Nursing Care Center

Please accept this proposal for the new Riverview Hospital Nursing Care Center. Key healthcare directors have contributed to this plan. Each director’s perspective is shared as related to his/her department. The following pages of this proposal contain their ideas and touch on the following considerations for the planning of this new facility: 1. The specific department services provided

2. How nursing care center services coordinate with the services the hospital provides 3. How nursing care center departments interact and coordinate with each other to provide efficient and effective care 4. Potential grants to assist with funding the nursing care center project 5. How departments demonstrate consideration and application of the nursing care center code of ethics Executive Summary

The nursing staff at Riverview Skilled Care Facility will ensure that the nursing home area is free from accident hazards and risks and will provide supervision to prevent avoidable accidents. The Director of Nurses will provide the necessary care and services to maintain the highest state of well-being of each resident and will keep each resident’s personal and medical records private and confidential. The nursing staff will encourage residents to exercise independence, but the nursing director will gladly assist with, and supervise, everyday life activities as needed. At Riverview Skilled Care Facility the nursing staff will practice and stand by its mission and code of ethics. The nursing director will also abide by the FEMA guidelines, state laws, regulations and guidelines from the Department of Health Services. The DON and nurse staff will work in collaboration with the physical and occupational therapy department director, laboratory director and information technology director to provide the facility and the staff with the latest forms of technology, equipment and training programs to enhance the quality of care for the residents.

Additionally, a well-defined laboratory structure must be established, which identifies key management and technical roles and responsibilities at each level, and establishes a functional laboratory network and referral system. The laboratory network should include a disease monitoring and response system. Some standards for competence are as follows, essential infrastructure, equipment, tests and techniques should be established for laboratories at each level of the lab. Infrastructure of appropriate size is needed, location, and with essential utilities, to provide a safe environment for workers, patients and visitors. The establishments required competency for staff each level of laboratory throughout the network. Availability of standard operating procedures (SOPs) in every laboratory for transportation of specimens, use of equipment, test procedures, reporting formats and guides to interpretation, including normal reference ranges for precise results. Provision of up-to-date inventories to all laboratory users of the available tests, their indications and limitations, costs and types of specimens required. Constant review of the cost-effectiveness and budget are recommended standards.

Similarly, it is the mission of the Physical Therapy Director for the Riverview Hospital Nursing Care Center to participate in every function of the community’s needs. The facility will utilize the physical therapy department in areas of home health care, out-patient and inpatient rehabilitation services, hospice care, and long-term and short-term residential care. An interdisciplinary approach will be used to facilitate creative recreational activities and personal physical therapy services to enhance optimal, comprehensive patient care. The physical therapy department will be a model of efficiency, profitability and compassion while producing positive patient outcomes.

Finally, the purpose of the Medical Information Technology Director would be to ensure that the MIT department would be to make sure that Riverview Hospital Nursing Care Center has the state of the art of when it comes to technology. Under the technology umbrella it would include hiring and training the best candidates on the computer software, training on HIPPA, PHI, Compliance, depending on the job title it would include Coding (HIMS). The Physician, Physicians Assistants and nurses would have full detail training on the hand held devices and EMR to ensure the patient privacy. Not only would the Medical Information Technology department offer different types of training but it would offer ongoing training. That way everyone stays up to date with compliance, HIPPA and ongoing training.

Mission Statement
Riverview Hospital Nursing Care Center will provide personalized, compassionate and professional care for patients who reside in our long-term and short-term facility while offering outstanding outpatient rehabilitation care services, hospice, and home health care services to our community. We will work as a team to enhance the best medical and personal care possible. Our doors are open to everyone, without discrimination of any kind, with kind and discreet professionals waiting to assist you.

Code of Ethics
Riverview Hospital Nursing Care Center
1. Corporate Code of Ethics Will Follow Mission Statement to Operate Under Ethical and Sound Business Practices.
2.The board of directors and officers will provide a code of ethics that encompasses full disclosure of all non-competitive information.
3.We will do no harm” is the general mantra.
4.Whistleblowers will be protected, and violators of the Code of Ethics will be held civilly and/or legally responsible in junction with termination.
5. The patient’s care is our primary focus. We will provide compassionate and comprehensive care by using an interdisciplinary approach and by utilizing the most cost-effective method of treatment.

6. We will comply with the strictest interpretation of the law. 7. We will be accredited by the Joint Commission, and will be prepared for emergencies by following the Joint Commission, FEMA and other emergency management guidelines in order to protect our patients, community and employees. 8. We will protect confidentiality of the organization, employees and patients.

9. We will not accept or give gifts that are in conflict of any interest. 10. We will provide a safe workplace for our employees and a safe environment for our patients and residents. 11. We will adhere to Human Resource guidelines and Civil Laws toward our employees. 12. We will as a group and as individual professionals to respect both laws and human life. 13. We will provide state of the art training and support to our employees, which will include continued education in social issues as well as technical and job specific skills. 14. We will provide the most cost efficient effective care available through our many programs.

Nursing Care Center Nursing Director
By Lizette Bojorquez
Nursing Director Department Plan
The Director of Nursing (DON) will work in collaboration with the Laboratory Services Director, the Physical Therapy Director and the Information Technology Director to have an efficient and effective process to accommodate the workflow for the staff for this facility by meeting on a monthly basis to ensure policies and procedures are maintained, workplace safety precautions are being practiced and infection control practices are being followed. The Directors also agree to abide by the Federal Emergency Management Agency (FEMA) guidelines in case of an emergency. The operating start-up costs for the facility can be funded through grants by The Department of Health and Human Services and reimbursements will be provided by Medicare, Medicaid and private insurance companies. “Hospices receive funds from government programs or private insurance, from donations made by the public or other corporations, and from grants donated by charitable foundations. Hospices are reimbursed by Medicare, Medicaid, or private insurance for care provided to the terminally ill” (“Hospice Patients Alliance”, n.d.).

In part, Riverview Skilled Care Facility will meet regulatory standards designed to protect residents by protecting residents from physical harm and mental abuse and proper management of medications as well provide best practices to give care, interactions with residents and maintain a clean and safe home environment. Care will be provided 24 hours per day by a team of health care professionals including physicians, nursing, social workers, physical therapists, phlebotomists, clerical staff and information technology staff. Competencies are assessed upon hire and an ongoing evaluation of performance/competency is documented and reviewed at least once a year. Key services provided to the department from other departments include physical therapy, information technology, laboratory services, dietary and housekeeping. Trained nursing staff of professionals will be available to help assist the hospice patient and the family members with answering their questions, concerns and making it an unforgettable experience. Every patient will be heard and cared for, for “Hospices exist to provide the end-of-life care that you and the family need to keep the patient comfortable and help everyone involved cope with all the changes.

After death, hospices must provide bereavement counseling for up to one year” (Hospice Patients Alliance”, n.d.). Sufficient research will be completed to ensure funding will be available. The Director of Nursing Services will report to the Nursing Home Administrator of Riverview Skilled Care Facility, but will have direct supervision and communication with the Assistant Director of Nursing Services, all nursing staff and clerical staff. The primary responsibility is to ensure the provision of quality nursing care on a 24-hour basis to the residents of the Riverview Skilled Care Facility in accordance with Federal, State and Local standards and regulations. The Nursing Director will develop nursing service objectives, policies and procedures and directs the implementation of these objectives. The Nursing Director will continuously monitor Federal and State guidelines and requirements and revises Departmental procedures accordingly. The Nursing Director will provide recommendations of in-service educational programs geared to the specialized needs of hospice, Alzheimer disease, long-term care and short-term care patients.

The DON monitors on-going staff development programs for all nursing staff. “The Director of Nursing Services functions as a liaison between the residents, their families, staff and the general public – responding to inquiries and providing information on nursing care and services, and may screen prospective residents to assure that staff has the ability to provide the care needed. The Director of Nursing Services assures that there is compliance with the regulations pertaining to care plans and resident assessments” (“Director of Nursing Services”, n.d.). The DON will work in collaboration with the physical and occupational therapy department, laboratory, information technology and various departments to enhance the quality of care for the residents. The Director of Nursing directs and manages the delivery of nursing services and patient care which are integrated with business plans and meet or exceed cost, quality, clinical and utilization standards and performance measures.

Will ensure that services meet the patients’ and physicians’ needs. Directs and ensures continuous improvements of all clinical practices, services and operations by managing the design and implementation of systems, processes and methods to evaluate and improve patient care. Consistently supports the compliance, mission statement and code of ethics by maintaining the privacy and confidentiality of information, protecting the assets of the facility, acting with ethics and integrity, reporting all non-compliance and adhering to applicable federal, state and local laws and regulations. The Riverview Skilled Care Facility staff will provide the best professional care to all patients with compassion. The DON will work with the Director of Physical Therapy to ensure we meet the requirements for patients who require Rehabilitation Services:

*Physical therapists, Occupational therapists, Speech Pathologist
*Separate room with proper equipment for PT use
*Review of Departments Policy and Procedure
*Patient care standards
*Workplace Safety Practices documentation of annual staff training
*Annual Compliance Staff documentation of staff training
*Develop a complete care plan that meets all of a resident’s needs, with timetables and actions that can be measured.
*Provide the staff with proper education as needed or requested The DON will work with the Director of Lab services to ensure we meet the requirements and needs of the facility which may include:

*Phlebotomists for blood draws
*Urine testing
*Any other tests needed by orders of the physician
*Ensure Laboratory is properly handling the specimens
*Latex free glove facility to avoid latex allergies
*Consistent disinfection of the drawing table areas
*Properly installed sharp containers & Maintenance of all equipment
*Ensure all personnel are completing annual health screening for patient and staff protection
*Policy and procedures are accessible to all staff

*Updates on all MSDS (Material Safety Data Sheet) binders kept in their department for references on how to clean up spills, chemicals used, precautions, etc. *Develop a complete care plan that meets all of a resident’s needs, with timetables and actions

that can be measured.

The DON will work with the Information Technology Director to ensure the requirements are meet as per the guidelines to protect patient privacy, to include accessibility to computers and will include the two databases required for the inspectors to review if needed. The data comes from two sources:

1. CMS’s Health Inspection database – Includes the nursing home characteristics and health deficiencies issued during the three most recent state inspections and recent complaint investigations. Data about staffing and penalties levied against nursing homes also come from this database (Medicare, 2012). 2. National database known as the Minimum Data Set (MDS) – Data for quality measures come from the MDS Repository. The MDS is an assessment done by the nursing home at regular intervals on every resident in a Medicare- or Medicaid-certified nursing home. Information is collected about the resident’s health, physical functioning, mental status, and general well-being. These data are used by the nursing home to assess each resident’s needs and develop a plan of care (Medicare, 2012).

Medical Information Technology Department Services

Medical Information Technology Department Services will provide 24 hour day to day support to Riverview Hospital Nursing Care Center. MIT would supply a 24 hour help desk support system to provide assistance to the medical staff. In addition each new hire would be provided training on the computer systems.

The healthcare providers would be trained on the electronic devices that meet the compliance standards as well JCAHO and CMS. The electronic devices that would be used weather it’s an IPad, Tablet, or Palm Pilot would all be updated with the newest spyware program to ensure that the files stay protected. Also all files would use an encrypted file when sharing over the internet/web to ensure that if the device was hacked it would scramble the documents. Always staff would be trained on how to send and retrieve patient information via their mobile device. Medical staff would be able to have real time to patient medical information to include medical records, progress notes, clinical notes, labs and pharmacy information.

The administrate staff would have real-time financial data concerning the patient billing and insurance information. The financial staff would have the capability to be trained on analytical and reporting tools. That would include the revenue cycle, claims status, code correct to ensure clean claims and overall financial management

Medical Information Technology Compliance
The Medical Information Technology Department will provide ongoing support and training to Riverview Hospital Care Nursing Care Center. This would include 24 hours help desk support not to mention 24 monitoring of all computer software and systems. Each employee would be trained on the computer system which would include the EMR Systems which is a different component to the software system. With each log-on to the system would be a reminder of the PHI and the HIPPA regulations that would have to be accepted before moving onto the next section of the software. This would include very detailed personnel information pertaining to the patient. To include laboratory results, radiology reports, financial data along with detail clinical information.

“The ethical obligations of the health information management (HIM) professional include the safeguarding of privacy and security of health information; disclosure of health information; development, use, and maintenance of health information systems and health information; and ensuring the accessibility and integrity of health information” (AHIMA, 2011). The Medical Information Technology Department will demonstrate consideration and application of the code of ethics by ensuring that electronic records are stored, accessed, and communicated only for lawful purposes. This is very important for the physicians that are using palm pilots, iPads, Tablets, or any other hand held devices that the facility may use to electronically send medical records. Medical Information Technology Director Department Plan

The plan for Riverview Hospital Nursing Care Center is too have the best capable, qualified, highly skilled IT team working at Riverview Hospital Nursing Care Center. The plan is to enlist the help of grants for funding a lot of the specialty high tech equipment that would be most beneficial for the facility to ensure the patients safely and to meet compliance guidelines. According to some of the doctors that are already using a device such as an iPad one of the doctors stated. “This is the missing piece,” stated Dr. Medhavi Jogi, Houston Endocrinologist in a press release. “Now I can use my iPad exactly as I’d use a notepad and I don’t miss a single point of communication with the patient. Better still, it eliminates the perceived barrier that some patients feel when I’m sitting at a computer entering data. It’s a much more natural form of interaction.” (Mobihealthnews, 2011) Medical Information Technology Director

Physical Therapy Director Department Plan
General Scope
The physical therapy director will perform services for hospice care, long-term residential care, short-term residential care, home health care, outpatient care, in-patient and out-patient rehabilitation care, and community living private residences. The plan for rehabilitation and restorative care will be state of the art combinations of personal therapy and group oriented programs. Further, the facility will accommodate patients with Alzheimer and dementia; therefore, the physical therapy department will develop a program for special needs patients. In order for the physical therapy program to integrate its services into the overall mission, cooperation with the Director of Nurses, Laboratory Director, and Medical Information Technology Director are critical.

Further, the physical therapy department will share the facility’s transportation for patients. The orders for patient care will come directly from physicians, but the management of care, and the progress of care, will be handled through real time patient updates by the DON, lab, and physical therapy department on I-pads that are programmed by the medical information technology department. The physical therapy director will attend daily meetings to collaborate upon patient care with the facility directors. As the hospital will refer patients to our facility, as well as contain the main laboratory, medical information technology department, emergency preparedness commander, human resource director, compliance director, and marketing director, the physical therapy director will integrate its services into the hospital’s for optimum care of patients and fiscal profitability. Safety

Safety and emergency preparedness are critical areas of concern for the facility. The physical therapy director will work directly under the hospital’s emergency commander to operate as a key facilitator in emergency preparedness in our facility. The facility will be accredited by the Joint Commission and approved by FEMA and other hospital and nursing home preparedness entities, and the physical therapy director will be an accredited leader in emergency preparedness for the facility. Training

Training for compliance issues, HIPPA privacy training, employee conduct, emergency preparedness, social skill training, and job specific training will be collaborated with each department, including human resources. The hospital’s compliance officer will guide the physical therapy department as to the types of continued education needed and the dates of the required updates. Further, the physical therapy director will attend all conferences and read all materials available by the Association of Physical Therapists to stay apprised of changes in method and law. Additionally, the physical therapy department will conduct monthly training programs that include the proper methods of mobility and equipment training.

Said training will be coordinated with the DON to ensure maximum employee education. The training meetings will be designed with the aid of Human Resources and the Medical Information Technology Director to establish the best possible outcomes and training methods as well as the announcements of the physical therapy training program content and dates of classes. The physical therapy department will direct its employees into training sessions directed by the other facility directors. The Physical Therapy Director will oversee the emergency preparedness training program for the physical therapy department, but it will be under the control of the hospital’s emergency preparedness commander. Administration

The Physical Therapy Director will work as an administrator in supervision of one physical therapist and six certified physical therapy assistants. Because the facility has many different areas of patient care and services, the physical therapy department is a key element to positive outcomes for both the patient and the organization. The Physical Therapy Director will supervise the employees working in the physical therapy functions as well as maintain their accountability to the patients and the organization. The Physical Therapy Director’s plan is to conduct employee assessments with regard to each patient and coordinate their production efforts and results reporting and outcome forecasts through the hospital’s Human Resource Director. According to the article, Therapy Services in Nursing Facilities published by the Alliance for Quality Nursing Home Care, “Centers for Medicare and Medicaid Services (CMS) is currently considering several changes to Medicare payment for therapy services. A better understanding of therapy’s role in nursing facilities may help inform this discussion.

As policymakers seek to move toward a more integrated, coordinated model of care that focuses on accountability for longer-term outcomes, therapy services will be an important partner in promoting greater physical and functional health for some of the most vulnerable Medicare beneficiaries”(Anonymous, 2010). Therefore, accountability for both service and outcome for patients is the Physical Therapy Director’ primary focus. Said goal cannot be accomplished without an interdisciplinary approach that includes technology, training, nursing staff, and laboratory collaboration. Further, billing and services specialists will be employed by the physical therapy director to work exclusive for the physical therapy department. Mission Statement and Ethical Considerations

The mission statement and statement of ethics for the facility is based upon professional, law-compliant, compassionate, and non-discriminate behaviors. The Physical Therapy Director and physical therapy department will operate with openness and knowledge sharing, which is in keeping with the facility goals. The vision of the physical therapy department is to provide creative and outcome based physical therapy to every type of patient, while providing profits to the organization.

Rehabilitation Services
The Physical Therapy Director’s vision of the rehabilitation unit is the new model for rehab services in both long-term care facilities and stand-alone rehabilitation inpatient service operations. The article Transforming Nursing Homes that was published as a newsletter by InformeDesign and posted by All Health describes the new model rehab center with an example: “Use a hotel-model space for rehabilitation and post-hospital care. Nursing homes are increasingly competing for the higher Medicare reimbursement rates for post-acute care, short-stay residents to help the financial bottom line. Although such residents do not want to be bored in the long interims between therapy sessions, they are not eager to see the nursing-home as their own or to participate in planned activities. Nor does a stay measured in weeks or at the most a few months allow time to order televisions and telephones. The operative model here is a hotel rather than a residence with a full range of amenities and conveniences such as phone jacks, television cables, microwaves, and refrigerators. The ability to entertain visitors, eat and serve food in one’s room, and be comfortable while recuperating or resting from rehabilitation are all part of a desirable setting…..” (Cutler, L., Kane, R., 2010).

This facility’s Physical Therapy Director’s model of care will emulate this design for the rehabilitation unit. The care will be directed as a patient centered, outcome based unit that embodies private sessions for rehabilitative care as well as group centered therapies such as Tai Chi and chair yoga. Training for daily living activities will be provided-tying shoes, entering bath tubs, walking with devices, driving, etc.-both to in-patients and home health care patients. The home health care physical therapy unit will collaborate upon treatment under the direction of the Physical Therapy Director with the inclusion of all other departments to maintain a home health care assessment of physical therapy needs, maintenance of home-bound patients, and documentation of therapy services and outcomes. Further, the Physical Therapy Director will make unannounced visits to the homes of our home health care patients to ensure the physical therapist and aids to those patients are in compliance with the highest standards of care. Hospice and Long-Term Care

As the facility will embrace long-term care patients and hospice patients that include dementia and Alzheimer disease, end of life experts will be hired to assist the facility social worker. The physical therapy program for this unit will utilize methods for preventing bed sores and other wounds by utilizing movements that control blood flow- which includes massage therapy. The patients will be given the option of participating in group activities if they are able to be transported from their rooms. The hospice section of the facility is interdisciplinary and described in the journal article Practice Physical Therapy and Hospice: Concept published by the Journal of the American Physical Therapy Association:

“The physical therapist, like other members of the team, provides palliative care. Modalities range from using heat, cold, and TENS for alleviation of pain; teaching activities of daily living that accommodate to the strength and body mechanical capabilities of the patient; and designing exercises and positioning that will maintain functional ranges of motion. Although the physical therapist often will provide “hands-on” treatment for the hospice patient, a more prevalent role Is that of educator. Education can take three directions that may occur concurrently. Obviously, teaching the patient to move efficiently and safely is a patient-therapist interaction. Another phenomenon occurs; as the therapist instructs the patient, the patient’s primary caregiver, the family, also receives instruction. This is particularly true with home-care hospice programs. If other members of the interdisciplinary team are present, they also receive instruction. Team members, however, will also learn from each other in a more formalized program. Continuing education is an essential element in the development of an interdisciplinary team” (Toot, J. 1984).

While the article is dated, it is current in its concept and practice. An interdisciplinary approach to hospice both in-patient and home-bound will be the focus of the Physical Therapy Director’s practice.

Community Living Residents

The community living residents will enjoy physical therapy in many forms: recreational activities coordinated with other disciplines to include exercise, games, Tai Chi, horseshoes, croquet, and other forms of mental and physical stimulation. The residents may choose to have private physical therapy functions in their rooms, and they will be accommodated. However, a pool, hot tub, and central garden will be available for recreational therapy. This type of community based living is the most profitable and
sought after method of long-term care and is embraced by the physical therapy department.

Laboratory Services Director Department Plan
The Laboratory Director will meet and report regularly with Hospital Director and attend mandatory meets with other departments. The laboratory holds a critical role in all key departments as everything such a blood and urine samples are processed through the lab its self. The Labs primary objective is to process all specimens in a precise and timely fashion. The laboratory will be made up of highly skilled professionals. The Laboratory will be located on the first floor with one security door entrance monitored by a health technician whom then checks patients in and out of the secured area.

Required Skills to have in order to work in Lab

* Understand the published research in clinical laboratory sciences, math and science necessary to broaden their knowledge in the field. * Demonstrate extensive knowledge in human anatomy and physiology, as well as, the pathology of disease. * Develop skill in performing all laboratory tests honestly. * Demonstrate the ability to effectively communicate orally to convey ideas and information to individuals with diverse capabilities and interests (physicians, medical personnel, staff members and patients). * Examine and evaluate Quality Control results and institute procedures for correction if results are not within the standards of the laboratory, to assure accuracy and precision in all work performed. * To become a member of a quality management team within the institution and help develop a working program assuring accurate and timely results. * Recognize the need for continued educational growth within the profession as a means toward professional competence through participation in college courses and professional seminars. * With attendance at seminars and lectures, develop the ability to agree or disagree with scientific presentations based on scientific theories and principles. Nursing personal will be required to

* Be trained in accordance with sample collections to insure sterilization and proper handling
* Familiar with placing lab orders for patients (scheduling blood draws etc.)
* Trained in accordance with hospital and medical regulations

Information Technology Personal are required to:

* Keep computing systems up to date
* Manage medical charts to insure they are up to date
* Registering patients properly and giving them proper identification bracelets Laboratory will accept samples from physical therapy department only if proper documentation and procedures are followed:

* Doctors authorization
* Nurses signature
* Proper containment
* Specimens must be labeled properly

Laboratory Goals

12 month goals

* Establish faculty teaching awards for Laboratory Medicine, Medical Student Teaching and Graduate Student Teaching * Hold a Laboratory Research Day to highlight the work of the Department * Benchmark laboratory utilization against national standards in collaboration with the Chief Quality Officer. 5 year goals

* Become a national leader in distance education for practicing pathologists using innovative technologies such as Second Life. * Obtain extramural funding for the Bio-specimen Archive Research Core. * Have at least 4 Department multi-investigator grants/contracts, each with an annual direct budget Publish more than 35 papers per year in journals with an impact factor > 5Balance the budget for the entire Department including the medical school, faculty practice plan, and research activities. * Develop a required rotation in diagnostic medicine in conjunction with the Department of Radiology.

References

http://www.bplans.com/laboratory_business_plan/company_summary_fc.php http://www.searo.who.int/linkfiles/publications_dev_national_lab_plan.pdf http://www.americanmedtech.org/Certification/MedicalLabTechnician.aspx