DURING ORIENTATION, DID YOU RECEIVE INFORMATION ABOUT A CONFLICT OF INTEREST POLICY?
• Yes! We received information and signed a conflict of interest form. Human Resources reviewed our agency policy with us and we received a copy in our employee notebook.
• The conflict of interest policy is designed to identify situations that present potential conflicts of interest and to provide employees the procedures for making the appropriate disclosure.
• Example: You work at your church as a congregational nurse and you also work at HPCG as a nurse (this could be a conflict of interest if you are acting in both roles with the patient).
CAN YOU TELL ME 3 OR 4 PATIENT RIGHTS? **KNOW THESE!**
• to receive effective pain and symptom management;
• to be involved in developing their plan of care and the updates to the POC;
• confidentiality and privacy of their health information;
• to be informed, both orally and in writing, in advance of care being provided, of the charges, including payment for the service/care expected from third parties and any charges for which the patient will be responsible;
• to refuse treatment after knowing consequences;
• to be able to identify staff through nametags;
• to choose their healthcare provider, including attending physician
• to have their property and person treatment with respect, consideration, and recognition of their dignity and individuality
HOW DOES HPCG INFORM PATIENTS OF THEIR RIGHTS & RESPONSIBILITIES?
• HPCG provides all new patients on admission with a notebook – HPCG’s Patient Care Notebook – A Guide for Patients and Families - containing lots of information including our Patient’s Rights and Responsibilities.
• Patients or their caregivers initial off on the patient consent form (this is part of informed consent, which is a right!) that they have been provided and understand these rights in a manner or language they can understand.
TO WHOM WOULD YOU REPORT SUSPECTED VIOLATIONS INVOLVING MISTREATMENT, NEGLECT, OR ABUSE OF THE PATIENT? WHAT IS THE TIMEFRAME FOR DOING THIS?
• Any suspicion of abuse, neglect and/or exploitation by anyone (including HPCG staff) is brought to the attention of Marta or her designee immediately. Communication must be direct – do not leave a voicemail. If Marta is unavailable speak with Risa or another clinical manager. An investigation is conducted and DSS is notified if suspicion is confirmed.
• In LTC, Donna notifies the facility’s Director of Nursing or Administrator and requests assistance in evaluating and taking necessary steps to correct the problem.
• During on-call hours, communicate with Clinical Resource.
• HPCG follows all Federal and State requirements regarding reporting suspected abuse, neglect or exploitation of a juvenile or disabled adult. The patient has the right to be free of mistreatment, neglect or verbal, mental, sexual, and physical abuse, including injuries of unknown source, and misappropriation of patient property.
TELL ME ABOUT YOUR AGENCY POLICY FOR HANDLING A COMPLAINT FROM A PATIENT? WHO DO YOU REPORT IT TO AND HOW IS IT DOCUMENTED?
• Anyone can make a complaint.
• All complaints, including those after-hours, get written up on a consumer complaint form and sent to Sue S. as the VP of Quality and Compliance.
• Complaints are then followed up and investigated with feedback given back to the consumer. We track for trends. Complaints help us think about ways to improve our services.
HOW DOES HPCG KEEP PATIENT INFORMATION CONFIDENTIAL?
Hospice and Palliative Care of Greensboro (HPCG) trains all employees at orientation and yearly about HIPAA and patient confidentiality. We sign a form agreeing to keep patient information private. Violations of the confidentiality policy may result in disciplinary action up to and including termination.
• If e-mail with patient information is sent outside HPCG, it is encrypted
• All trash containing patient information is placed in shred-it bins
• Do not leave patient information visible and unattended
ARE PATIENTS PROVIDED INFORMATION ABOUT ADVANCE CARE DIRECTIVES AT THE START OF CARE? HOW IS THIS DOCUMENTED?
• Yes. Information about Advance Care Directives is in our Patient Care Notebook given to patients and family members on admission to HPCG.
• Team members – especially the Social Workers – then review this information with the patient as care continues.
• Updates are shared with other team members by voicemail/email, in the Interdisciplinary Group (IDG) meetings, shift reports and changes are reflected in the chart as well as on the IDG meeting menu.
WHAT ARE HPCG’S RESUSCITATIVE GUIDELINES AND WHO DOES WHAT?
• When a patient / representative expresses the desire for a DNR, the RN gets a verbal order and the Social Worker obtains two out-of-facility DNR’s or facilitates the completion of a MOST form.
• In the event of transportation by ambulance, a signed Out-of-Facility DRN and / or MOST form must be in the patient’s home or facility to prevent CPR if a cardiac or respiratory arrest occurs.
HOW DOES HPCG GO ABOUT HANDLING ETHICAL ISSUES? HOW ARE THEY REPORTED, DOCUMENTED, AND RESOLVED?
• We use team conference, clinical managers’ meetings (scheduled or called), our Professional Advisory Committee, Cone Health Ethics Committee, or others as needed to discuss these ethical concerns. We can also meet with the patient and family to discuss concerns.
• Marta, the Director of Support Services / Risa, VP of Clinical Services, collects information and coordinates these discussions. Risa reports to the Board quarterly.
• Example: A patient lives alone, does not have a caregiver, and is very unsafe. The patient is slightly confused at times but is adamant that he wants to remain at home. Staff want to ensure the patient’s well-being (beneficence/do good) but also want to respect the patient’s self-determination (autonomy).
CULTURAL DIVERSITY – WHAT DOES HPCG DO WHEN A PATIENT IS ADMITTED WHO IS FROM A DIFFERENT CULTURE? HOW DO WE HANDLE SITUATIONS INVOLVING COMMUNICATION AND LANGUAGE BARRIERS?
**We utilize interpreters or the AT&T Language Line for situations involving communication/language barriers.**
IF YOU SUSPECTED FRAUD & ABUSE IN THE AGENCY, WHO WOULD YOU REPORT IT TO?
• informing a manager: supervisor, the Compliance Officer (Sue Sciabbarrasi), or a member of the Compliance Committee (Sue S, Pat Soenksen, Marion Taylor, Clay Smith, Tab Haigler, Pat Gibbons, Risa Hanau, Susan Cox, Maggie Conklin, Chip Reklis, and Dr. Carlos Monguilod)
• or by leaving a message in the confidential Compliance voicemail (x2425).
• Everyone in the organization is responsible for compliance!
HOW DOES HPCG INTRODUCE THE AVAILABILITY OF SPIRITUAL COUNSELING?
• AN RN completes an initial assessment to determine the patient’s immediate care and support needs within 48 hours of the patient’s election of hospice care. She provides education on HPCG’s services, including chaplain services. If spiritual issues are identified at that time, the RN communicates this to the hospice interdisciplinary group (IDG).
• The IDG conducts and documents a patient-specific comprehensive assessment within 5 days of election that identifies the patient’s need for hospice care, including medical, nursing, psychosocial, emotional and spiritual care.
• Social Workers regularly assess for spiritual needs when updating the comprehensive assessment and plan of care. All non-LTC patients receive a call from the Chaplain to introduce services.
HOW WOULD YOU HANDLE A PATIENT WITH SPECIFIC DIETARY NEEDS?
• The patient’s nutritional status is assessed by the hospice RN during the comprehensive assessment and subsequent reassessments. These interventions are part of the plan of care and education is provided to patients and families as needed.
• When the IDG or attending physician identify nutritional needs or problems that exceed the expertise of the RN Case Manager or other members of the IDG, an appropriately trained individual (typically the dietician) is retained to provide more specialized interventions.
WHEN MORE THAN ONE ORGANIZATION IS PROVIDING SERVICES TO A PATIENT, HOW ARE SERVICES COORDINATED?
• The RN Case Manager coordinates the patient’s plan of care and facilitates the ongoing sharing of information with the attending physician, contracted facilities, vendors, other members of the IDG, and non-hospice healthcare providers furnishing services to the patient (for conditions related and not related to the terminal illness).
• Communication mechanisms include, but are not limited to:
o IDG meetings
o ad hoc case conferences when needed
o family meetings as appropriate
o discharge and/or transfer summaries as needed
o telephone communications and voice mail
o reports from and to on-call staff
o documentation in the patients’ records
• The IDG meets weekly to provide care planning for the hospice’s patients/caregivers. Each patient/caregiver is discussed, at a minimum, every 15 days, and when changes occur.
HOW ARE CHARGES FOR CARE CONVEYED TO PATIENTS?
• Admission staff discuss with patients and caregivers on admission what is covered and not covered.
• Susan Walters works with our private insurance patients.
• Patients are admitted to HPCG services regardless of their ability to pay.
• Social Workers also talk about charges as it relates to patients going to Beacon Place.
• Medication coverage is reviewed with patients and caregivers on an ongoing basis.
• Medicare/Medicaid reimburses HPCG for most of the care we provide.
DID YOU RECEIVE A JOB DESCRIPTION UPON HIRE? DESCRIBE IT.
Yes! I received and signed a job description upon hire. In addition, I receive an updated job description, which I sign annually, as part of the annual evaluation process.
DESCRIBE YOUR ORIENTATION.
• HPCG has an agency orientation that covers all kinds of agency information including mission statement, conflict of interest, patient rights, information about abuse and neglect, cultural diversity, infection control, Conditions of Participation, services our agency provides, and many other things.
• Then we each go through a job-specific orientation.
DID YOU RECEIVE AN ANNUAL EVALUATION? HOW WAS IT DONE?
Yes! Evaluations are completed yearly by your supervisor based on your job description. Both you and your supervisor have input in your evaluation and sign off on it electronically.
HOW MANY CONTINUING EDUCATION HOURS ARE NEEDED EVERY 12 MONTHS?
• Clinical staff are required to have 12 hours yearly; administrative staff 8 hours a year.
• HPCG offers regular in-service training for its staff. We utilize the Hospice Education Network via the computer as well as other opportunities both on-site and off-site.
WHAT TYPES OF IN-SERVICE TRAINING HAVE YOU RECEIVED?
Annual education topics include: 1) cultural awareness, 2)compliance , 3) disaster planning , 4) infection control, 5)HIPAA/HITECH, 6) Ethics, 7) professional boundaries, 8) communications barriers, 9) OSHA Right to Know laws, 10) methods for coping with work-related issues of grief, loss and change, 11) patient’s rights and responsibilities, 12) safety, 13) pain and symptom management, 14) consumer complaints.
DID YOU RECEIVE A COMPETENCY ASSESSMENT PRIOR TO PERFORMING YOUR JOB?
Yes! All clinical staff are assessed for competency prior to performing their job
HOW ARE PHYSICIAN / NURSE PRACTITIONER LICENSURE VERIFIED?
The HPCG Referral Center has a process by which all physician / nurse practitioner licensure is verified through the NC Medical Board website. A log of this is kept in the Referral Center.
HOW DO WE ASSESS AND DOCUMENT THE PATIENT’S NEED FOR A VOLUNTEER?
• Typically the social worker assesses for volunteer needs – this is done at the original psychosocial assessment and with any updates to the comprehensive assessment.
• The IDG conducts and documents a patient-specific comprehensive assessment within 5 days of admission that further identifies the patient’s needs.
WHO QUALIFIED YOU TO BE COMPETENT PRIOR TO BEGINNING PATIENT CARE?
• Supervisors are responsible to make sure all clinical staff are competent and comfortable in doing the tasks assigned prior to asking them to perform these tasks.
• This is completed on orientation and then annually. At least yearly, a visit is made by the supervisor with clinical staff to the homes of our patients.
IF AIDES WERE UNABLE TO COMPETENTLY PERFORM A TASK, WHAT IS THE FOLLOW-UP TRAINING?
The supervisor will follow-up to ensure that the aide receives training in the particular task. The supervisor will then require the aide to perform another competency evaluation.
HOW DO YOU ASSURE THAT ALL AIDES ARE SUPERVISED ON-SITE ANNUALLY?
The Hospice Aide Supervisor, LaSandra Keen, is responsible for performing competency evaluation at least once a year. This is done on-site in the home / facility where a patient resides.
IF PATIENTS OR FAMILY MEMBERS SHARE A CONCERN WITH AN AIDE, WHO SHOULD IT BE REPORTED TO AND HOW IS IT DOCUMENTED?
Any concerns should be reported to the RN Case Manager and documented in the note. Complaints should be reported to Sue Sciabbarrasi, VP of Quality and Compliance, on a Consumer Complaint form.
WHO WOULD A NURSE CONFER WITH TO SELECT THE MOST APPROPRIATE DRUGS TO MEET A PARTICULAR PATIENT NEED?
A nurse would confer with a physician (attending or hospice) or a pharmacist.
HOW DO YOU ACCESS REFERENCE MATERIALS NEEDED FOR YOUR JOB?
• HPCG maintains a professional reference library of books, journals, audiovisuals, and other learning materials to promote the professional learning and growth of the staff.
• Staff can also use the Internet to access reference information.
• MSDS (Materials Safety Data Sheets) are available in Jewel’s office, Beacon Place, Kids Path, and Dolley Madison. These give you information regarding contexts of each product found in the medical supply rooms.
WHAT DO YOU DO WHEN A PATIENT IS FOUND TO BE OUT-OF-COMPLIANCE WITH A DRUG REGIMEN?
• At admission, all patients sign a Medication Use Agreement, outlining expectations related to obtainment, use, and refills of certain medications.
• The RN Case Manager or designee identifies and documents any misuse of controlled substances and notifies the patient’s attending physician, the hospice physician and the Clinical Manager for further intervention.
• An Incident Report is completed for suspected or actual diversion of controlled substances and the IDG, in consultation with the hospice Medical Director, the patient’s attending physician to determine the appropriate course of action, including reporting the diversion to appropriate authorities.
WHO IS RESPONSIBLE FOR MAINTAINING THE CURRENT MEDICATION PROFILE AND REVIEWS ALL PATIENT MEDS? WHAT DOES THE MEDICATION PROFILE REVIEW INCLUDE?
• A licensed nurse maintains a current medication profile and reviews all patient medications, including herbal and over-the-counter, on an ongoing basis in collaboration with other IDG members, including a physician and/or pharmacist.
HOW DOES THE PSYCHOSOCIAL ASSESSMENT HELP THE IDG IN MAXIMIZING THE BENEFIT FROM HOSPICE CARE AND SERVICES?
• A social worker (SW) completes the psychosocial assessment as part of the comprehensive assessment of the patient. In addition to the physical needs, the SW identifies the psychosocial, emotional and spiritual needs of the patient related to the terminal illness that must be addressed in order to promote the patient’s well-being, comfort and dignity throughout the dying process.
HOW IS THE PATIENT INCLUDED IN THE PLANNING OF THEIR CARE?
• Patients / caregivers are involved from admission in developing their plan of care by establishing goals, based on their needs and desires, which are reviewed and revised on a regular basis.
• The plan of care is discussed with patients / caregivers during each visit and this is documented in the notes. The IDG reviews the plan of care each time the patient is discussed.
WHAT TYPE OF EDUCATION, SERVICES, AND EXPERTISE DOES HPCG OFFER THE COMMUNITY REGARDING GRIEF AND LOSS?
• HPCG offers grief counseling, support, and education to anyone in the Greater Greensboro community who has been affected by grief.
• Families and caregivers served through Hospice are eligible for 13 months of bereavement support following the death of a loved one.
• Services include individual grief counseling, grief support groups, seminars on grief, expressive arts workshops, remembrance gatherings, support for grieving children, and a resource library.
HOW DOES THE HOSPICE COORDINATE AND PROVIDE A CONTINUUM OF CARE FOR THE PATIENT AND FAMILY THROUGH THE TRANSITION OF DYING TO THE TIME OF DEATH AND FOLLOW-UP BEREAVEMENT CARE?
• The interdisciplinary group provides support to the patient and family throughout the continuum of care. Personnel are available to attend to the patient’s death 24/7.
• Staff ensure that caregivers are taught about the dying process & what to do when death occurs.
• Staff respect cultural and religious traditions of the patient/family related to death & dying
• At the time of admission, the Social Worker identifies risk factors and issues that may impact the family’s particular bereavement needs. The social worker reassesses pre-bereavement needs at least monthly and through weekly interdisciplinary meetings.
• Pre-bereavement services are typically provided by the social worker or the bereavement counselor. However, all members of the interdisciplinary team are responsible for supporting patients and caregivers as they grieve the loss of health and anticipate death.
• After the patient’s dies, the IDG reviews the circumstances of the death the needs of the caregivers. The bereavement counselor follows up based on the needs identified (early or routine bereavement).
• Kids Path services are available for children.
WHAT PROVISIONS ARE THERE FOR THE FAMILY AFTER THE DEATH OF A PATIENT?
• The hospice staff attending the death respects the cultural, religious, and spiritual traditions of the patient’s family/caregivers and provides support as needed and appropriate.
• Provisions for the family after the death include the following:
O assessing caregiver coping and supporting their role in the patient’s living/dying process
O assisting caregivers with needs (patient’s personal care, funeral arrangements, disposal of medicine, etc).
O asking the caregiver if they would like to spend time alone with the patient
O educating the caregiver about bereavement follow-up
DESCRIBE HOW YOU ARE INVOLVED IN THE QAPI (QUALITY ASSESSMENT PERFORMANCE IMPROVEMENT) ACTIVITIES?
• ALL STAFF have a role in performance improvement through making a suggestion in our suggestion box, working on a PIP (Performance Improvement Project), or working with their supervisor on suggestions for improvement.
• Several PIP’s that we have worked on or are working on are: Gracious Goodbye, DNR, Anxiety/Sadness. HPCG uses the Plan-Do-Study-Act model for performance improvement.
EXPLAIN HPCG’S SYSTEM OF DOCUMENTATION AND RETRIEVAL OF THE PATIENT’S SPECIFIC DATA ELEMENTS AND HOW ARE THEY USED IN CARE PLANNING?
• Staff electronically document all contacts with patients/family members, health care professionals, and community agencies.
• Specific data elements, such as pain level, PPS, and level of care, are documented in the notes and discussed during IDG meetings. This assists the IDG in care planning and meeting the patient’s/caregiver’s goals.
HOW WOULD YOU REPORT AN INCIDENT (UNUSUAL OCCURRENCE) INVOLVING A PATIENT?
• The HPCG Nurse contacts the patient’s physician immediately.
• The incident is documented on an incident report form and turned in within one business day.
• Reports are given to the HPCG Vice President of Quality and Compliance within 48 hours.
HOW WOULD YOU REPORT AN INCIDENT OR ACCIDENT INVOLVING YOURSELF?
• The incident is verbally reported to a supervisor immediately. (If on weekends or holidays –clinical resource.)
• The incident is documented on an incident report form and turned it in within one business day.
• The HPCG manager contacts HPCG’s Human Resources immediately and not later than 48 hours following the incident.
IF AN EMPLOYEE HAS A GRIEVANCE, WHAT DO THEY DO?
• Any employee may submit a grievance in response to disciplinary/corrective actions, job evaluations, and promotional decisions.
• Step 1: the employee should go to the direct supervisor to attempt to resolve the concern (Step 1 may be skipped if the concern is directly with the supervisor, the employee does not feel the supervisor can be impartial, and the employee feels intimidated or threatened by addressing the supervisor).
• Step 2: make a written appeal and submit this to the VP of HR, Clay Smith, within 10 days of the completion of step 1.
• Step 3: If satisfactory resolution still cannot be made, the employee may make a written appeal (within 10 days) of the same grievance, to our President/CEO, Pat Soenksen.
• Any employee may submit a complaint if they feel their rights have been violated by a staff member, patient, family, or community contact. The employee writes a letter to the VP of HR including the
WHAT EDUCATION DO YOU PROVIDE TO A PATIENT REGARDING INFECTION CONTROL?
• Hospice admission materials include written information for patients, family and other caregivers on the prevention of infection and the use of standard precautions.
• As appropriate, during the course of providing care, hospice staff will provide additional instruction.
• Staff document patient and caregiver education, the response to teaching, and the patient/caregiver understanding and comprehension in the medical record.
WHAT TYPE OF TRAINING HAVE YOU RECEIVED IN REGARDS TO WORKPLACE AND HOME SAFETY?
• Safety training is provided through initial orientation and annually. Topics include:
o body mechanics
o electrical safety
o fire safety and evacuation plan to include illumination of exit routes
o common environmental safety hazards (i.e. icy walkways, blocked exits, etc.)
o basic home safety measures
o workplace security including alarm systems and office equipment safety
o personal safety technique
o emergency communication system (Dr. Sharp)
o use of restraints, if applicable
• In addition, any safety concerns can be reported to our safety committee or put in the suggestion box for review.
WHAT TYPE OF SAFETY TRAINING DO YOU PROVIDE THE PATIENT AND FAMILY?
• Patients/caregivers receive a Patient Care Notebook which contains information on general safety, lifting and moving techniques, fire safety; electrical safety; bathroom safety; medical equipment safety, oxygen use safety, safety and compliance related to patient’s medication, hazardous chemicals/materials in the home, and disaster planning.
• As appropriate, hospice staff provide additional safety instruction during the course of care.
• Staff document patient and caregiver education, the response to teaching, and the patient/caregiver understanding and comprehension in the medical record.
TELL US ABOUT YOUR DISASTER PLAN.
• A disaster is any emergency situation, internal or external, which will result in the interruption of patient services.
• Staff teaching is done in orientation and annually. Patients/caregivers are provided education (information is in the Patient Notebook) so they are prepared in a disaster.
• Patients are assigned a patient priority level of care when they are admitted to HPCG and then reassessed as needed based on their ability to respond to the disaster. Level one patients are in the greatest need category and are the first HPCG staff would contact.
• Pat Soenksen, President/CEO, activates the disaster plan. She contacts members of the HPCG leadership team who contact staff. Staff are to report to work as instructed by their supervisor, or prepare to work from home or an alternate location if instructed. Beacon Place operates 24/7.
HOW DO YOU ASSESS AND MANAGE PAIN?
• Pain is rated on a scale from 1-10.
• Pain is assessed on the initial assessment and every visit made to the patient.
• Document pain assessment and interventions on every visit or pain-related phone call.
• Pain can be physical, emotional, spiritual, or psychological.
• All disciplines are expected to report complaints of pain to the IDG.
• Patients have the right to decide how to manage their pain with respect for their decision.
• Patients have the right to education about their pain and option for its management.
• Patients can decide what level of pain is acceptable to them.
WHAT PROCESS WOULD YOU FOLLOW IF A MEDICATION ERROR OCCURRED?
• All medication errors are documented on an Incident Report and reported immediately to the patient’s attending physician.
• The patient’s response to the medication error is evaluated to determine potential negative effects and reported to the physician. The hospice nurse will initiate an emergency response if necessary and as instructed by the physician.
HOW DO YOU DISPOSE OF CONTROLLED DRUGS WHEN THEY ARE NO LONGER NEEDED BY THE PATIENT?
• Caregivers will be instructed to dispose of all medications via the General Guidelines for Medication Disposal teaching sheet (in the Patient Care Notebook).
• The hospice nurses or other hospice personnel are not required to witness medication disposal. The nurse documents that she has instructed the caregiver to dispose of the drugs after the patient dies or if medication is no longer part of the plan of care.
• If the caregiver requests the Hospice Nurse to dispose of the meds, caregiver needs to witness this and sign off on a medication disposal form.
• Long Term Care facilities dispose of medications per their policy.
WHAT PROCEDURES DO YOU FOLLOW WHEN MAINTAINING EQUIPMENT USED IN THE PROVISION OF CARE?
Reusable equipment, such as blood pressure cuffs, is cleaned using alcohol, antiseptic spray and/or soap and water as appropriate.
• HPCG maintains contracts with accredited DME providers for the provision of safe and effective DME for patients. All DME with the exception of glucometers and sphygmomanometers is stored and will be delivered, setup, maintained, cleaned and picked up by them.
• In Long Term Care, skilled nursing facilities provide DME according to written agreements.
• The DME provider assures that emergency maintenance, replacement and backup of DME is available 24 hours a day, seven days a week.
• HPCG routinely inspects other