a.   Do progress notes make reference to a new medication? Do the progress notes have evidence that the patient was asked about medications?  Make sure the referenced medication is listed on the medication list! The patient record summary should be continuously updated as orders are received and carried out.  At least monthly, review medical records comparing medications to those listed on the medication profiles.  Take a look at NPSG.03.06.01 Note 3, for the definition of “good faith” effort.  Documentation of supporting assessments with each visit, along with a monthly review, is evidence of a “good faith” effort!

B   Lack of evidence of drug regimen review can be a potential hazard in the Joint Commission accreditation process, as can lack of evidence of physician notification in the event of drug interactions. Drug regimen reviews performed by a licensed professional who can take an order, such as a nurse, physical therapist or occupational therapist, should occur at start of care, recertification  and when there are changes in the medications ordered.  Anytime there is a note in the record regarding a drug interaction there should also be a note or recording of successful attempts to contact the patient’s primary physician, or an agent of the primary physician, such as an office nurse.

c.   Patient education is also important in accreditation Does your facility’s documentation support the patient being educated about their medication, and, if so, what type of education was given? Information should include what to watch for, in regards to side effects, as well as any possible drug interactions.

d.    If a new medication is an antibiotic, is the antibiotic review included in the agency’s Infection Control program? Daily clinical notes should be reviewed, and when there is an antibiotic listed, an infection screen form must be completed so that the antibiotic is captured in the Infection Control program.

e.    Did you know that National Patient Safety Goal 8 has now been changed to Standard 3.06.01s? What does your agency need to do to work toward meeting the national goal for Patient Safety?

f.    During the monthly review of medication regimen, inquire if the patient is taking medications as ordered. The nurse can also assess if the patient discontinued the medication. For instance, if the medication is dated 1/1/2011 and today is 2/1/2011 (medication ordered for daily use), is there  half a bottle of medication remaining?   Findings such as insulin non adherence, or discontinuing potassium when taking a diuretic, would be some examples of problem areas.

Daily review of  progress notes can lead to identification, prevention and/or corrections of medication – related administration issues , and prevention and / or correction of  problems as they occur.   Keep a list of those patients whose medication administration is the reason for a home health visit, and include several of these patients in the comprehensive chart review.  Hold staff accountable.

A free resource for drug interactions with severity levels: http://www.drugs.com/drug_interactions.html.  The site offers teaching guides too, and it is free.

The interview
Be on time for the interview. Dress for successin neat, conservative business attire. Minimize jewelry and cover tatoos. Keep hairstyle conservative and do not play with hair or jewelry during the interview.Be enthusiastic but let the recruiter control the pace and tempo of the interview. Keep your answers clear and concise. Be helpful with your explanations, but when you have answered the question fully, stop. Silence is acceptable and does not have to be filled with unnecessary talking. Graciously answer awkward or challenging questions without adopting a defensive posture. There may be a purpose in this line of questioning. Candidates who bristle may not move beyond the initial interview. Have the right attitude. Too much confidence may come across as arrogance. Don’t lie and avoid speaking badly about previous employers or colleagues. The only exception to the no snail mail rule may relate to the thank you note. Be sure to send one to the interviewer in order to demonstrate that you value the interviewer’s time and effort. Also it will demonstrate your continued interest in the job.

Sources:
Ashurst, A. (2010).Moving on up: Career prospects for registered nurses. Nursing & Residential Care, 12(8), 400-402.

Gaddis, S. (2009). Your nursing career: 10 tips for perfecting a nursing interview. Tar Heel Nurse, (April-May), 6-7.

Thomson, H. (2007). Tipped for the top.Nursing Management, 14(2), 16-18.

Frequently our consultants are asked by our clients to help with choosing which accreditation will be the most appropriate for their particular business.  Some important considerations include: their client preferences or mandates, value of performance measurement data required by a particular accreditation process, cost, contribution to company infrastructure or marketing advantages.

Positioning one’s company in this current healthcare reform environment is challenging.  It is important  to examine your goals  to calculate the most  advantageous accreditation path: TJC, CHAP, NCQA, URAC?  We know them all, and can sort through the maze with you.

Call or write Peggy Thomas, Senior Consultant today to discuss your accreditation needs!

A decent resume can get you in the door for an interview.  A poor one can sink an otherwise promising relationship with an employer.

Through our experience at PSN, we know what works and what does not for applicants seeking direct hire or temporary staffing opportunities in the health care world of a registered nurse, especially in the specialties of case management, utilization review, and medical record review jobs.

Here is our list of “do’s” and “don’ts” for nurses seeking direct hire or temporary staffing employment with some of the best clients locally and nationally. It all starts with a resume…

Do:

…use a cover letter – A cover letter allows you to introduce yourself, summarize your abilities, and make the statements that support your resume. Proper use of a cover letter shows a level of professionalism that our Nurse Recruiters look for.

…make sure your objective is relevant - We just “love” getting resumes for case management positions where the resume objective is to find a position with a caring company as an obstetrics nurse. You may want to use a short professional summary in place of the objective. This would be similar to the information in your cover letter, but more clear-cut and to the point. Avoid the use of personal pronouns such as I, me, my, in your summary.

…check your spelling and grammar, we do! - Check for spelling errors and misuse of language. Nothing stands out more to a hiring manager than misspelled words, especially if it’s the name of the school you graduated from. Make sure your verb tenses are consistent throughout the document. These types of mistakes can make you appear careless with your work.

…get your degree and credentials right - For instance, there is no such thing as a “Bachelorette” degree in Nursing. If your credentials or certifications have expired, they should not appear after your name on your resume. If you are a licensed registered nurse it is also helpful to indicate your state of licensure.

…keep it short and to the point – Your cover letter is for extolling your virtues. Your resume should be concise, and no longer than absolutely necessary. No need for you to tell us all about the waitressing job you had in high school if you are applying for an academic position 30 years later. Provide details for the past 10 to 15 years. You can list older, relative, positions under the separate heading of “Additional Work History,” without all of the detail.

Don’t:

…use an unprofessional email address and voice mail – You can have a great cover letter & resume, but an email address such as “partygirl2” can tarnish your image before you even get the interview. Why not set up a separate account for professional use only? Yahoo and Gmail are free. The same can be said for your voice mail. It’s always fun when we call someone to arrange an interview and hear a voice mail message that starts out, “Yo yo yo, wassup?”

…leave out dates of employment – Include these dates on your resume. Leaving them out may seem to us as though you are trying to hide certain information.

…include personal information such as age, gender, picture, etc – This type of information should not be included on your resume unless you are applying for an acting job. We don’t need to see the glamorous head shot you just had done. And using special paper to get our attention doesn’t help matters either. Though your floral scented pink resume will make the rounds to different departments, it won’t be for the reason you had in mind.

…use abbreviations or contractions -If you are going to take the time to write it, take the time to spell it. Your resume is a formal document; do not use abbreviations or contractions in your words or sentences.

…have just one version of your resume – Your resume should be tailored to the position you are seeking. You may have several different versions depending on the type of jobs you are going after.

At PSN, we provide expert NCQA accreditation preparation in the following areas:

• Health Plan (HP) Accreditation
• Managed Behavioral Healthcare Organization (MBHO) Accreditation
• Preferred Provider Organization (PPO) Accreditation
• Disease Management (DM) Accreditation/Certification
• New Health Plan (NHP) Accreditation
• Medicare Deeming (MA)
• Special Needs Plans (SNP)
• Credentials Verification Organization (CVO) Certification
• Physician Practice Connections (PPC)
• PPC-Patient Centered Medical Home (PCMH)
• Physician/Hospital Quality (PHQ)
• Utilization Management (UM) and Credentialing (CR)
• Privacy Certification for Business Associates
• Wellness and Health Promotion (WHP)
• Physician Recognition Programs in Back Pain (BPRP), Diabetes (DPRP) and Heart/Stroke (HSRP)

Our NCQA consulting services for these programs include:

• Assessment of documentation compliance to NCQA standards
• Expert blueprint for compliance
• Gap analysis
• Assembling of your application
• Policy and procedure development
• On-site mock surveys
• File audits
• Program design
• And more

When you work with PSN, you will be successful! To learn more, view our NCQA Accreditation page or contact us.

1.    Provide adequate resources: The NCQA standards not only address quality improvement, but they also address a number of other areas, too.  Areas such as utilization management, provider relations, marketing, informatics, member services and support must be involved.  These areas must be supported by senior management and must be afforded the training and time to devote to the survey preparation effort.

2.   You can never start too early: Many NCQA standards require an organization to demonstrate compliance over a number of years.  It is advisable for an organization to start preparation activities three years prior to a survey.  This will afford the organization with time to make sure that structure and processes are in place and that required measurements and improvements can be documented.

3.    Engage expert help: Preparation for an NCQA survey requires expertise in NCQA subject matter and complex project management skills.  Often times the day-to-day working operations within an organization are all encompassing and do not afford individuals with the time to devote to the NCQA process.  If permanent staff devoted to NCQA oversight and preparation is not possible, consider investing in a consultant.   A consultant can establish project plans, interpret the intent of the standards, assess compliance, participate in and coordinate preparation activities, and track time lines and milestones.  If considering the use a consultant, make sure that the consultant is an NCQA surveyor.  Only an NCQA surveyor will truly understand the NCQA process, the intent of the standards, the philosophy behind NCQA accreditation and certification.

Ellen is a health care executive with more than 25 years of diversified experience in developing, training, implementing, supporting, and promoting health services strategies.  She has been an active NCQA surveyor since 1991 and helped to develop many of the NCQA Accreditation and Certification products.  Through her hands-on and personable consulting approach, Ellen has successfully guided many organizations towards successful NCQA Health Plan Accreditation and NCQA Disease Management Accreditation and Certification.

Concurrent utilization review takes place while a patient is receiving healthcare services. These services can be inpatient, outpatient, for rental of durable medical equipment, continuing use of medications and treatments, mental health services, and other specialized healthcare.  The goal of the review is to ensure that the patient continues to receive reasonable, appropriate care in the right health care setting to meet his/her healthcare needs.

Data collected during this review includes information about the patient’s continuing health status and the current treatment plan. In the event additional information is needed, the utilization review coordinator or physician reviewer may contact the patient’s attending physician to discuss the patient’s status and care. All information collected is reviewed against established utilization review guidelines or criteria, that may be nationally recognized or approved by the medical staff of the managed care organization. A decision is then made to approve or not approve services requested. In the event continuing services are not approved, a physician is involved in making the decision according to national standards because a denial or non-certification of services can only be determined by a physician.  A nurse or social worker can only approve care, and does  not non-certify a request for service, but must refer any case that does not meet clinical criteria to the physician for review.  The attending physician/other provider, facility and patient are informed of the decision in a timely manner, and each has the right to an appeal.

Voluntary accreditation in utilization management is a process that ensures that managed care companies have processes in place to ensure a fair process for persons involved, i.e. the patient, the attending physician, the facility. Healthcare organizations that are accredited by URAC, have the responsibility to conduct utilization review in accordance with URAC standards.

Aspects of the URAC requirements include ensuring licensed personnel conduct the review and that notification of the decision occurs in a timely manner.

HEDIS measures are associated with many important health issues. Data collection includes collecting information about varied  aspects of care provided to individual health plan members by health plan participating physicians. Annually, information is collected through the review of randomly selected medical records located in physician offices or other health care settings to identify evidence of the following:

• Cervical Cancer Screening, Women Age 21-64: PAP test performed within 2010 or prior 2 years.
• Breast Cancer Screening, Women 40 – 69: Mammogram completed  in 2010 or 2009.
• Childhood Immunizations completed by 2nd birthday: immunizations administered include DTaP/DT, IPV, MMR, HIB, hepatitis B, hepatitis A, and VZV.
• Colorectal Cancer Screening, adults 50 – 75 years old:  Occult blood testing conducted annually or sigmoidoscopy in 5 years or colonoscopy in 10 years
• Comprehensive diabetes care, Age 18-75:  Yearly screening of HbA1c testing,  LDL-C, Retinal eye exam, nephropathy screening test,  Blood pressure measurement
• Controlling High Blood Pressure, ages 18-85: if diagnosis of hypertension is present, is blood pressure controlled, i.e. < 140/90.
• Prenatal and Postpartum Care, pregnant women: Prenatal visit occurred within first trimester; postpartum visit between 21 and 56 days after delivery
• Beta-blocker treatment after heart attack, Age 18 and older: for patients who were hospitalized and discharged after an acute myocardial infarction, medication prescribed included treatment  with beta-blockers for six months after discharge

Many health plans evaluate and utilize HEDIS data to enhance the quality of the health care services that they provide. HEDIS data allows employers, as well as benefit consultants, to select the best plans suited for their employees needs. NCQA makes sure that the HEDIS results are valid through a health plan audit process that checks the accuracy of  the HEDIS measures that are collected and also evaluates how the data is  measured.

HEDIS measures are essentially a report card that evaluates the health plan’s success in providing preventative care delivered by physicians in a health plan’s network of providers.

References:
Fallon Community Healthplan (2010) 2011 HEDIS® measures. Retrieved 1/22/2011 at
http://www.fchp.org/providers/resources/hedis-measures.aspx

National Committee for Quality Assurance  (2011) 2009 HEDIS Performance Measures. Retrieved 1/22/2011 at
http://www.ncqa.org/tabid/855/Default.aspx

The Patient Centered Medical Home  model (PCMH) is a promising option for expanding primary care coverage while reducing costs and improving the quality of patient care. In February 2007, the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic published a set of joint principles describing the key characteristics of a Patient-Centered Medical Home (PCMH). A year later, the NCQA released its own standards for recognition of Patient Centered Medical Home practices; the NCQA plans to release updated standards in 2011.

The main characteristics of a Patient Centered Medical Home (PCMH) are:

1. Personal physician: Each patient at a Patient Centered Medical Home practice has a designated physician, who leads a collaborative team which provides primary care.
2. Coordination of care: The Patient Centered Medical Home coordinates the patient’s care with other providers and facilities to ensure that information about all medical care of the patient is consolidated in one location.
3. Access to care: Patients have easy access to care, with open scheduling of appointments and after-hours access to primary care providers when needed.
4. Technological solutions: Patient Centered Medical Homes make full use of electronic health records and information technology tools to accurately record and analyze care provided to each patient.

Recognition as an accredited Patient Centered Medical Home (PCMH) means physician practices and other organizations meet national standards in providing continuity of care is for each patient, and preventative care is fostered by creating a stronger ongoing relationship between patient and physician and by facilitating patient healthcare access to the providers.

The centralized coordination of care should also reduce the potential for unnecessary repetition of treatments or harmful medication interactions.

In the United States and internationally, recognized organizations providing a review process for organizations seeking voluntary accreditation include:

• The Joint Commission on Accreditation of Healthcare Organizations (TJC)
• Healthcare Facilities Accreditation Program (HFAP)
• National Committee for Quality Assurance (NCQA)
• Utilization Review Accreditation Commission (URAC)
• Accreditation Commission for Health Care (ACHC)
• Healthcare Quality Association on Accreditation (HQAA)
• Accreditation Association for Ambulatory Health Care (AAAHC)
• Community Health Accreditation Program (CHAP)
• Commission on Accreditation of Rehabilitation Facilities (CARF)

The process of healthcare accreditation usually involves a review of infrastructure, i.e. policies and procedures, job descriptions, credentialing processes, information management, as well as an operational assessment to determine that written documents stating policy and procedure are carried out in accordance to what an organization says it does. An assessment of organizational structure, processes and outcomes affecting the delivery of client healthcare services are carefully assessed in order to determine quality practices are in effect as that organization provides consumer services.

To meet accreditation standards, organizations invest resources of people and time because of a desire to be among the best, which meeting national standards exemplifies. Today, cost containment can affect quality and quantity of services, and an organization that meets accreditation standards is one that a consumer can have additional confidence in as standards of national quality and service have been achieved.

Reference:

Agarwal, R. (2010). A Guideline for Quality Accreditation in Hospitals. Quality Digest. Retrieved
1/15/2011 at http://www.qualitydigest.com/inside/health-care-article/guideline-quality-
accreditation-hospitals.html