National Patient Safety Goals

CMS: Centers for Medicare and Medicaid Services

Awareness of HCAHPS scores

Knowledge of Advance Directives

HIPAA: Health Insurance Portability and Accountability Act

Disability Management

Worker’s Compensation

Discharge planning

The Joint Commission

Universal Precautions

Cardiac Arrest/CPR/AED

Rapid Response Teams

Health History, review of physical examination, review of systems

Psychosocial Assessment (social history, support systems, emotional, caregiver support, ability to deal w/loss)

Financial Assessment (income, ability to manage needs)

Emotional Assessment (response to illness, treatment, support)

Spiritual Assessment (religion, beliefs, practices and relationship to care)

Terminal Care Assessment (5 stages of grief, hospice, palliative care, crisis)

Development of problem list

Perform Initial Evaluation

Develop and revision of care plan

Assess outcome to treatment

Establish and revision of goals c

Initial assessment and treatment plan

Skilled visit notes

Follow Physician orders

Documents according to POC

Documents key information to physician, supervisor and case manager

Discharge Summary

Follows Plan of Care

Review POC prior to care

Communicate and Coordinates with interdisciplinary team members

Knowledge of criteria for participation in Medical/State Regulations

Knowledge of skilled reimbursable visit

Effective Case Coordination

Knowledge of available community resources

Community Resource Planning

Attends case conferences as required

Hand washing

Exposure plan

Utilizes Personal Protective Equipment PPE

Determine learning needs

Set goals/objectives

Develop and implement care plan

Evaluate effectiveness of teaching

Ability to revise care plan