Volume 2025 | No. 2
SURVEYOR
HOME INFUSION THERAPY
HIT5-3C Frequency of the citation: 26%
ٝ Notice of receipt of Client/Patient Rights and Responsibilities statement. ٝ Clinical and progress notes including client/patient response to care/ service provided. ٝ Physician’s orders appropriate to the level of care/service.
Nerd Newbies (understand the requirement) continued
Overview of the requirement: There is a written plan of care established by a physician for each patient prescribed home infusion therapy services. The initial plan of care addresses 13 specific data points. Comment on deficiencies: Compliance is assessed through review of policies, procedures, and client/patient records. Most deficiencies cited plans of care lacking sufficient detail. Examples of ACHC Surveyor findings: ■ Records included no documentation of the type of solution used to prep skin for sterile PICC dressing change or for sterile central line dressing change. ■ Blood pressure and pulse only recorded every hour during the administration of IVIG. No temperatures recorded for patient. ■ Plan of care does not include diabetic precautions under Safety Measures. Patient is insulin dependent. ■ Plan of care does not include oxygen under Safety Measures. Patient is on oxygen. ■ The plan of care states, “Frequency and duration of visits: Ongoing.” This is inadequate documentation because it does not indicate how often nurse is performing visits. ■ The nursing note indicates patient has pain and is taking Tylenol. The medication is not included on the plan of care medication list. ■ There was no physician signature on the plan of care.
■ Diagnosis. ■ Plan of care – initial and updated. ■ Assessments: ٝ Initial. ٝ Ongoing, if applicable. ٝ Home, if applicable. ■ If applicable:
ٝ Evidence of coordination of care/service provided by the organization with others who may be providing care/service. ٝ Copies of summary reports sent to physicians. ٝ A discharge summary. ٝ Admission and discharge dates from a hospital or other institution. ٝ Advance directives.
■ Audit patient records for documentation of each required element. ■ Correct missing information promptly. ■ Review policy and procedure documents to ensure that all required elements are identified. ■ Train staff on policy at the time of hire and annually.
Nerd Apprentices (audit for excellence)
Nerd Trailblazers (prepare the path for others)
Compliance tips for:
The intent of this standard is patient safety through appropriate care. Orders in the plan of care for home infusion therapy will focus on, but not be limited to, that treatment. A complete plan of care provides a well-rounded view of the patient/client’s health condition to help staff identify potential risk factors, adverse effects, and interactions. ■ Audit plans of care to ensure that they are thorough in describing the type, amount, and duration of HIT services and the details of administration. ■ Audit for other principle and additional diagnoses, allergies, medications, clinical services ordered, and appropriate safety measures. ■ Audit for evidence of physician involvement in the plan of care. ■ When audits reveal missing documentation, continue to an analysis. Are errors specific to a particular category of information? To individual providers? If so, plan focused training sessions.
Nerd Newbies (understand the requirement)
Nerd Apprentices (audit for excellence)
Nerd Trailblazers (prepare the path for others)
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