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Avoiding Common Mistakes and Achieving the Wow Factor
Requirements and policies
Frequent concerns/challenges
Achieving the “Wow Factor”
Requirements:◦ Cursory◦ Complete entrance exam◦ Laboratory tests◦ Immunizations◦ TB Test◦ Walk-in clinic◦ An appointment system◦ Off-center specialist referral system◦ 24-hour emergency care system◦ HIPAA Notice
5. Do not use VFC/improper immunizations 4. Entrance exams are not done within the required
timeframe3. Students with chronic health conditions are not
monitored2. Ineffective use of walk-in clinic or ineffective
appointment system1. Issues with the health record/documentation
Student, Joe
ID# 123456
Allerg
ies: Am
oxicilli
n
Sticker indicates that
Joe has insurance.
May put allergies on the cover
Mental Health
Oral H
ealth
Lab Resu
lts
Medical n
otes
History
Health records are confidential,
chronological accounts of medical information!
Every record documents continuity of care by
nursing, medical, dental, and mental health.
Student, Joe
Health and wellness staff should review the
record each time a student reports to the health and wellness
center!
The center physician and the HWM should review student health
records for completeness on a
regular basis (excellent CQI project). Joe Student
11/11/08 7:00am
S = Joe in at open hours. Says, ‘I don’t feel well. My head hurts. My chest hurts. I am freezing and burning up and can’t stop coughing. I have got worse for the last 2 days.’
O = Rales bilaterally. Pulse 82, Respirations 22 and labored. Wheeze noted on inspiration. Skin dry and hot to the touch. T-102F. Coughing during exam and phlegm green tinged. Denies vomiting/diarrhea, has no appetite.
A = Alterations in Comfort, URI
P = Per HCG, gave Keflex 500mg TID, po. Guituss cough syrup 1 tsp every 4 hours, Tylenol 500 mg. po every 4 hours. Instructed on benefits, possible side effects and need to complete antibiotics. Instructed to increase fluids, esp. H2O and to report back to Wellness if no improvement or gets worse in 2-3 days. Student verbalized understanding. Medication Handout provided. F/U in 1 week.
Linda Goodnurse, RN
Student, Joe
11/11/08 Student in and feels bad.Been coughing, head hurts.Has a cold. Gave antibiotics, Tylenol and cough syrup.
LG, RN
11/11/08, 7:00 am
S =“I have a cold”O = Temp: 101, BP 112/74, Resp 20, Non-
productive cough, lungs clearA = Upper Respiratory SymptomsP = Put to bed in HWC—Force fluids, Ibuprofen 400
mg. Q 6 hours, cough syrup, if needed, Monitor for sore throat, rash, ear ache or persistent temp >101. Reevaluate before sending to dorm when HWC closes. Reevaluate in AM.
11/11/08
S = Student reports having difficulty sleeping in the dorm along with feelings of sadness and disinterest in center activities over past two weeks. Student states that he is becoming increasingly irritable. Personal history includes past depression with meds about one year ago, physical abuse and foster care placement from ages 12 to 18.
O = Student was generally anxious throughout the session with a flat affect. At one point became tearful and slightly agitated. Denied any suicidal thoughts or past suicidal behavior.
A = Student has been on center for two months and is experiencing adjustment issues which may be triggering a recurrent episode of depression. Shows moderate level of motivation to address symptoms and remain in program.
P = Schedule next appointment for 11/19/2008 @ 12pm for further diagnostic assessment and to continue short term cognitive-behavioral therapy. Gave student sleep hygiene brochure and told to return to Health and Wellness Center if problems do not get better before next appointment. Refer to Center Physician for psychiatric/medication evaluation. Referred to Counselor’s Adjustment Group. Alert RA and Counselor to watch for any behavioral changes over the week and refer back to Health and Wellness, if needed.
Janet Counselor, PhD
Student, Joe
Maintaining accurate chronological record of health care in progress notes
Enhancing communication among health care providers
Monitoring health provider performance Meeting legal requirements Standardizing care Achieving cost benefits Following through on treatment plans Documenting student non-compliance with
care
How much do you know?
1. Only when the student sees the center physician
2. If the student receives any type of medicine
3. Every time a student comes to wellness4. None of the above
1. Only when the student sees the center physician
2. If the student receives any type of medicine
3. Every time a student comes to wellness4. None of the above
1. The record should be thrown away2. The record should be sent to the RO3. The record should be reviewed for
completeness, sealed in an envelope and forwarded to the appropriate department, except in cases of student death
1. The record should be thrown away2. The record should be sent to the RO3. The record should be reviewed for
completeness, sealed in an envelope and forwarded to the appropriate department, except in cases of student death
Strong community connections Notate Health Care Guideline in health
record (more about HCGs later) HWM has an active role on center, outside
the wellness center Think outside the box!
Common Concerns:◦ Students are not evaluated annually◦ Staff are not trained in CPR/First Aid
Achieving the Wow Factor:◦ Devise a tracking system for annual medical
clearances◦ Create a notification system to let the recreation
supervisor know about restrictions
Common Concerns:◦ High pregnancy rates◦ Lack of contraception options
Achieving the Wow Factor:◦ Partner with a local agency to provide education
to students◦ Institute a peer-education program◦ Have a ‘Baby Think it Over’ or similar program
Common Concerns◦ Students do not receive pre/post-HIV test
counseling within 14 days
Achieving the Wow Factor◦ Strong case management◦ Good referral system set up◦ HIV-prevention education programs
Common Concerns◦ Lack of SART team leadership/Ineffective SART
team◦ Team does not meet regularly
Achieving the Wow Factor◦ Connections with law enforcement and victims’
groups◦ Education for students to avoid risky situations
Common Concerns◦ Vacancies over long periods of time◦ Issues with licenses
Achieving the Wow Factor◦ Creative advertising methods
Common Concerns◦ Only file signature page of authorization◦ Not posting HIPAA Notice
Achieving the Wow Factor◦ Post HIPAA information throughout the center
Common Concerns◦ Double dipping
Achieving the Wow Factor◦ Providing students with information in writing
regarding basic health services
Common Concerns◦ Excessive ER visits◦ Discontinued major medical information still on
center◦ Unaware of student third-party coverage
Achieving the Wow Factor◦ Most students on center have third-party
coverage◦ Strategy to obtain coverage or community
resources
Common concerns:◦ No subcontract for optometrist◦ Expired licenses are in the file
Achieving the Wow Factor:◦ Have copies of current state nurse practice act for
RN and LPN◦ Subcontractors picture and license in lobby
Common Concerns◦ Two staff members do not perform the count◦ Same staff orders and receives shipments◦ No double lock…The room door lock may not
serve as one of the locks! ◦ Narcotics are kept in exam rooms
Achieving the Wow Factor◦ Use a lock with a numeric key pad◦ Have students sign off on narcotics
Refer to: JOB CORPS INFORMATION NOTICE NO. 08-17 September 17, 2008
Common Concerns:◦ Not documenting waivers adequately◦ No STI testing
Achieving the Wow Factor:◦ Aggressive patient education to avoid waivers
Common Concerns:◦ Over or under use of FECA/OWCP
Students are considered federal employees for purposes of OWCP.Refer to TAG E for details
Common Concerns◦ Failure to submit annually
Achieving the Wow Factor◦ Notating health care guideline in documentation
Common Concerns◦ Orientation after the cursory/none at all
Achieving the Wow Factor◦ Good wellness orientation booklet◦ Not just wellness manager—mental health, TEAP,
oral health involved
HIPAA Notice should be signed during orientation!
Common Concerns◦ Lack of follow-up for students out on MSWR◦ Proper referrals are not provided
Achieving the Wow Factor◦ Devise a log to follow up on MSWRs
Common Concerns◦ Issues with paperwork/reporting
Achieving the Wow Factor◦ Grief counseling or critical incident plan
Common Concerns◦ Not reporting based on state and local health dept
laws
Achieving the Wow Factor◦ Intense education program on communicable
diseases (health department speakers, etc.)◦ Good advertisement for flu-vaccine clinics◦ Information on flu vs. common cold◦ Antibiotic misuse education◦ Signs in restrooms about hand washing◦ Hand sanitizers throughout center
Common Concerns◦ Equipment is dated or does not function properly◦ Records on dispensing, inventory, and disposal of
medical and dental supplies and medications are not maintained
Note: Use Job Corps recommended list of medications in TAG-M and purchase from government supply companies (GSA, HHS, VA) whenever possible.
Common Concerns◦ Centers do not survey students◦ Don’t have an established quality improvement
program
Achieving the Wow Factor◦ Use a form with a numeric rating and a qualitative
section for comments-document changes you’ve made based on this survey
◦ Meet regularly with the Student Wellness Committee◦ Conducting quarterly student focus groups◦ Conduct studies on treatment protocol
Common Concerns◦ The CMHC and Center Physician do not meet with
the Center Director◦ Minutes of meetings are not kept
Achieving the Wow Factor◦ Entire wellness team (including wellness
manager, dentist, and TEAP specialist) meets with CD
Common Concerns◦ Reports are not filed on time
Reporting requirements are:
•Health Services Program Description
•Health Services Utilization Report (kept on center)
•Alcohol Testing Report
Health Insurance Portability and Accountability Act (HIPAA) regulations mandate strict attention to privacy laws and confidentiality of records (April 2003).
Protection of PII: personally identifying information (refer to Program Instruction Notice NO. 06-23)
Suggest reviewed and modified with any PRH changes
Must be individualized to meet center’s needs
Should be a blueprint Should have at least one for each PRH
requirement, more based on center policies Sent for approval to RO yearly or with any
changes
Develop community connections See if local hospital will allow center to use “indigent
program”, sliding fee scale, give discounts Check local mental health agencies for victim services that
are provided through grants, provision of speakers for groups, assemblies, pamphlets
Do a MOU with Voc Rehab (refer to Program Instruction Notice No.99-03)
Look at other local, state, or national resources Use Health Department services Use Walmart $4.00 prescription plan when possible Use student insurance to purchase their medication when
possible Use Vaccine for Children's Program (VFC) Pharmaceutical companies for programs available
Make sure you prepare the pre-ROCA tools Make sure your PRH and forms are up to date Be prepared to share at least 3-5 innovative
programs or promising practices Demonstrate how Health and Wellness is part of
the center team outside wellness Make every effort to have subcontracted staff
available Review last ROCA responses and be prepared to
talk about how you’ve addressed them
SOPs/COPs Health Care Guidelines Personal authorizations Subcontracts, licenses, certifications, and malpractice
insurance for all contracted staff (current), waivers if applicable
Licenses for health and wellness staff SIRs for past year MSWRs for past year 2-3 disability folders Narcotics Logbook Disclosures log Quarterly alcohol summary for past year
HMIS reports for past year Minutes from monthly
meetings with CD/CMHC/ Quality Assurance
(surveys, minutes from committees)
Quarterly SART meetings Required Wellness training
logs (can get from HR manager)
MSDS SHARPS exposure log CA-1 log
Pre-ROCA tools Interview time set up for
various center staff/subcontracted staff
Any MOUs or contracts with other medical providers, voc rehab
Clia certification Dental Productivity Data Most recent Corporate and
ROCA reports Typed list of all Wellness
staff and subcontractors names, hours, days on center and length of time in their positions
List of 3-5 Best Practices