they are stored in the locked medication room and cabinet with the clients pre-filled dosage box. When the client s doctor has authorized a PRN, the PRN will be listed separately on the medication record for administration by unlicensed personnel. The medication record will direct the unlicensed personnel in proper administration for each PRN and will list any special instructions. The PRN's are kept in a specifically labeled dosage sleeve by the pharmacy for the client or in the original bottle with the client's name and original label. The [AGENCY NAME HERE] RN will monitor the client s medication record on a weekly basis for PRN usage and will monitor accordingly with the client and their physician. Any client on the Medication Administration program is asked NOT to keep any medication in their room unless there has been clearance for this by the RN or their physician. All medications being administered by the [AGENCY NAME HERE] must be locked and handled by the RN or the pharmacist prior to the unlicensed personnel administering to client , subp. 3.B(4), subp The [AGENCY NAME HERE] RN will review each client s medication administration record and note PRN usage and medication compliance weekly. The RN will make note of this directly on the medication record. Any notes of significance will be directed by the RN to the client s doctor for direction. Unlicensed Personnel can administer PRN medication according to the doctor s order on the medication record. 8. Method of refrigeration of biological medications. Any medication that needs refrigeration by [AGENCY NAME HERE] is kept in a separate lock box in a separate compartment of the refrigerator , subp. 3.B(5). 9. Medication samples. A sample of medication provided to a client by an authorized prescriber may be used by that client, and must be kept in its original container bearing the original label with legible directions for use. If assistance with self-administration of medication or medication administration is provided by [AGENCY NAME HERE], a client's plan of care must and will address the use of the medication sample , subp. 6. Sample 10. Procedure for notifying an RN when a problem with administration, record keeping, or storage of medications is discovered ( , subp. 3.B(6)). A. Immediately upon recognizing that there is a problem with administration of a medication, unlicensed personnel are directed to contact the [AGENCY NAME HERE] RN for further direction on how to proceed, which may include instructions to contact the client's pharmacy and/or the Medicare Certified Agency in the event the client is a Veteran. B. In the event of a record keeping or storage of medication problem, the unlicensed personnel should contact the [AGENCY NAME HERE] RN within [complete this section of your form by filling the blank with whatever the RN considers to be an appropriate time frame; then delete this italicized note] 23 CENTRAL STORAGE OF MEDICATION.doc 2006, 2007 Sdc Consulting, LLC 3

34 CENTRAL STORAGE OF MEDICATION 11. Storage of Schedule II drugs. [AGENCY NAME HERE], which provides central storage of medications, must and does provide a separately locked compartment, permanently affixed to the physical building or medication cart for storage of the controlled Schedule II drugs listed in the MN Statutes Section , subdivision , subp. 9. Sample 23 CENTRAL STORAGE OF MEDICATION.doc 2006, 2007 Sdc Consulting, LLC 4