Home Care Policies

Our job is to help health care organizations, such as yours, achieve accreditation from The Joint Commission (formerly JCAHO). We have never had a client fail to get their full accreditation in the 28 years that we have been in business.

Your company’s prestige in the health care community will soar, not to mention your bottom line if you are awarded full accreditation and The Joint Commission’s “Gold Seal of Approval”. This gives deemed status for Medicare and Medicaid reimbursement, plus eligibility for reimbursement from third party payers. Could it be that those who are getting the lion’s share of the Home Care Providers’ business are accredited by The Joint Commission? That would be the case. Do you want more business for 2009 and the years beyond?

The Joint Commission’s accreditation will allow you to enjoy a competitive edge. Fast-Tracking your accreditation is our specialty. Call us for more details and a cost proposal.

John Dow, Director of Marketing, 800-950-4410
Healthcare Quality Improvement Resources, Inc

If you are in need of any of these policies and procedures, please send E-mail. Be sure to include the name and # of the policies that you desire. The first 5 policies are free. Additional policies will be made available for a fee. A CD of all of the policies will be available in the near future on our website. If you are interested in the CD, please contact us by E-mail so that we have an idea of the approximate number of CD’s needed for possible purchase.

2005 HC-POLICY JCAHO REF

POLICY NAME	SECTION & POLICY #	POLICY CROSS REFERENCE #		JCAHO STANDARD(S)
*RIGHTS & ETHICS*	*SECTION I*
*Patient Information Packet*	*1001*			*RI.2.60* *RI.2.20*
*Patient Rights & Responsibilities* *Procedural Aspects*	*1002*			*HR.2.10* *RI.2.70* *RI.2.10* *RI.2.30*
Home Care Patient Rights & Responsibilities	*1003*			*HR.2.10* *RI.2.30* *RI.2.10* *RI.2.70*
*HIPPA Regulations & Patient Information*	*1003 A*			*RI.2.20* *RI.2.30* *RI.2.10*
*HIPPA*	*1003 B*			*RI.2.30* *HR.2.10*
*Advance Directive Policy*	*1004*			*RI.2.20-ER.2-3* *RI.2.80-ER.1-9*
*Patient Information on Advance Directives*	*1004 A*			*RI.2.20* *RI.2.80*
*Durable Power of Attorney*	*1005*			*RI.2.70*
*Declaration*	*1006*			*RI.2.30*
*Patient Informed Decision Making*	*1007*	*1003*		*RI.2.30*
*Consents*	*1008*
*Patient Consents & Authorizations Form*	*1009*	*10007*
*Clinical Documentation*	*1010*	*10007*
*Destruction and Disposal of Protected Health Information Media*	*1010 A*
*Photographing or Videotaping of Clients*	*1011*			*RI.2.50*
Consent to Photograph/Video Form	*1011 A*	*10007*		*RI.2.50* *IM.6.20*
*Emergency Intervention*	*1012*
*Do Not Resuscitate/Do Not Intubate*	*1013*
*DNR/DNA Request Form*	*1014*	*10007*
*Withholding/Withdrawing Life Support*	*1015*			*RI.2.10* *RI.2.30* *RI.2.70*
*Patient Complaints*	*1016*			*RI.2.120*
*About the Right to Express Grievances*	*1017*			*RI.2.120*
*Patient Complaint Form*	*1018*			*RI.2.120*
*Confidentiality of Information*	*1019*	*10003*		*IM.2.10* *IM.6.10* *RI.2.130*
*Confidentiality Statement Form*	*1020*	*10003 A*		*IM.1.20*
*Sensory Impaired Patients*	*1021*			*RI.2.100*
*Non-English Speaking Patients-Cultural Considerations*	*1022*			*RI.2.100*
*Code of Ethics*	*1023*			*RI.1.10*
*Ethics Committee*	*1024*			*RI.1.10*
*Conflict Resolution*	*1025*			*RI.2.30*
*Acceptance of Patients*	*1026*
*Conflict of Interest*	*1027*			*RI.1.10* *RI.1.20*
*Conflict of Interest Disclosure Statement*	*1028*			*RI.1.20*
*Ethical Practices-New Life*	*1029*			*RI.1.10*
*Integrity Of Clinical Decision-Making*	*1030*			*RI.1.30* *RI.1.40*
*Protecting Patients from Abuse*	*1031*			*RI.2.150*
*Protective Services*	*1032*			*RI.2.170*

ASSESSMENT OF PATIENTS	SECTION II
*Intake Services*	*2001*			*PC.2.20*
*Admission Record Form*	*2002*	*10007*		*PC.2.20* *IM.6.10*
*Intake/Referral Form*	*2003*	*10007*		*PC.2.20* *IM.6.10*
*Orders for Service Form*	*2004*	*10007*		*IM.6.10*
*Patient Assessment Functions & Qualifications*	*2005*			*PC.2.20* *PC.2.120*
*Assessment*	*2006*				*PC.2.20* *PC.2.120* *PC.8.10*
*Nursing Assessment/Medical History Form*	*2007*	*10007*			*PC.2.20* *PC.2.120* *PC.8.10 (Pain)*
*Nursing Progress Report Form*	*2008*	*10007*			*IM.6.10* *PC.8.10 (Pain)*
*Nursing Diagnosis Form*	*2009*	*10007*			*IM.6.10*
*Proposed Plan of Treatment Form*	*2010*	*10007*			*PC.4.10*
*Patient Abuse*	*2011*				*PC.3.10*
*Patient Abuse-Child*	*2012*				*PC.3.10*
*Suspected Adult or Child Abuse Report Form*	*2013*	*10007*			*PC.3.10* *IM.6.10*
*Reassessment*	*2014*				*PC.2.150*

*CARE, TREATMENT & SERVICES*	*SECTION III*
*On-Call Coverage*	*3001*
*Care Planning*	*3002*				*PC.4.10*
*Patient Identifiers*	*3002 A*				*PC.5.10*
*Home Health Certification and Plan of Treatment Form*	*3003*	*10007*			*IM.6.10* *MM.1.10* *PC.2.150* *PC.4.10*
*Skilled Nursing Plan of Care Form*	*3004*		*10007*		*IM.6.10* *MM.1.10* *PC.4.10*
*Personal Care Instructions*	*3005*				*IM.6.10*
*Personal Care Instructions Form*	*3006*		*10007*		*IM.6.10*
*Confirmation of Physician Telephone/Verbal Orders Policy*	*3007*		*10007*		*IM.6.10*
*Confirmation of Physician Telephone/Verbal Orders Form*	*3008*		*10007*		*IM.6.10*
*Guidelines for Medical Management &b Physician’s Responsibilities*	*3009*
*Pain Management*	*3010*				*RI.2.160* *PC.8.10*
*Pain Management Assessment Tools*	*3010 A*		*10007*		*PC.8.10*
*Care of Terminally Patient*	*3011*				*PC.8.70*
*Home Antimicrobial First Dose & Management of Anaphylaxis*	*3012*				*MM.5.10* *MM.6.10*
*Use of Investigational Treatments/Trials*	*3013*				*MM.7.40*
*Adverse Responses to Medication*	*3014*				*MM.5.10* *MM.6.20*
*Possible Drug Reaction Sheet*	*3015*				*MM.5.10* *MM.6.20*
*Medication Profile “A” Form*	*3016*		*10007*		*IM.6.10* *MM.1.10*
*Medication Profile “B” Form*	*3016 A*		*10007*		*IM.6.10* *MM.1.10*
*Controlled Drug Disposal*	*3017*
*Medication Errors*	*3018*				*MM.6.10*
*Nutritional Assessment*	*3019*				*PC.2.20 EP # 5*
*Nutrition Assessment Form*	*3020*		*10007*		*PC.2.20 EP # 5*
*Waived Testing*	*3021* *6012*				*PC.16.10* *PC.16.20* *PC.16.30* *PC.16.40* *PC.16.50* *PC.16.60*
*Discharge/Transfer/Referral of Patients*	*3022*				*PC.5.60* *PC.15.10* *PC.15.20* *PC.15.30*
*EDUCATION*	*SECTION IV*
*Multidisciplinary Patient Education*	*4001*				*PC.6.10* *PC.6.20*
*Patient Education*	*4002*				*LD.3.120* *PC.6.10* *PC.6.30*
*Pain Management Education*	*4002 A*				*RI.2.160* *LD.3.120* *PC.6.10* *IM.6.10* *PC.6.30* *PC.8.10*
*Patient/Family Education Form*	*4003*		*10007*		*LD.3.120* *IM.6.10* *PC.6.30*
*Use of Restraint Devices*	*4004*				*PC.4.10*
*Emergency Preparedness*	*4005*
*Emergency Checklist*	*4006*
*Home Safety*	*4007*
*Waste Disposal*	*4008*
*Infection Control-Patient/Family Education*	*4009*				*LD.3.120* *IC STANDARDS*
*CONTINUUM OF CARE*	*SECTION V*
*Coordination of Services*	*5001*
*Monthly Medical Update Form*	*5002*		*10007*
*Discharge/Transfer of Patients*	*5003*
*Criteria for Discharge-Discharge Summary*	*5004*
*Discharge Summary-Final Note*	*5005*
*Skilled Nursing Discharge Summary Form*	*5006*		*10007*
*Discontinuance of Service Against Medical Advice Form*	*5007*		*10007*
*Physician Discharge Summary Form*	*5008*		*10007*
*IMPROVING ORGANIZATIONAL PERFORMANCE*	*SECTION VI*
*Performance Improvement Plan*	*6001*				*PI.1.10* *LD.4.10* *LD.4.50* *LD.4.60*
*Performance Measurement*	*6002*				*LD.4.10* *LD.4.50* *LD.4.60*
*Healthcare Topic Methods*	*6003*
*Special Performance Improvement Studies*	*6004*
*Sentinel Events*	*6005*				*PI.2.30* *LD.4.40* *PI.3.10*
*Framework for a Root Cause Analysis*	*6006*				*PI.2.30* *LD.4.60*
*Root Cause Analysis Flowchart*	*6007*				*LD.4.60* *PI.2.30*
*Fiscal Planning*	*6008*		*7007*		*LD.4.60*
*Performance Measures*	*6009*
*Trending Sheet*	*6010*
*Medical Record Review Sheet*	*6011*
*Glucose Monitor Operator Proficiency Record*	*6012*				*PC.16.10 - PC.16.60*
*Home Health Service Questionnaire*	*6013*
*Home Health Medical Records Audit Form*	*6014*				IM

LEADERSHIP	*SECTION VII*
*Mission & Vision Statement*	*7001*				*LD.3.10* *LD.3.20*
*Goals & Objectives*	*7001 A*				*LD.2.50* *LD.3.10*
*Philosophy*	*7002*				*LD.3.10*
*Provision of Services Plan*	*7002 A*				*LD.3.20* *LD.3.10* *LD.1.20* *LD.3.50*
*Strategic Plan*	*7002 B*				*LD.1.20*
*Scope of Services*	*7002 C*				*LD.1.20*
*Annual Agency Evaluation*	*7003*				*LD.1.20*
*Annual Report to the Board*	*7003 A*				*LD.4.40*
*Non-Discrimination Policy*	*7004*
*Agency Supervision*	*7005*				*LD.1.10*
*Organization Chart*	*7006*				*LD.1.10*
*Annual Operating Budget*	*7007*				*LD.2.50*
*Capital Expenditure Plan*	*7008*				*LD.2.50*
*Patient Safety Program*	*7009*				*LD.4.40* *LD.4.60* *LD.4.70*
*MANAGEMENT OF THE ENVIRONMENT OF CARE*	*SECTION VIII*
*Statement of Policy*	*8001*
*Letter of Appointment*	*8002*
*Duties of Safety Director*	*8003*
*Duties of Department Manager in Safety Program*	*8004*
*Safety-Hazard Surveillance Program*	*8005*
*Home Hazard Analysis Checklist Form*	*8006*
*Initial Home Safety Evaluation and Instruction Form*	*8007*
*Safety Precautions When Using Oxygen*	*8008*
*Safety Education*	*8009*
*Safety and Security Training for Home Health Personnel*	*8010*
*Employee Safety Information Form*	*8011*				*HR.2.20*
*Safety When Moving Objects*	*8012*
*Security Plan*	*8013*
*Security Education*	*8014*
*Hazardous Materials and Waste Plan*	*8015*
*Infectious Waste Management Plan*	*8016*
*Antineoplastic Waste Management*	*8017*
*Chemotherapy Liquid Spills*	*8018*
*Fire Safety Plan*	*8019*
*Fire Drill Report Form*	*8020*
*Emergency Preparedness Plan*	*8021*
*Incident Reports*	*8022*				*HR.2.20* *HR.2.30*
*Incident Report Form*	*8023*				*HR.2.20* *HR.2.30*
*Utility Systems Management Plan*	*8024*
*Durable Medical Equipment*	*8025*
*Medical Device Problem Recall*	*8026*
*Safe Medical Devices*	*8027*

*MANAGEMENT OF HUMAN RESOURCES*	*SECTION IX*
*Staff Recruitment-Retention-education*	*9001*				*LD.2.10*
*Applications for Employment*	*9002*
*Attendance and Tardiness*	*9003*
*Change in Personal Information*	*9004*
*Classification of Employees*	*9005*
*Current Licensure/Certification and Registration*	*9006*				*HR.1.20*
*Competence Assessment*	*9006 A*				*HR.3.10*
*Performance Evaluations*	*9007*				*HR.3.20*
*Summary Report to Board re: Performance Evaluations*	*9007 A*				*LD.2.10*
*Equal Opportunity Employment*	*9008*
*Orientation-New Employment*	*9009*				*HR.2.10* *HR.2.20* *LD.3.60*
*Position Description/Performance Evaluation-Administrator*	*9010*				*LD.2.20*
*Position Description/Performance Evaluation-Director of Patient Care Services*	*9011*				*LD.2.20*
*Position Description/Performance Evaluation-Intake Nurse*	*9012*
*Position Description/Performance Evaluation-Clinical Supervisor*	*9013*
*Position Description/Performance Evaluation-Case Manager*	*9014*
*Position Description/* *Performance Evaluation-Home Health Aide*	*9016*
*Employment of Certified Home Health Aides/Nursing Assistants*	*9017*
*Certified Home Health Aide Supervision*	*9018*
*Supervision Checklist*	*9019*
*Certified Home Health Aide Competency Evaluation Program*	*9020*				*HR.2.10*
*Certified Home Health Aide Skills Checklist*	*9021*				*HR.2.10*
*Certified Home Health Aide Skills Checklist Form*	*9022*				*HR.2.10*
*Monitoring of CHHA & CNA* *In-service Hours*	*9023*
*Orientation-Certified Home Health Aide Services*	*9024*				*HR.2.10*
*Employee Education Programs*	*9025*		*3011*		*HR.2.30*
*Education re: Needs of Dying Patients*	*9025 A*				*PC.8.70*
*Education re: Pain Management*	*9025 B*				*RI.2.160*
*Continuing Education/In-service Attendance Record Form*	*9026*				*HR.2.30*
*Medical/Surgical Staff Skills Checklist Form*	*9027*
*Ethical Dilemmas in Patient Car-Staff Rights*	*9028*				*RI.1.10* *HR.*
*Disciplinary Action*	*9029*				*HR.3.10*
*Dress Regulations*	*9030*
*Employee Assistance Program*	*9031*
*Employee Communications*	*9032*
*Employee Photo Identification*	*9033*
*Employee Requests for Time off*	*9034*
*Employment of Foreign Applicants*	*9035*
*Employment of the Disabled*	*9036*
*Employment of Relatives*	*9037*
*Exit Interviews*	*9038*
*Exit Interview Form*	*9039*
*Garnishment of Wages*	*9040*
*Holiday Policy*	*9041*
*Payroll Distribution/Time Verification*	*9042*
*Personnel Files: Contents and Originations*	*9043*				*IM.2.10*
*Position Control*	*9044*
*Personnel Requisition Form*	*9045*
*Re-Employment*	*9046*
*Reference Checking/Criminal Background Checks*	*9047*				*HR.1.20*
*Harassment, Sexual (Either Sex)*	*9048*
*Sick Leave Policy*	*9049*
*Termination of Employment*	*9050*
*Vacation Policy*	*9051*
*Workers’ Compensation*	*9052*

*MANAGEMENT OF INFORMATION*	*SECTION X*
*Information Management Plan*	*10001*				*IM.1.10* *IM.1.20* *IM.3.10* *LD.1.20* *LD.2.10*
*Patient Access to Medical Records*	*10002*
*Confidentiality of Information*	*10003*		*1020* *1019*		*IM.2.10* *IM.6.10*
*Confidentiality Statement*	*10003 A*		*1020*		*IM.2.10*
*Approved & Unapproved Symbols and Abbreviations*	*10004*				*IM.2.30*
*Disaster Recovery Plan for Information Systems*	*10005*				IM
*Medical Record Entries & Information*	*10006*				*IM.6.20* *IM.6.10*
*Medical Record Approved Forms*	*10007*				*IM.6.10*
*Medical Record Review*	*10008*				*IM.6.10*

LEADERSHIP