04/09/1975
626
0063/
MINUTES OF BOARD OF HEALTH MEETING - April 9, 1975
Present: Dr. James Smith, Chairman, Mr. George L'hadwick, Mr. Joe Reeves,
Mr. Bruce Freeman, Mr. W. K. Whitmire, Mrs. Vivian Wright and
County Manager Dan Eller and County Attorney James Fox
Absent: Dr. F. Reynolds, Dr. James TidIer and Mr. R. E. Carter
Minutes of the March meeting were approved as presented.
Home Health A2enCy Policies: The proposed Home Health Agency Policies were
amended to include: "As the members rotate off the Advisory Council, re-
placements are to be appointed by Dr. Knox and his Administrative Staff,
with approval of the Board of Health." With this amendment, the policies
were approved. Mr. Whitmire made the motion, seconded by Mrs. Wright.
The motion carried unanimously. (Copy of policies attached to permanent
minutes).
Tentative Bud2et for 1975-76: After much discussion of the budget as
presented by the Health Director, Mr. Chadwick made a motion that the
budget be adopted. There was no second to the motion. Mr. Whitmire made
a substitute motion that the budget be adopted as presented, but that this
board request the County Commissioners to scrutinize the 5% cost of living
increase and step increases. The substitute motion was seconded by Mr.
Chadwick and carried. Mrs. Wright abstained from voting but asked that it
be recorded in the minutes that she appreciates the recommendation from
this board to the County Commissioners.
Capital Outlay - Equipment: Dr. Knox requested permission to use approxi-
mately $2,500 of the money from the capital outlay-equipment account to
_~ purchase a new centrifuge for the laboratory and an additional filing
cabinet for the clinic area. Motion was made by Mr. Reeves, seconded by
Mr. Chadwick that we ask the County Commissioners for permission to purchase
these items. Motion carried unanimously.
V. D. Control: Mr. Bobby Waters, Public Health Investigator on the staff of
the Health Department presented a very interesting program on veneral diseases,
giving statistics with graphs, etc. Members present commended Mr. Waters for the
good job done and by common consent asked that arrangements be made for Mr.
Waters to present this program to the Board of Education since the highest
age group involvement seems to be high school students. It was also sug-
gested that we should work with UNC-W and Cape Fear Tech. Dr. Knox will
contact Dr. Heyward Bellamy, Superintendent of Schools, to arrange for Mr.
Waters,to speak to the Board of Education as a beginning point.
There being no further business, the meeting was adjourned.
Respectfully submitted,
Approved: May 7, 1975
/J{~ 73. ;fJ~
~~k~
NL I-LiilO1lE:? COUNTY H}1,LTH DEPilRT:IENT
IILiIHGTON t NOl1TH CAUOLINA
POLIG:::~;;S GOvJ.;;nuoo HOlle; H&,LTH SG;1VIC"S
i.JURSING S;~TION
of the
IlULTH DEPARTl mIT
:?evised: September, 1971,
~ 7Yz~ 7
-4t '7 ~-
POLICES FOR HOt;E m,ALTH AGENCY
NEil I-hNOVm COUNTY 1l&\LTH D2PA;'1T::.<:NT
'lIliiINGTOH. NORTH CA:tOLIlIA
SEPT.l:idm, 1974
405.1221
Standard a: Home health service is one component of the overall public health
nursing program of the Neu Hanover County Health Department. The purpose of this
service is to. under orders of a physician or dentist licensed to practice in
North Carolina. provide on an intermittent basis certain skilled rmrsir18.
physical therapy and home health aide needs, Hhich can be safely met in the home
setting. to any homebound patient uithout regard to age. sex, creed, national
origin or ability to pay.
standard b: The governing body of this ,\gency is the local Board of Health
~:hose members are:
Dr. James Smith, Chairman
i'urchison BuildinG
Dr. James Tidler
1919 South 16th street
I~. Bruce R. Freeman
llt. 2, Box 21.5 A
dr. ij. ~{.:hi tmire
P. O. Box 2007
Ix. R. E. Carter
2001 Princess Place Drive
dr. Georse Chadllick
32051riehtsville Averme
l,r. J. il.. Reaves
2502 South 17th street
Dr. Frank Reynolds
1613 Jock street
tJrs. Vivian S./right
2$()9 Hel/lurk Avenue
This board assumes full legal authority and responsibility for the operation of
the Agency. It has adopted and periodically reviells these policies and oversees
the management and fiscal affairs of the j,gency. It has appointed the health
director as the qualified administrator of the program.
standard c: As administrator the Ilealth Director directs the Agency's program;
maintains liason among the Board of Health, the J~dvisory Council and the staff;
employs qu:.:.lified nersonnel and ensures adequate in-service education and
evaluations; oversees all other aspects of the program.
In the absence of the health director he has designated the rmrsing supervisor
or director to act as administrator.
Standard d: The services of this Home Health Agency are under the supervision
and direction of the health director, the rmrsing director and or supervisors,
one of \-Thom is available at all times durinG operating hours.
- < -
'ltandard e: The l"Ules and, re~lations in the ~rsonnel ?olicies. !.2E. ]Ecal
Goverrunent E1,lploymen! ~.J.e.c~ i~ !d!! 3,tat':. ~rsonn!l.~ ;~ ~rill be follo11ed
in em;Jloyill(; staff t establis..'1ing c1.:.ssification, setting salary. hours of
lTorlet vacation and sick leave. III enr;>loyees ,rill have a s'dn test and/or
Chest X-~t serology c.nd other appropriate tests as indicated anrmally to
determine freeLoiU from co,mllunicable disease. Il.ej'JOrts of all such tests shall
be ',e;Jt in the confidential ;Jersonnel .rile of each elilployee.
J.:uch ne'.! staff member is .:;iven .m orientation cOlllnensurata to eX!1ibited needs.
Evaluation of the \!or~, load anri performaTlce of each person ~rill be made in
Ilriting alUl\ld.lly (Ol' as necessaL"J) and leept in the individual's confidential
personnel rile, alol1[; ,rith the job description of the position Clhicb the
person fills. The qualifications and licensure of all staff are com;xl.led and
'.e,t up to date and retained in a separate file folder.
Professional liability insuranee shall be carried on all professional stafr t the
a=l IJreilliu"l beil1[; su;Jportec' 'r1y the county.
In-service education is planned ~l offered to leeep staff abreast of ~1
prozrams and developments in the health field in :.;eneral as ,'!ell as
fulfilline e::pressed needs of Gl'OUps arrl/or individuals.
Standard f: F\Jysical thera;JY services lrill be IJrovide<l on an hourl;v basis
under contract ~rith a Licensed ~ysical l~erapist. Part time nursinJ
ssrvices to [.I.::le )atients lrill be furnished on a ;:Jer visit basis by a :nale
Home Heulth Aicee .::nd a mule Licensed ?r.::ctical llurse as 1011[; as they are
dvailable.. These contracts are maintained in a separate file folder.
'3tancJ.al"C 5: Coordination of ;Jatient services is rmntained throu@1 inter-
chan3e of information, re,'JOrting and recordill(; by all ;Jersonnel involved I-rith
the lJatients' care. Tllis is cone by tele)hone, by personal contact and/or 'r1y
a ..titten &Ul,ll,l<lry bein,3 sent to the physician at least ever.! 60 cleys, a cow
of ~!hich is incor,lOrated in the :>atinets' record.
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405.1222
The Advisory Council of this Home Health >'gency consists of the following
representation: one lic<;:nsed physician, three reeistered professional nurses,
one physical therapist, one pharmacist, one social \~orker and t\~O interested
citizens. The health director. nursing director and nursing supervisors are
permanent ex-officio members of the Council.
The chairman of the Council is elected by the members. The term of all
members is three years. A member may succeed himself for a second term
but should go off the Council for at least one year after each tll0
consecutive terms of service before being considered for re-appointment.
Appointment ta the Council shall be made by the Health Director and his
administrative staff and approved by the Board of Health.
The functions of the Advisory Council shall be to assist the "gency \1ith:
1. Program development
2. Reviet1ing these policies periodically and revising them as
necessary.
3. Program evaluation
4. Public relations
The council shall meet quart:.erly. Special meetin3s may be called at the
discretion of the chairman. Dated minutes of all meetings shall be kept.
on file.
405.1223
Home Health Services provided to homebound patients on an intermittent
basis are skilled nursing physical therapy and home health aide.
A Homebound patient is one who i.s essentially confined to his place of
residence due to an illness or injury and, if ambulatory or otheI'l'lise
mobile, is unable to be absent from his residence except for periods of
relatively short duration, e.g., fer visit to doctor's office. to barber
shop, for a short ~lalk prescribed as therapeutic exercise.
Intermittent basis means that service ~rill require a fe~' hours a day, several
times a l'Ieek. Some patients may require longer service on one day than on
other days and such adjustments are to be encouraged. Occasionally, because
of special circumstances occurring during a brief period, service for a full
day may need to be provided.
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I. Admission Policies and i'jedical SU1)0rvisioi1
--- ---- - - -----
,.. The patient shall be u11<1er the su,1ervision of a physician ,Iho provides
and or coorclinates orders for his care.
ll. The res')onsibility for seeJd113 medical care belongs :>rimariJ.;r to the
i'al:1iJ.;r. :-!ealth Department personnel, uhile in the home, do not summon
D. physician except in the case of a real emersency.
c. ,.n alternate physician ma;)' be named by the family to ;Jrovide care :Ihen
the reGUlar :;X1Ysician is not avdilable.
-). If the i'arson ,~ivin7> care finds th&.-c._ the patient has chan3ed medical
supervision, she may not S"ive fU1'ther C2re until neH !!I'itten orders
have been obtaine~.
:~. If, on first visit, the nurse finds that the ')/itient is not under
meclical SU;Jervision, she should explain to :'Jatisnt and family that
raer1ical su,10rvision is essential for continued service, and that she
crill return U"lOn request 0-' patient's olJ.c'sician.
II. z.~.2! !r.~~tl:.1..ent.
I. Rec,uest for s"'''vice and 01,(1ers for care lrill be acce'Jt,ed from
:>l1ysicLms el11L. "~n+.ists licensed to ;:>ractice in the state of
..lorth '~LrolinOi and IJro,,+,icinr\ ,.rithin a reasona.1Jle radius of the
Iiealth Departr'lent.
ll. [,adicul orders uill be acce;Jted f,'om p.'1ysicians in hospitals
and nursin:> homes uhich Lre beyond r",",sonable radius of the
c.~:;ency. (3uch as Veterans "c!ministration H03pitals and out-
patient clinics at Duke and Iiemorial lIosj11tal in Chapel lIill).
Ii', hOHaver, the referrinG :mysician is not responsible for the
;Jatiant's l:laclical care at home, the local family ph~'dciun
should. be contacted for a?proval of orders "cfore, or j romediately,
follman,; the fir,,+. visit. Ii' no local physiciau h~s been
selected by the family, this shou.ld be done befora a ".."one!
visit is made. ,rhen ;z>s"ible, the ;>Q.t.ient or the fumil::l tAll be
res"9Qnsi.ble for securin.:; or..-lers froin the physician.
c. 'lritten Ol''(lers for patient eare era to be procured from the }h'lld.cLm
and sif_~ne(1. b~r him. ~'1.. rec;istered. nurne may accept verbal oroe:6 'l.'rom
a phyn;_ci~n in some instances, Ol1.t t.hese are to hq fo1.1o''I(,;;u. \'nt.h11.
three days 1~' l~ltten orders an0 before the service is repeated.
'1. Orders for nurcoti"" and dangerous dr\J.[;s trust be received in ~!I'iting
and signerl by the physic'i~n 'J~Ti'0rv~ beinr; d.(JJ:d.nis-tercd.
C. Ver':>al or('.er5 cannot be accarrr.ed from the patient or family.
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F. Uhen obtaining orders from the physicians. specific information shall
be requested l1ith regard to:
Diagnosis and treatment
[iedications and dressings
Dosage and interval
Nutritional requirements
;rethod preferred for administering medication or treatment
Frequency of treatment
Precautions, if any
Prognosis
G. All orders for patient care must be reviel1ed by the physician and
reneued in uriting every tllO months. R.ene~lal forms trill be provided
for the physician by the aGency at the appropriate time.
III. Request!2r Service
A. '!be agency reserves the right to make discretionary judgment if and
llhen adequate staff is not available. aec;uest from physician for
service trill be ans',rered I'lith a minimum of delay. Requests received
before 9:00 a.m. lrill be made the same day uhen possible. Rec,uests
received later than 9:00 a.m. trill be ansllered the follotring day, or
on the nurse's first visit to the area. Nell orders for treatment lrill
not be initiated betlleen Friday noon and Iionday 8:00 a.m., nor on
holidays.
B. The nursinG staff \rill call the office betl'leen 12:00 and 2:00 p.m.
to receive calls that need more immediate attention.
C. Frequency and duration of visits trill be determined according to
medical orders, needs of patient and availability of staff.
D. forking hours of the nursing staff lrill conform to the regular agency
schedule - i-londay through Friday.
1. Nursing service on Saturday, Sunday, and holidays lrill be
extremely limited. All orders for medication and treatments
trill be scheduled for regular l'yorking days '-mENEVER roSSIBill.
E. The nursing staff ,.rill receive compensatory time for \'Ieek-end and
holiday service. They trill be expected to take this time the
follolring ueek.
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l1'. A s;Jecific hour for visits cannot be Jivenj atteln,?ts !Iill be made to
foll~'1 a practicable schedule for patient and staff.
IV.'tesponsibilitz
f,. Patient lJi.ll be expected to select a ph~rsician and to remain under
medical supervision.
0. Patients I.rill be expected to secure all medications and dressi~"ls and
as milch equipment as is feasible.
c. .\ member of the householC. must be 'rilling and able to assume responsi-
bility for care of the patient bettTeen nursing visits.
J. The patient, c.rhen possible, or a household member lrill be expected to
learn to assume responsibility for procedures "Ihich, in the opinion of
the physician, can be safely t;;.ue;ht the individual.
v. payment.J2!. ~ Health Services
". Philosophy of fee collection
1. The family's financial status doos not determi.ne the pat.~nt' s
need for home health services.
2. The charGe for home visits ~Ji.ll be based on a cost established
by an annual cost report.
3. !hen families aloe unable to ,)Uy full fee and are ineligible for
contract services \'lith insurance Cor.lpanies, the fee is adjusted in
accordance ,dth the (juir:e for'urses (Fee Scale) and/or abilit~' of
the fami~ to ;x.y. Tho fee uill be l'e-evaluated annually or sooner,
if the fa,rl.J.;f situ&tion chan~es.
"
t....
iethod of fee collection: The person ma!dll3 the visit
every effort to collect fees at the time of the visit.
unable to do this, the patient may be billed.
lrill ma'ce
If she is
_r. Jischarge ~l:i.cies
''lervice trill be terIilinatec1. Nhan on consultation lrith physician, nurse,
supenisor, physical thera7i.st, and other professional ;>ersonnel
involved, it is cletermined that the:
1. Patient has reached his md;;it:n.Jm benefit from services.
2. Patient's condition halO sl.,mili.7.ad ",nd other suitable arrall3efflnts
can be made.
3. Patients alli'./or fD.l'rl.ly have ?I'oven not to M acc"r'''.i.nr: or cooperatinG
:dth '11an for c<lI'e.
h. Sldllcd care is no 101l3er necessary.
- 7 -
5. Patient's condition has deteriorated so that intermittent care
is no longer sufficient and other arrangements should be made.
6. Physical environment is no longer suitable for patient's care.
7. other demands for agency service have higher priority based on
medical and nursing needs and resources of agency are inadeCluate
to continue this care.
VII. Nursillf, ~
a.
( 1)
( 2)
( 3)
( 4)
( 5)
( 6)
( 7)
( S)
( 9)
(10)
(11)
(12)
(13 )
(14)
(15)
b.
Examples of nursing care uhich the agency ,lill provide in the
home are:
subcutaneous and intramuscular injections (excluding drugs
for treatment of allergies, immunizing, and first injections
of penicillin).
catherization of female patients (except first catheterization
tlhen there is a history of obstruction or tumor).
catherization of, or enema for male patients (as long as
services of a male nurse or aide are available).
irrigation and care of retention catheter
dressings
colostomy care
enema
douche
bed or tub bath
sldn care
feedinG
positionill[;
simple exercises
care of tracheoto~J
blood pressure
3xamp1es of nursilll> care ~lhich the agency does !!2i provide
in the home:
( 1) giving blood transfusions
( 2) gi vill[; intravenous fluids
( 3) Giving fluids by hypodermoclysis
( 4) removill3 suture s
(5) insertion and removal of outer tracheotomy tube
( 6) first injection of penicillin
(7) imriRlnizing agents and drugs for the treatment of allergies.
n
v
( 3) visits to ;JOtentially violent ~tients
( 9) insertion of Levine tube
(10) insertion or removal of supra}Ubic catheter
c. The follouinG nursing activities are a part of all public
heD.lth nursin::; visits and trill be continued in the home
nursing cnre program:
(1) instruction and ~uidance in relation to diseases
(2) instruction and Guidance in General health ;JI'omotion
( :3) emotional sup;JOrt, 3Ui(~ance and counseling in acceptin;.;
D.nd adjusting to illness and its limitations.
(4) guid~nce in use of community resources
VIII. ~ndinc. Orc:.ers
<.."1.. PurrlO so:
stanrling orders are authorized by the Health Director. These
orders [;uic:.e the nursin;~ staff of the agency in givinG nursing
care lIhen:
(1) Services lIhich may be renderec' '1ithout a medical Ol'c:.ei" on
a first visit include:
(11) te''''Jei'ature, :rulse, res)iration and blood ;)ressure
(1)) S')Qn;;e bath or partial care if not contraindicated.
(no tub bath t1ithout 'lhysician's order)
(c) cure of ",)l"'0SSUre sore - cleo.nse uell .dth soa'') 2.nc~
", Tater _ relieve .I)1"'cssure - instruct in !(cepin.'3
areQ clenn and dry - chan3c position.
(2) Emer,~ency orc1.;)rs for severe druC reaction
(a) the public health rn.li'se \1ill contact the patient's
physic inn for er.:er;~~cncy or(ers if l)()ssible
(b) if physician cannot be reached, or if reaction is
so sudtlen and severE: that dekJr is not feasi"ule,
the public health nurse .rill administer 3 - 5
minil.lS of aclre=lin chloride 1: 1000 solution,
:rhich she ~rl.ll carry in her nursing bo.:::;.
(c) the nurse lrill contact su~)()rvisory personnel c.t th0
IIec.lth 'Jepartment as soon "-s :x>ssible to notifj'
them of the C1Jer.:;ency and 2..ction ta1"en. Su)ervisory
personnel 1:111 help obtain or advise about emergency
mec'icd supervision fo"' the patient if this has not
been arran.1ed for.
9 -
(d) in an emer:::;ency the nurse should remain crith the
:w.tient until medical sU;JOrvision can be obtained.
In some instances, the most :::>ractical means of
obtainin;; emer::;ency medicDl supervision may be
havin;; the patient moved to the hospital emergency
room. The nursinij staff, hO'Jever, does not trans-
;JOrt patients and/or families.
IX. Licensed Practical Nurse
-
405.' ??';) I..
Supervisory ~elationships betueen the ReGistered Nurse and the
Licensed Practical Nurse in the Home Health Care Program.
A. The Licensed Practical llurse is clirectl,y res:x>nsible to the
llegistered Nurse.
3. Initial visit <:nd evaluation to all nel/ patients /.1V.<".e by the
.1e::;istered ;lurse. The case record is o;xmed at this time and
relative information obtained.
C. The ite::;istered Nurse is res;JOnsible for carrying out the
follo:ril1G:
1. Co-ordinates the duties of the L.P .li. in the Home Health
G;;:;.re Progrm:l.
2. j~valuates :::>atient's care plan and proGress.
3. j;v<:luates the duties and lJOrformance of the L.P.N. as
they relate to the patient's care plan and progress.
4. The n.ll. ;rill make a nursing visit to the patient
uhen needed as indicated and also uhen rec;uested by
L.P.N.
D. Rec;istered Burse is res'X)nsible for nursillG care of the Home
Health Care ProGram patients IIhich are assigned to the
Licensed 'Tactical :.iurse.
1. n.ll. and 1.;>.11. confer at regular intervals concernin,;
p~tient cuTe and proGress.
2. aecord should reflect the consultation of R.N. and the
L.P.l1. re~ard.iUG the patient.
~1!Y_~ica! 1!leI2I'Y 2!"!.YJ.ces
Physical therapy services :rl11 be provided by a Licensed Physical
Therapist under a contract.
Physical thernpy ,rill be a<lministered onl,y by a person registered
to practice :i1ysic2.1 therapy in the state of North Carolina.
1. Physical then,py visits IIi n be made to carr"J out physician's
orders.
2.
Procedures j.rill be <>t\ministe!'ed a.cc<>-rding to accepted physical
therapy practices.
!hen indic3-ted and feasib:v-" and '.rith the consent of the
:Jhysician, many yrocedures n..y bo tau::;ht to a member of the
famil,y or other responsible )e.,,()n ion the '.ousehold.
~
J.
- 10 -
4. it \1!'itten report of visits 'Jill be maintained in the aeency
office and periodic reports ,lill be transmitted to the
physician.
l~mples of procedures ~hich the physical therapist must administer:
1. MUscle testinz, joint range, ambulation and other )hysical
evaluation procedures.
2. therapeutic exercises.
3. selecting and teaching proper gait pattern(s).
h. determinil15 proeression of treatment ?lan.
5. application of any modality involving the therapeutic use
of electricity.
SJ:ar.lples of procedures uhich the phynical therapist may tcach and
su~rvise :
1. application of heat or cold.
2. TJOsitioning.
3. therapeutic pro~ram of passive and active e;mrcises.
h. supervise nractice of transfer and ambulation activities.
Consultation and cooTJeration in planninG and implementing services:
1. participation on advisory committees.
2. assist :lith traininG and utilization of non-professional
l:>ersonncl.
-11-
I'ffiSOihL CJh'U AND F.'liiILY "IDS SffiVICE
DEFINITIOn:
The Health Aide is a non-professional member of the nursing team
uho uorks directly under the su;JCrvision of the Public Health Nurse.
The Health Aide is administratively responsible to the Health
Director through the Director of Nurses.
f}UALIFIC"TIONS:
* As home health aides are employed, they I-rill be carefully
screened and must meet the fol101ring qualifications:
1. Education: Graduate of an accredited high school or meet
equivalency qualification. i1Ust have the ability to understand
directions and to communicate inforraation about the patient's
needs and progress. (Experience in porviding non-technical
assistance to professional personnel in a health department
may be substituted for the high school education on a year
for year basis - lierit System.)
2. Age: ;.ge is a factor only as it relates to the expected
degree of maturity. The candidate should behave like an
adult uho is capable of follolrin" instructions, observing
reactions, and change, and communicating lrith the patient,
nurse, and others concerned lrith the care of the patient.
:3. Appearance: Good personal GTooming is expected of the Home
Health Aide since she may be called upon at any time to
provide direct personal care to patients in any class of
home.
4. Attitudes: The candidate should communicate a belief in the
uorth and dignity of the patient, as uell as the job.
5. Health status: The Aide must be free from health problems
that may be injurious to the patient, or to herself as she
performs deleGated tasks. Also, she must shOll evidence of
the practice of good personal health habits.
6. Previous Training and/or Experience: It is preferable for the
candidate to have successfully completed the course for Home
Health Aides in Public Health uhich is approved by the Public
Health Nursing Section of the state Board of Health. HO\'lever,
consideration ,-Jill also be Biven to applicants uho have trained
and \'lorked in a hospital setting \'lhen quality references are
given.
PRRSONNEL POLICIES:
Same as for all staff members.
* Alamance County Health Department. Burlington. North Carolina
October 1967, paees 2.3.
- 12 -
OI3Ji';CTIVSS:
1. To extend services in the home by G~VJ.~ )Crsonal care 1~hich
does not require the sldlled serviccs of a public health nurse I
thereby giving the professional personnel more time to car~J
out those duties and responsibilities I.lhich require their sJdll and
judGment.
2. 3y helpin,r; family 11ith care of the patient at home, institutional
care may be avoided.
3. To assist in rehabilitating the patient to his fullest potential.
OnBl!T!\TION:
1\11 ;JroGrams or the aGency, their purposes, are covered. The role
of the Aide in relation to the total prOGram is tau~~t.
2!LTI~S :
(The assiGnment of duties ~1ill be made b;' the Director of Nurses
and/or su)Jervisor.)
1. The health aide is tauGht (and supervised) by the public health
nurse to take blood ~~ressures and to car~J out procedures in
the home uhich a family member could be klUGht to <10 I except
injections. Supervisory visits are mac.e by the nurse every
t\!O :leeJ:s. not necessarily at the same tit:le the aide is in
the home.
2. The male health aide Iii ves :>f)rsonal care to male patients
only I includinG challGillG catheters, Gi vine'; enemas, etc. He
is approved by the urolOGists at ['leI 1 Hanover lIemorial Hospital
before being employed. The actual procedures of changinG
catheters of male i1atients or :jiving enemas to male patients
are not observed or sU;JOrvised by the Public Health Burse.
3. The adie has conferences l1ith the ?ublic Health Nurse before
and after making home visits, ancc recor(;.s visits.
h. Attends in-service education .JroGrams 11hen a)J[llicable.
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405.122f.l
CLINICAL'tCCO:WS:
Clinical records containinc all pertinent information are
maintained on all patients receiving nursing and/or other services
from the Agency. Included in the record are:
1. Identifying information on the patient
2. Name of physician and the plan of treatment signed by
hir.l
3. Progress notes dated and signed by the person giving
service
4. Copies of summary reports sent to the physician every
t1l0 months
5. SiGned release of information
6. Discharge information
STANDful.JS !l f: !!:
These records are removed from the Agency by nurses only l1hen
service is being rendered. The aides record their visits after they
return to the office.
The records are retained by the Agency at least five years after
the month the cost report to \'lhich they apply is filed lrith the
intermediary. Should the Agency discontinue service the records trill
be kept by the Health Department for the length of time as stated
above.
- 14 -
405.1229
A(I~NCY l':VAIDATION:
There lIill be an annual eValuation of the Horne Health Agency Program of the
lie'. 1 Hanover County Health De?artment by this agency in accordance l"lith
405.1229 Condition of Participation - liedicare. A subcommittee of the
advisory committee including the agency administrator and the nursing
supervisor I.Jill be responsible for the administrative evaluation of the
agency. This evaluation '.Till include the follO\ling elements.
A. 1.
2.
3.
Cost audit (annual)
Statistical report huarterly and annually)
Policy and administrative revie'l
B. Clinical Case record revieu (quarterly)
1. Clinical revieu committee structure
There lJill be established a comnittee of professionals
representing at least those services offered by the
aGency to do a (;uarterly revieH of clinical records.
This comrnittee shall consist of:
(a) Supervising nurse
(b) Coordinator of IlOIJe Health Services
(c) Physical therapist (contract of state consultant)
(d) ~10 staff nurses
( e) One HOine Health "ide
2.
Selection of cases for clinical review
Cases to be reviewed lnay be:
(a) Randot1 sample of active and discharged
(b) Problem cases referred from the field
case s
3.
Purpose of the clinical review shall be:
Determine if plan of treatment is being implemented
Assure that established policies are followed in
providill!3: service
(c) Document noeds for services not presently provided
(d) Assist in agency evaluation
~~~
4.
The revieu forms used shall be those furnished by the
ne"ional Office and these shall HOT be filed uith patient
folder but in a se~rate confidential folder for such
forms for agency use only.
CI_ _ JJ --',-"7'-'0''-,'" ~
if;:! - - -,
Dr. Joseph C. ;(nox, li.D., n.p.H.
Health Director