3. Tardiness and Missed Appointments without Adequate Notice -- the agency received several complaints from clients or from their family members about service providers who had failed to keep scheduled appointments without any notice. There were also numerous complaints about late arrivals at the homes of patients. The supervisor determined that all of the complaints about missed appointments related to two CNAs; they determined that the tardiness complaints pertained to many service providers but that in the vast majority of cases, the delays were unavoidable and attributable to delays incurred by the service providers at the homes of previously scheduled patients.

4. Unnecessary Referrals for Services and Misstatements of Public Program Eligibility -- in several instances, patients had been referred inappropriately for home health services by their physicians. In most of those cases, the patients and their families had also been misinformed about their eligibility for public assistance for the financial responsibility for home health services.

5. HIPAA violations in the Field -- During several unannounced visits by field supervisors, they discovered inappropriate handling of protected health information (PHI) that should have been secured from potential unintentional disclosure. Because these instances were HIPAA violations, they were immediately referred to the respective ISO from the office dispatching the service provider involved. The ISOs determined that the violations were purely unintentional and the result of negligent handling of paperwork for convenience. Typically, paperwork from previous clients or paperwork being amended by the service providers involved were carelessly left in the open at other patients' homes where they could have been unintentionally exposed to being viewed by non-privileged individuals.

Description of Solutions

Nosocomial Infections -- the agency implemented mandatory supplemental training for all home health service providers. Those training sessions emphasized antiseptic preparation, insertion, and inspection of Foley catheters to prevent nosocomial urinary tract...

They also covered wound care and, more generally, the importance and mandatory nature of proper hand washing.
Bedsores -- the agency provided additional training in the form of a mandatory one-session review class emphasizing the importance of involving family members in the prevention of bedsores and of the need to make accurate assessments of the ability of family members to fulfill related responsibilities.

Tardiness and Missed Appointments without Adequate Notice -- the two individuals who had missed appointments without valid excuses were placed on formal notice of unsatisfactory performance. One was subsequently terminated. The other service providers received supplemental training and instructions emphasizing the need to provide immediate notice by telephone to clients in the event of unavoidable delays as soon as the need became apparent and of the need to avoid unrealistic schedules based on previous experiences with specific patients whose care typically took longer than their scheduled time slots.

Unnecessary Referrals and Misstatements of Public Program Eligibility -- the agency has the least amount of control over this variable. To minimize the problem, agency telephone intake representatives received additional training to enable them to identify and address potential inappropriate referrals on their initial inquiries and requests for services.

HIPAA violations in the Field -- the ISOs immediately responded to this problem by making formal entries into the personnel files of the employees involved and required all service providers to attend a supplemental training session on HIPAA compliance in the area of protecting confidential health information appropriately at all times.

Conclusion

This project revealed several significant problems encountered by the organization during the observation period. The exiting supervisory staff exhibited professionalism and efficiency in recognizing and implementing appropriate measures to resolve the identified problems immediately. At the conclusion of this project all of the problems identified had been effectively resolved.