Avoiding Common Mistakes and Achieving the Wow Factor

Requirements and policies

Frequent concerns/challenges

Achieving the “Wow Factor”

Requirements:◦ Cursory◦ Complete entrance exam◦ Laboratory tests◦ Immunizations◦ TB Test◦ Walk-in clinic◦ An appointment system◦ Off-center specialist referral system◦ 24-hour emergency care system◦ HIPAA Notice

5. Do not use VFC/improper immunizations 4. Entrance exams are not done within the required

timeframe3. Students with chronic health conditions are not

monitored2. Ineffective use of walk-in clinic or ineffective

appointment system1. Issues with the health record/documentation

Student, Joe

ID# 123456

Allerg

ies: Am

oxicilli

n

Sticker indicates that

Joe has insurance.

May put allergies on the cover

Mental Health

Oral H

ealth

Lab Resu

lts

Medical n

otes

History

Health records are confidential,

chronological accounts of medical information!

Every record documents continuity of care by

nursing, medical, dental, and mental health.

Student, Joe

Health and wellness staff should review the

record each time a student reports to the health and wellness

center!

The center physician and the HWM should review student health

records for completeness on a

regular basis (excellent CQI project). Joe Student

11/11/08 7:00am

S = Joe in at open hours. Says, ‘I don’t feel well. My head hurts. My chest hurts. I am freezing and burning up and can’t stop coughing. I have got worse for the last 2 days.’

O = Rales bilaterally. Pulse 82, Respirations 22 and labored. Wheeze noted on inspiration. Skin dry and hot to the touch. T-102F. Coughing during exam and phlegm green tinged. Denies vomiting/diarrhea, has no appetite.

A = Alterations in Comfort, URI

P = Per HCG, gave Keflex 500mg TID, po. Guituss cough syrup 1 tsp every 4 hours, Tylenol 500 mg. po every 4 hours. Instructed on benefits, possible side effects and need to complete antibiotics. Instructed to increase fluids, esp. H2O and to report back to Wellness if no improvement or gets worse in 2-3 days. Student verbalized understanding. Medication Handout provided. F/U in 1 week.

Linda Goodnurse, RN

Student, Joe

11/11/08 Student in and feels bad.Been coughing, head hurts.Has a cold. Gave antibiotics, Tylenol and cough syrup.

LG, RN

11/11/08, 7:00 am

S =“I have a cold”O = Temp: 101, BP 112/74, Resp 20, Non-

productive cough, lungs clearA = Upper Respiratory SymptomsP = Put to bed in HWC—Force fluids, Ibuprofen 400

mg. Q 6 hours, cough syrup, if needed, Monitor for sore throat, rash, ear ache or persistent temp >101. Reevaluate before sending to dorm when HWC closes. Reevaluate in AM.

11/11/08

S = Student reports having difficulty sleeping in the dorm along with feelings of  sadness and disinterest in center activities over past two weeks. Student states that he is becoming increasingly irritable. Personal history includes past depression with meds about one year ago, physical abuse and foster care placement from ages 12 to 18.

O = Student was generally anxious throughout the session with a flat affect. At one point became tearful and slightly agitated. Denied any suicidal thoughts or past suicidal behavior.

A = Student has been on center for two months and is experiencing adjustment issues which may be triggering a recurrent episode of depression. Shows moderate level of motivation to address symptoms and remain in program.

P = Schedule next appointment for 11/19/2008 @ 12pm for further diagnostic assessment and to continue short term cognitive-behavioral therapy. Gave student sleep hygiene brochure and told to return to Health and Wellness Center if problems do not get better before next appointment. Refer to Center Physician for psychiatric/medication evaluation. Referred to Counselor’s Adjustment Group. Alert RA and Counselor to watch for any behavioral changes over the week and refer back to Health and Wellness, if needed.

Janet Counselor, PhD

Student, Joe

Maintaining accurate chronological record of health care in progress notes

Enhancing communication among health care providers

Monitoring health provider performance Meeting legal requirements Standardizing care Achieving cost benefits Following through on treatment plans Documenting student non-compliance with

care

How much do you know?

1. Only when the student sees the center physician

2. If the student receives any type of medicine

3. Every time a student comes to wellness4. None of the above

1. Only when the student sees the center physician

2. If the student receives any type of medicine

3. Every time a student comes to wellness4. None of the above

1. The record should be thrown away2. The record should be sent to the RO3. The record should be reviewed for

completeness, sealed in an envelope and forwarded to the appropriate department, except in cases of student death

1. The record should be thrown away2. The record should be sent to the RO3. The record should be reviewed for

completeness, sealed in an envelope and forwarded to the appropriate department, except in cases of student death

Strong community connections Notate Health Care Guideline in health

record (more about HCGs later) HWM has an active role on center, outside

the wellness center Think outside the box!

Common Concerns:◦ Students are not evaluated annually◦ Staff are not trained in CPR/First Aid

Achieving the Wow Factor:◦ Devise a tracking system for annual medical

clearances◦ Create a notification system to let the recreation

supervisor know about restrictions

Common Concerns:◦ High pregnancy rates◦ Lack of contraception options

Achieving the Wow Factor:◦ Partner with a local agency to provide education

to students◦ Institute a peer-education program◦ Have a ‘Baby Think it Over’ or similar program

Common Concerns◦ Students do not receive pre/post-HIV test

counseling within 14 days

Achieving the Wow Factor◦ Strong case management◦ Good referral system set up◦ HIV-prevention education programs

Common Concerns◦ Lack of SART team leadership/Ineffective SART

team◦ Team does not meet regularly

Achieving the Wow Factor◦ Connections with law enforcement and victims’

groups◦ Education for students to avoid risky situations

Common Concerns◦ Vacancies over long periods of time◦ Issues with licenses

Achieving the Wow Factor◦ Creative advertising methods

Common Concerns◦ Only file signature page of authorization◦ Not posting HIPAA Notice

Achieving the Wow Factor◦ Post HIPAA information throughout the center

Common Concerns◦ Double dipping

Achieving the Wow Factor◦ Providing students with information in writing

regarding basic health services

Common Concerns◦ Excessive ER visits◦ Discontinued major medical information still on

center◦ Unaware of student third-party coverage

Achieving the Wow Factor◦ Most students on center have third-party

coverage◦ Strategy to obtain coverage or community

resources

Common concerns:◦ No subcontract for optometrist◦ Expired licenses are in the file

Achieving the Wow Factor:◦ Have copies of current state nurse practice act for

RN and LPN◦ Subcontractors picture and license in lobby

Common Concerns◦ Two staff members do not perform the count◦ Same staff orders and receives shipments◦ No double lock…The room door lock may not

serve as one of the locks! ◦ Narcotics are kept in exam rooms

Achieving the Wow Factor◦ Use a lock with a numeric key pad◦ Have students sign off on narcotics

Refer to: JOB CORPS INFORMATION NOTICE NO. 08-17 September 17, 2008

Common Concerns:◦ Not documenting waivers adequately◦ No STI testing

Achieving the Wow Factor:◦ Aggressive patient education to avoid waivers

Common Concerns:◦ Over or under use of FECA/OWCP

Students are considered federal employees for purposes of OWCP.Refer to TAG E for details

Common Concerns◦ Failure to submit annually

Achieving the Wow Factor◦ Notating health care guideline in documentation

Common Concerns◦ Orientation after the cursory/none at all

Achieving the Wow Factor◦ Good wellness orientation booklet◦ Not just wellness manager—mental health, TEAP,

oral health involved

HIPAA Notice should be signed during orientation!

Common Concerns◦ Lack of follow-up for students out on MSWR◦ Proper referrals are not provided

Achieving the Wow Factor◦ Devise a log to follow up on MSWRs

Common Concerns◦ Issues with paperwork/reporting

Achieving the Wow Factor◦ Grief counseling or critical incident plan

Common Concerns◦ Not reporting based on state and local health dept

laws

Achieving the Wow Factor◦ Intense education program on communicable

diseases (health department speakers, etc.)◦ Good advertisement for flu-vaccine clinics◦ Information on flu vs. common cold◦ Antibiotic misuse education◦ Signs in restrooms about hand washing◦ Hand sanitizers throughout center

Common Concerns◦ Equipment is dated or does not function properly◦ Records on dispensing, inventory, and disposal of

medical and dental supplies and medications are not maintained

Note: Use Job Corps recommended list of medications in TAG-M and purchase from government supply companies (GSA, HHS, VA) whenever possible.

Common Concerns◦ Centers do not survey students◦ Don’t have an established quality improvement

program

Achieving the Wow Factor◦ Use a form with a numeric rating and a qualitative

section for comments-document changes you’ve made based on this survey

◦ Meet regularly with the Student Wellness Committee◦ Conducting quarterly student focus groups◦ Conduct studies on treatment protocol

Common Concerns◦ The CMHC and Center Physician do not meet with

the Center Director◦ Minutes of meetings are not kept

Achieving the Wow Factor◦ Entire wellness team (including wellness

manager, dentist, and TEAP specialist) meets with CD

Common Concerns◦ Reports are not filed on time

Reporting requirements are:

•Health Services Program Description

•Health Services Utilization Report (kept on center)

•Alcohol Testing Report

Health Insurance Portability and Accountability Act (HIPAA) regulations mandate strict attention to privacy laws and confidentiality of records (April 2003).

Protection of PII: personally identifying information (refer to Program Instruction Notice NO. 06-23)

Suggest reviewed and modified with any PRH changes

Must be individualized to meet center’s needs

Should be a blueprint Should have at least one for each PRH

requirement, more based on center policies Sent for approval to RO yearly or with any

changes

Develop community connections See if local hospital will allow center to use “indigent

program”, sliding fee scale, give discounts Check local mental health agencies for victim services that

are provided through grants, provision of speakers for groups, assemblies, pamphlets

Do a MOU with Voc Rehab (refer to Program Instruction Notice No.99-03)

Look at other local, state, or national resources Use Health Department services Use Walmart $4.00 prescription plan when possible Use student insurance to purchase their medication when

possible Use Vaccine for Children's Program (VFC) Pharmaceutical companies for programs available

Make sure you prepare the pre-ROCA tools Make sure your PRH and forms are up to date Be prepared to share at least 3-5 innovative

programs or promising practices Demonstrate how Health and Wellness is part of

the center team outside wellness Make every effort to have subcontracted staff

available Review last ROCA responses and be prepared to

talk about how you’ve addressed them

SOPs/COPs Health Care Guidelines Personal authorizations Subcontracts, licenses, certifications, and malpractice

insurance for all contracted staff (current), waivers if applicable

Licenses for health and wellness staff SIRs for past year MSWRs for past year 2-3 disability folders Narcotics Logbook Disclosures log Quarterly alcohol summary for past year

HMIS reports for past year Minutes from monthly

meetings with CD/CMHC/ Quality Assurance

(surveys, minutes from committees)

Quarterly SART meetings Required Wellness training

logs (can get from HR manager)

MSDS SHARPS exposure log CA-1 log

Pre-ROCA tools Interview time set up for

various center staff/subcontracted staff

Any MOUs or contracts with other medical providers, voc rehab

Clia certification Dental Productivity Data Most recent Corporate and

ROCA reports Typed list of all Wellness

staff and subcontractors names, hours, days on center and length of time in their positions

List of 3-5 Best Practices