| CRITERIA MEASURE |
Met |
Not Met |
Comments |
Refer to Department |
 Prospective patients receive and sign informed consent forms that delineate services |
|
|
|
|
| A proactive system exists to identify on-going risks to patient safety |
|
|
|
|
| Available services are posted in the clinic area. If the population of the community is bi-lingual, postings are are bi-lingual |
|
|
|
|
| Patients are informed in writing the professional providing services is not a physician |
|
|
|
|
| Patients are informed in writing the scope of services prohibited by the professional providing care |
|
|
|
|
| Prescription prohibitions are controlled through restrictive software programs |
|
|
|
|
| Patients are informed that some conditions may require services beyond what is available at the clinic |
|
|
|
|
| Proactive risk compliance evaluation is conducted at least every six months |
|
|
|
|
| Failure mode events are given high priority |
|
|
|
|
| Policies and Procedures are updated as changes are implemented |
|
|
|
|
| Policies and Procedures do not conflict with other Policies and Procedures |
|
|
|
|
| Barriers to communication are identified and remediated: interpreters are available to all patients |
|
|
|
|
| Clinic marketing materials accurately represent services available |
|
|
|
|
| The clinic identifies what constitutes a conflict of interest |
|
|
|
|
| Informed consent policy includes: |
|
|
|
|
| Which procedures require Informed Consent |
|
|
|
|
| The process used to obtain informed consent |
|
|
|
|
| How Informed Consent is documented in the patient's record |
|
|
|
|
| When a surrogate decision maker can grant consent |
|
|
|
|
| Informed Consent contains: |
|
|
|
|
| Nature of the proposed treatment, procedure, care, diagnostic test, medication |
|
|
|
|
| Potential benefits, risks, side effects and recovery risks and expectations |
|
|
|
|
| The likelihood of achieving treatment goals |
|
|
|
|
| Reasonable alternatives related to the treatment or care |
|
|
|
|
| Risks of receiving care from a non-physican professional |
|
|
|
|
| Care is provided only after informed consent is signed |
|
|
|
|
| Risks and benefits related to alternative care |
|
|
|
|
| Patients and families are informed regarding filing complaints |
|
|
|
|
| Complaint resolution is documented |
|
|
|
|
| Resolved complaints are reported to patients and families |
|
|
|
|
| Patients and families are informed regarding filing complaints with state agencies |
|
|
|
|
| Policies exist to prevent abuse, neglect and exploitation |
|
|
|
|
| Patients are informed regarding how to access adult and child protection agencies |
|
|
|
|
| Policies address when to discharge patients when treatment needs exceed the capabilities of the clinic |
|
|
|
|
| Contractual agreements are in place for receiving hospitals |
|
|
|
|
| Policies include provisions of care the clinic cannot provide |
|
|
|
|
| Policies are in place to evaluate victims of crimes, abuse or neglect |
|
|
|
|
| Policies include provisions for referral to law enforcement agencies when abuse, criminal acts or neglect is identified |
|
|
|
|
| Policies are in place to address patients identified with alcoholism and substance abuse disorders |
|
|
|
|
| Policies are in place to address patients identified with psychological, developmental and emotional disorders |
|
|
|
|
| Discharge planning is initiated immediately upon admission. Patients and families are included in discharge planning |
|
|
|
|
| Patients are informed how to obtain continuing care after discharge |
|
|
|
|
| The Infection Control Program is evaluated with a risk analysis at least annually |
|
|
|
|
Copyright © OmniSure Consulting Group, Inc., 2008
|
