Running head: MOBILE MEDICATION AND MONITORING ASSISTANCE 1
Mobile Medication and Monitoring Assistance
Crystal Bendele, Christina Bookheimer, Susan Headley, Kristen Lintjer, Tracie Peterson
Ferris State University
MOBILE MEDICATION AND MONITORING ASSISTANCE 2
Abstract
The mobile medication and monitoring services are committed to helping the elderly that are
unable to get to the lab or need help setting up their medications. This paper explains the staff
and their job duties, as well as the mission, philosophy, and objectives of the business. It also
explains the internal and external factors of the services. Advertising is a big part of starting a
new business so this is also included. Finally, the budget is included for the first year of service.
MOBILE MEDICATION AND MONITORING ASSISTANCE 3
Introduction
In a world of soaring health care cost and shrinking budgets it is important to have
programs in place that meet the needs of the less fortunate or those that cannot access the system
easily. This is especially true in our elderly population. Many are unable to get out of the house
for basic services and because of this poor control of chronic illnesses and re-hospitalizations can
be the result. Mobile Medication and Monitoring Assistance is a program developed to address
providing services such as medication management and phlebotomy in the patients’ home. It is
believed that this basic care can have a valuable and worthwhile impact on those served.
Assessment of External and Internal Environment
Environmental Scan and Background
The rapidly changing healthcare environment is forcing nurses and health care
organizations to provide care more efficiently without sacrificing quality. A major focus for
acute care hospitals in today’s society is readmission rates. This is concerning for organizations
because as healthcare moves forward with changes, reimbursement for readmissions may be
jeopardized. With that said, hospitals are obviously focusing on ways to reduce or prevent
readmissions. While home care agencies and sub-acute rehab facilities are in place to facilitate
care post discharge, some patients may not have a skilled need. Acute care hospitals may benefit
from an external support service that helps those patients in need of health care services not
covered by insurance; a service such as this could be beneficial in preventing a percentage of
readmissions. If patients have a skilled need such as nursing for wound care or physical therapy,
those services are easily obtainable and covered by insurance. However, there are certain tasks
that the Centers for Medicare and Medicaid Services (CMS) do not feel are skilled therefore,
they do not provide reimbursement. These stand-alone services are medication set up and lab
MOBILE MEDICATION AND MONITORING ASSISTANCE 4
draws. These services alone or in combination, if not followed after discharge could result in
extra physician visits, emergency room visits, or hospital readmissions. This planning group has
identified the need for a medication set up and lab draw service for patients that do not meet the
skilled need post discharge from an acute care hospital, home nursing service, or sub-acute rehab
facility. Senior patients often have multiple medications which may contribute to confusion in
taking their medications correctly. Additionally, some patients may forget to take their
medications if not arranged in a manner to assure compliance. If a CHF patient misses even one
dose of Lasix this could potentially lead to an emergency room visit or hospital admission.
Having medications set up already could potentially increase compliance and prevent such a
visit. A second service is assistance in drawing blood samples and delivering the samples to the
lab. Patients could face challenges in remembering that a lab draw is due or have difficulty with
obtaining transportation to the lab.
It has been identified that medication set up and lab draws can be two very challenging
tasks for some of the elderly population. The focus of this project will offer these two basic
services to patients living in their own homes as well as those patients in Assisted Living
Facilities and Adult Foster Care Homes. As a group, the decision was made to name our service
Mobile Medication and Monitoring Assistance.
Internal Environment
Internal environment needs for this service was also examined. Because the program is
starting with services in one county, it was decided to pursue an office space at the contracted
hospital in the county of service. The one county service program would serve as the pilot. As
the pilot program becomes successful, plans would be to proceed with services in additional
counties. The pilot county chosen was Alcona County because 31.4% of the population is 65
MOBILE MEDICATION AND MONITORING ASSISTANCE 5
years or older (U.S. Census Bureau, 2010). The goal would be to add two to three counties
within a year. To help pay for overhead expenses, our group would pursue a grant from the
participating hospital. This would be in exchange for a decreased readmission rate.
Additionally, plans to contract with the participating hospital for an office space would be
negotiated. Initially, this would be a non-profit program staffed with a receptionist and a nurse.
The receptionist would maintain the office and obtain the referrals. The nurse would be
responsible for seeing the patients and providing the services. As this organization grows, the
plans would be to add additional staff. Case management and discharge planning of the
contracted hospital can contact our service with referrals for potential patients in need of either
of these services. Additionally, local nursing facilities and home care agencies could provide
referrals for patients being discharged that may need additional assistance at home.
In summary, this group has identified a need for medication set up and lab draw service
post-acute care, sub-acute care, or discharge from home nursing services in elderly patients. Our
goal is to service those patients in need to help prevent additional physician office visits,
emergency room visits, or readmissions to the hospital. Hopefully, this will enhance the quality
of life for participating seniors.
Mission Statement
Mobile Medication and Monitoring Assistance is a non-profit service organization
serving the elderly population in Alcona County. Our mission is to provide services not covered
by Medicare/Medicaid for the homebound population. Our staff is committed to reducing
unnecessary emergency room visits, physician office visits, and hospitalizations by assisting in
managing medication administration and laboratory services.
MOBILE MEDICATION AND MONITORING ASSISTANCE 6
Philosophy
The staff of Mobile Medication and Monitoring Assistance strives to aid a segment of
the aging population that presently is underserved by existing insurance coverage and area
services. Our vision is to reduce hospital readmissions and unnecessary health care encounters
by providing timely intervention and support within the home while protecting the safety of our
clients. All staff value and respect the individuality and self-determination of our clients.
Our vision is to assist the senior community while being wise stewards of healthcare
resources. Our clients and area health care providers are partners in our mission and participate
in the planning, decision making and implementation of services. Our goal is to become an
indispensable member of the health care team in Alcona County.
Mobile Medication and Monitoring Assistance Goals
Protect the safety of the elderly, homebound population in Michigan.
Support the elderly population to remain in their homes by assisting them to maintain
their functional independence.
Cover a gap which exists in healthcare by providing a service which is not covered by
insurance.
Decrease the cost of healthcare by decreasing the risk of preventable causes of healthcare
encounters.
Responsibly use our limited healthcare resources.
Expand the provision of these services to elderly, homebound patients throughout
Michigan.
Decrease fatalities which are due to preventable causes.
MOBILE MEDICATION AND MONITORING ASSISTANCE 7
Nurture relationships amongst healthcare providers and offer options for the provision of
needed healthcare.
Mobile Medication and Monitoring Assistance Objectives
To evaluate the effectiveness and outcomes of the pilot program.
To provide the highest quality services to the elderly population in Alcona County.
To decrease the number of preventable readmissions and unnecessary health care
encounters.
To serve as a model for innovative, cost effective methods of health care delivery.
To provide medication set up and lab draw services for elderly, homebound patients that
are not covered by Medicare/Medicaid Services.
To expand our service area.
To maintain the elderly population’s ability to safely stay in their own homes.
To demonstrate our value in the healthcare environment.
Job Descriptions
The Mobile Medication and Monitoring Assistance organization is overseen and
governed by a Board of Trustees (see appendix A for organizational chart).
Members of the Board of Trustees are as follows:
Physician
Registered Nurse
Social Worker
Member of the community
Physician/Board member
MOBILE MEDICATION AND MONITORING ASSISTANCE 8
This position will be a volunteer lead position that will oversee the overall functioning of the
non-profit organization.
Education Requirements:
MD or DO, with a minimum of 5 years medical experience, preferably with the
geriatric population and is currently licensed in the State of Michigan with no
restrictions to their license.
Responsibilities:
Volunteer position that oversees the functioning of the organization.
Participates and runs the Board meetings monthly.
Actively educates the community on what the organization is and what they can
offer.
Registered Nurse/Board member
This position is a volunteer position that will oversee the overall clinical nursing aspects of the
organization.
Education Requirements:
BSN preferred with 10 years of nursing experience with 5 years of it in
management and holds a current license in the State of Michigan.
Responsibilities:
Volunteer position that participates and attends monthly board meetings.
Oversees the staff nurse and their training.
Participates in writing of grants to help fund the organization.
Actively participates in educating the community on what the organization has to
offer.
MOBILE MEDICATION AND MONITORING ASSISTANCE 9
Social Worker/Board member
This position is a volunteer position that will make sure that the staff nurse has all the
community resources for the clients that are needed.
Education Requirements:
Master’s degree with current licensure within the State of Michigan and at least 2
years of experience.
Responsibilities:
Volunteer position that participates and attends monthly board meetings.
Research and provide education resources for staff nurse on the community
resources that are available for the clients.
Actively participates in educating the community on what the organization has to
offer.
Community Member/Board member
This position is a volunteer position to be able to provide necessary input as to what the needs
are of the community and how the organization can assist.
Education Requirements:
Medical professional that is an active part of the medical community.
Responsibilities:
Volunteer position that participates and attends monthly board meetings.
Actively participates in educating the community on what the organization has to
offer.
MOBILE MEDICATION AND MONITORING ASSISTANCE 10
Staff Nurse
This position will be filled by a Registered Nurse that will be able to work closely with
physicians, patients, referral sources and other members of the community. They will be goal
driven and be able to work not only independently but also as an active team player in the
medical community.
Education Requirements:
Minimum associate degree or diploma in nursing from an accredited nursing
program with 2 years of experience in the nursing field and maintains a current
licensure in the State of Michigan.
Responsibilities:
Reports directly to the Board of Trustees.
Participates and attends monthly board meetings.
Assists with the writing of grants for funding of the organization.
Assesses patients with a head to toe assessment.
Sets up patients medications for them for a 2 week period.
Admits patients to the service and assesses what their needs are.
Draw lab work as needed via venipuncture with physician order.
Follows universal precautions.
Communicates with physicians, nurses, referral sources, and other medical
professionals regularly.
Maintains patient confidentiality at all times.
Supervises the Administrative Assistant.
MOBILE MEDICATION AND MONITORING ASSISTANCE 11
Actively participates in educating the community on what the organization has to
offer.
Administrative Assistant
This position will take care of the everyday operations of the office and will work closely as a
team member with the staff nurse.
Education Requirements:
Minimum of a high school diploma, GED, or equivalent with at least 2 years of
experience in the medical field.
Responsibilities:
Works under the supervision of the staff RN.
Answers phone calls and directs them appropriately.
Gathers intake information from the referral sources and provides the staff RN
with all the pertinent information.
Provides any administrative support that is needed.
Communicates with referral sources as needed.
Actively participates in educating the community on what the organization has to
offer.
Job Advertisement
Advertising and ultimately selecting the appropriate employees is crucial to the success
of an organization. “Health care is centered on caring for people, and nurses with appropriate
people skills are essential for producing satisfied patients and families” (Yoder-Wise, 2011, p.
296) is applicable to the mission and goals of Mobile Medication and Monitoring Assistance.
The position chosen by the group to advertise for is that of the staff nurse. Information
MOBILE MEDICATION AND MONITORING ASSISTANCE 12
considered was advertising in a major nursing journal, local newspaper, and other sources that
would be appropriate.
Nursing Journal
The American Journal of Nursing (AJN) has been considered the leading voice of nursing
since 1900 and is currently the oldest nursing journal in circulation. Published monthly and with
a circulation of approximately 340,000 it has the ability to reach many potential candidates for
our position (AJN, 2012).
The closing date for publishing in the May edition would be April 2, 2012. Our ad must
be digitally submitted with appropriate format (Appendix B). The advertisement size chosen
will be half page vertical presentation at 3 3/8”x9 5/8 in size. The cost will be $5,270.00 for one
month (Lippincott Williams & Wilkins, 2012). It is our hope that this will allow for enough
exposure to fulfill the position of staff nurse.
Local Newspaper
A search for local newspapers in and around the Alcona County area found limited
resources. The Alcona County Review was judged to be the best local option for advertising for
the staff nurse position. The newspaper has a weekly format and is circulated to eleven areas in
Alcona County (Alcona Review, 2012).
No stipulations were found as to the overall size of the ad. A basic classified
advertisement will be utilized (Appendix C) at the rate of $4.50 for the first ten words and fifteen
cents for each word thereafter. This resulted in a total of $22.65 per week with a projected run
time of four weeks. It was decided that this would allow for increased exposure to potential job
applicants.
Alternate Advertising Resource
MOBILE MEDICATION AND MONITORING ASSISTANCE 13
The Michigan Talent Bank is an excellent resource that could be considered in filling the
staff nurse position. This is an on-line resource that employers can go and search resumes that
have been posted by those seeking employment. The search can be narrowed according to
profession and job duties. Job postings can be created for this resource however it would be
easier for us to use the Talent Scout application (Michigan Works, 2011) that is offered. As a
free resource this would be beneficial to our organization in reducing start-up cost.
Employee Budget
The mobile medication and monitoring services will need two full time employees. The
first will be the administrative assistant. This person will work 8am to 5pm Monday thru Friday.
Starting salary will be $30,000 per year with room for advancement in the future. The second
person will be the registered nurse. This person will also work 8am to 5pm Monday thru Friday.
The starting salary for this person will be $45,000 per year with room for advancement in the
future as well. Both employees will be full time and will be offered benefits. Benefits will be
approximately $8,000 per person per year. Both employees will have the option to decline the
benefits but then will need to prove that they have benefits through another source. Both
employees will start with 40 hours of personal time off (PTO) per year. They will be able to take
personal time but will need to work that around the clinic needs. In the future there will be room
to expand the staff to include two administrative assistants and two registered nurses. When that
happens, each person will be able to cover the job duties of the other without having to close
services for a day. There will be six paid holidays during the year. They include Christmas day,
New Years day, Thanksgiving, Labor Day, Memorial Day, and Fourth of July. If the holiday
falls on a weekday the clinic will be closed on that day. If the holiday falls on the weekend,
Saturday or Sunday, the clinic will be closed either Friday or Monday in observance of the
MOBILE MEDICATION AND MONITORING ASSISTANCE 14
holiday. There will not be any on-call time with the start of the business although that could be a
possibility with future growth. The other members of the team will be voluntary. They will set
their own hours they will just need to be during the normal business hours.
Hours of Operation
The hours of operation will be Monday thru Friday 8 am until 5 pm. There will need to
be some flexibility with the morning hours as there will be times that there needs to be an early
morning fasting lab drawn. If this is the case the nurse will come in early and then be able to
leave early as well. The administrative assistant will call the patient at least one day in advance
to schedule an appointment for the next day or sometime in the week. If the patient needs
medication set up they will be put on a weekly schedule without the need to call for an
appointment. The final appointment for each day will be between 3 pm and 4 pm so that the
nurse will be able to come back to the office and have time to do any necessary paper work
before the end of the day.
Supplies and Operating Budget
There will be supplies and operating costs for the clinic. Both will be covered by a grant
that has been made possible by anonymous foundations. The patient’s insurance will be billed
with the first visit, some may reimburse for services and others will not. If insurance will not
reimburse, the patient will not be charged out of pocket. Those costs will be absorbed with the
grant money. The cost for each service will depend on what is needed. For medication set up, it
will be the cost of a pill box approximately $3.99 to $12.99 per box depending on the size that is
needed. There will be a greater cost for phlebotomy supplies. Some are start up costs and some
are patient costs. The nurse will need a blood transport cooler bag which will be $19.99. There
will also be a need for a phlebotomy tray where the nurse can store needles, lab tubes, and prep
MOBILE MEDICATION AND MONITORING ASSISTANCE 15
supplies, this be a cost of $57.50. Sharps containers will also be needed which will be at a cost
of $12.50 for five containers. A tourniquet will also be needed at a cost of $15.95; this will be a
reusable item between patients. As far as patient costs it will vary depending on what and how
many labs need to be drawn. The estimated cost for each patient will be approximately $1.89 to
$3.00 for lab supplies. That includes the prep supplies, gloves, lab tubes, needle, and band-aids.
The nurse will need to fill out an expense sheet for each patient visit. This will track exactly how
many supplies are being used (Appendix D); the budget can then be adjusted based on that data.
We expect the patient referrals to increase in the first year of operation.
The administrative assistant will need an office space to work from. This space is going
to be in the main hospital and donated by it as well. The hospital staff will then be able to walk
the referral forms to the administrative assistant so that appointments can be made. There is also
going to be a need for office supplies. There will be a need for a computer at an approximate
cost of $641.97. There will also be a need for paper, pens, a printer/copier/fax machine, a paper
shredder, and a phone. An approximate start cost for those supplies is $540.97. There will be a
monthly fee for additional supplies such as paper and printer ink with an approximate cost of
$100.00 per month. The nurse will also need to have a laptop or a tablet to take along to the
patient’s home. This is where all of the patient charting will be done. The hospital will add on
the same program that they use for charting so that all files can be crossed over and doctors can
see all results. The cost of the nurse’s computer will be approximately $700.00 total.
There will also be an expense for the nurse’s traveling. Currently the plan is to have the
nurse drive his/her vehicle with the business reimbursing for mileage. The current rate for
reimbursement is approximately $0.52 per mile. It will be the nurse’s responsibility to keep
track of the mileage and submit the appropriate form for reimbursement (appendix E). The nurse
MOBILE MEDICATION AND MONITORING ASSISTANCE 16
is going to be traveling different amount of miles every day but we are going to average that it
will be about 100 miles per day for a total reimbursement of $52 per day and $260 per week.
That is averaging four patients per day for five days, for a total of 80-100 patients per month.
Overall the first fiscal year (May 1, 2012-April 30, 2013) will be a trial to see what the
actual operating expenses are going to be. There will be quarterly and yearly expense sheets that
will need to be filled out (appendix F) by the nurse or administrative assistant. The budget will
then need to be proposed for the following year. The board of directors will be in monthly
contact with the employees to see how things are going. There will be at least one monthly
meeting to review the data from the previous month. In the beginning, they may decide to meet
weekly to go over operating expenses.
Conclusion
The mobile medication and monitoring assistance is focused on providing quality care for
the aging population and in turn decreasing hospital readmissions. Hospital readmissions are
costly; using this service will provide quality care at home leading to a decrease in costs. Our
staff is committed to exemplifying compassion and professionalism as we endeavor to assist our
clients to maintain functional independence. By using the mobile medication and monitoring
services, the aging population will be able to stay at home more and feel more independent with
their medical needs.
MOBILE MEDICATION AND MONITORING ASSISTANCE 17
References
Alcona Review (2012). Classifieds. As retrieved from http://www.alconareview.com
Lippincott Williams & Wilkins (2012). American Journal of Nursing—Recruitment. As retrieved
from http://www.lwwratecards.com/journal.php?journal=215
Michigan Works (2011). Michigan Talent Bank. As retrieved from
http://www.michworks.org/mtb/user/MTB_EMPL.employerMainMenu
U. S. Census Bureau. State and County Quick Facts. (2010). Retrieved from
http://quickfacts.census.gov/qfd/states/26/26001.html
Yoder-Wise, P. S. (2011). Leading and managing in nursing. (5th ed.). St. Louis: Mosby.
MOBILE MEDICATION AND MONITORING ASSISTANCE 18
Appendix A
Mobile Medication and Monitoring Assistance
Organizational Chart
Board of Trustees
Registered Nurse
Administrative
AssistantPatients
MOBILE MEDICATION AND MONITORING ASSISTANCE 19
Appendix B
MOBILE MEDICATION AND MONITORING ASSISTANCE 20
Appendix C
Mobile Medication and Monitoring Assistance is a non-profit service organization serving the elderly population in Alcona County.
We are currently seeking a Registered Nurse to become an intricate part of our organization. Candidate must be able to work closely with physicians, patients, referral sources and other members of the community.
Requirements include a minimum of an Associate Degree from an accredited nursing program with 2 years of experience and current licensure in the State of Michigan.
Duties will include patient assessment and admissions to program, in home visits to provide medication set up and management, venipuncture services, as well as reporting to Board of Trustees, grant writing, monthly board meetings, supervision of administrative assistant and community education.
Interested candidates may contact Chris Bookheimer at (231) 555-1212 or by email at [email protected]
MOBILE MEDICATION AND MONITORING ASSISTANCE 21
Appendix D
Expense Report--Supplies
Patient Number Number of lab tubes
Lab Supplies$1.75/patient
Medication Box Total
$1.75
$1.75
$1.75
$1.75
$1.75
Patient Total:
MOBILE MEDICATION AND MONITORING ASSISTANCE 22
Appendix E
Mileage Reimbursement Form
Patient Number Mileage x$0.52 Total
x$0.52
x$0.52
x$0.52
x$0.52
x$0.52
Grand Total for the Week:
MOBILE MEDICATION AND MONITORING ASSISTANCE 23
Appendix F
Quarterly Budget Worksheet
Mobile Medication and Monitoring Services
First Quarter
Second Quarter
ThirdQuarter
Fourth Quarter Total
Salaries 18,750 18,750 18,750 18,750 75,000
Fringe Benefits 1,000 1,000 1,000 1,000 4,000
Office Supplies 1,982.94
Patient Supplies 1,250.00
Mileage
Total