DVA Community Nursing Program Education Package for 1 October 2014 - PowerPoint PPT Presentation

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DVA Community Nursing Program Education Package for 1 October 2014

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  1. TABLE OF CONTENTS Part 1 - Overview of the new Procedure Manual Part 2 – Classifying under the new Classification System (starts slide 45) Part 2A – Workshop examples (starts slide 97) Part 3 – Claiming and Reporting (starts slide 116) DVA Community Nursing Program Education Package for 1 October 2014

  2. Part 1 Overview of the new Procedure Manual DVA Community Nursing Program Education Package for 1 October 2014

  3. Session Objectives At the end of this session you will have: • A good understanding of the background to the new Classification System and Schedule of Fees. • A good understanding of the requirements and obligations within the Procedure Manual for the Provision of Community Nursing Services.

  4. DVA’s Community Nursing Program The aim of DVA’s Community Nursing Program is to enhance the independence and health outcomes of the entitled person by avoiding early admission to hospital and/or residential care by providing access to community nursing services to meet an entitled person’s assessed clinical and/or personal care needs. These community nursing services are delivered by a skills mix of registered nurses (RN), enrolled nurses (EN) and nursing support staff (NSS). Please see section 2 of the Procedure Manual Information updated October 2014

  5. DVA’s Community Nursing Program Care Environment A CN Provider must: • deliver community nursing services in line with industry recognised evidence based best practice and community nursing industry standards; • provide, at a minimum, a contact for an entitled person for emergency purposes 24 hours a day, 7 days a week; • deliver community nursing services in an environment that promotes dignity, integrity and a respect for cultural and linguistic diversity and social differences; and • assist an entitled person to develop, increase or maintain their independence and well being. Please see section 4 of the Procedure Manual. Information updated October 2014

  6. Procedure Manual for the Provision of Services Previously known as the Guidelines for the Provision of Community Nursing Services, the document has now been renamed to Procedure Manual for the Provision of Community Nursing Services (Procedure Manual). As per the Deed of Standing Offer, all DVA contracted Community Nursing Providers (CN Providers) are required to comply with the Procedure Manual. A CN Provider must ensure that all of its personnel and subcontractors have access to, and a working knowledge of, the current Procedure Manual, including any amendments made over time. The Procedure Manual has been emailed to your organisation. If another copy is required, please email nursing@dva.gov.au Information updated October 2014

  7. DVA Community Nursing Classification System The previous Community Nursing Classification System had been in operation since 1 March 2010 and it was timely that a comprehensive review was undertaken. Health Outcomes International (HOI) was appointed in August 2012 to undertake this review. HOI recommended that DVA implement a revised banding model that allows claiming of ‘combinations of care’. Information updated October 2014 Running Footer

  8. DVA Community Nursing Classification System The aim of the new classification system is to: • Allow combinations of care using a “core” and “add-on” classification and fee structure • Provide an accompanying Exceptional Case payment model designed to correlate with the Schedule of Fees • Provide a payment model for situations where two workers are requiredfor the same task Information updated October 2014

  9. DVA Community Nursing Classification System Combination of Care Model Comprises separate Schedules for: • Clinical Care • Personal Care • Other Items (including Exceptional Case Unit (ECU), Coordinated Veterans’ Care (CVC) and Wound Consumables). Information updated October 2014

  10. ContractualArrangement Deed of Standing Offer (as per Request For Tender) • Procedure Manual for the provision of community nursing services • Schedule of Item Numbers and Fees Contract performance monitoring • DVA CN Quality Management Framework • Ongoing post-payment monitoring • Ad-hoc as issues arise (eg complaints) Information updated October 2014

  11. WHAT’S NEW IN THE PROCEDURE MANUAL? World War II Nurses on an excursion to the Pyramids Information updated October 2014

  12. REFERRALS Referral Sources A Nurse Practitioner specialising in a community nursing field is now able to refer an entitled person to a DVA-contracted community nursing provider for an assessment of community nursing care needs. Referrals Obtaining a new referral every 12 months is no longer required. A referral is only required for: - newly admitted entitled persons - entitled persons starting a new episode of care. Information updated October 2014

  13. ASSESSMENT Assessment – Ongoing (NA02) - must be undertaken by a Registered Nurse Can be claimed: • on admission at the beginning of the episode of care. • at every 12 month anniversary for all entitled persons who have been receiving ongoing community nursing services. It is expected that the entitled person’s care plan will be reviewed and rewritten in this review, and referral source notified of the outcome. If an entitled person has their 12 month anniversary, after 1 October 2014, a CN Provider can claim the Assessment Ongoing item number (NA02). Information updated October 2014

  14. ASSESSMENT – No ongoing services required (NA99) Must be undertaken by a Registered Nurse Can be claimed if the outcome of the comprehensive assessment indicates that the entitled person does not require community nursing services. Only one Assessment – no ongoing services required classification can be made in three consecutive 28-day claim periods. If the entitled person does not require any services, it is expected that the CN Provider will feedback this information to the referral source. Information updated October 2014

  15. Palliative Care – Deteriorating and Terminal The requirement to register all entitled persons in Palliative Care Deteriorating and Terminal phases with the ECU has been removed. Please see section 6.5.2 of the Procedure Manual. Information updated October 2014

  16. Wound Management Consumables The range of item numbers for wound management consumable range has been increased to $10.00 to $300.00, per 28-day claim period. Wound management consumables over $300.00 (GST exclusive) continue to be reimbursed through tax invoice to DVA. Please see Attachment D of the Procedure Manual. Information updated October 2014

  17. Entitled Person Not Responding Clinical and administrative policies – Entitled Person Not Responding The Commonwealth Home Care Standards require community care service providers to develop, where agreed with the entitled person, an individual plan of action to be implemented as part of their policy and procedures in the event that an entitled person does not respond when the care worker arrives to deliver the scheduled service visit. Any occasions where the ‘entitled person not responding’ plan has been implemented, a summary of events should be document in the entitled person’s care documentation. If an Entitled Person Not Responding Plan is implemented, a CN Provider can claim one visit. More information can be found at the following link: http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-commcare-qualrep-standards.htm Please see section 10.4 of the Procedure Manual. Information updated October 2014

  18. Claiming Up to and including 30 September 2014: For 28-day claim periods commencing on or before 30 September 2014, the CN Providers must claim using the ‘old’ Schedule of Fees. After 1 October 2014: Any services provided in the 28-day claim period that commences after 1 October, must be claimed using the new Schedule of Fees. All claims prior to 1 October 2014 should be submitted by 23 December 2014. Information updated October 2014

  19. Minimum Data Set (MDS) – Assessment Data The requirement to record Assessment Data (ADLs) in the MDS has been removed. Information updated October 2014

  20. MDS – Other Items Add-Ons All Palliative Care add-on items require MDS, as well as Bereavement follow up, ECU items including Second Worker and both Assessment items. In other words the only items that do not require staffing resources for MDS are Additional Travel, CVC and Wound Consumables. Information updated October 2014

  21. What is an occurrence for MDS purposes? In instances where an RN/EN delivers Clinical and Personal care in the same visit and a CN Provider claims a core and add-on item, each component of the care delivered should be counted and recorded in the MDS as a separate occurrence. There is a possibility in one visit there maybe three separate occurrences of services being delivered, e.g: • core item • opposing schedule add-on • palliative care (other items add-on) Information updated October 2014

  22. Visits vs Occurrences A visit is where only one type of care is delivered, e.g. NSS providing personal care. An occurrence can be defined as the total number of different tasks completed by the RN or EN within a visit, e.g. when an RN/EN provides both Clinical Care and Personal Care in the same visit, this will be counted as two occurrences. Information updated October 2014

  23. Example of an occurrence for MDS purposes? An RN makes four visits in a 28-day claim period (one visit per week), each visit lasts 1½ hours. Within each visit, half an hour of personal care services are delivered by the RN and one hour of Clinical Care. A total of eight visits/occurrences will be recorded over the 28-day claim period, with the MDS being reflected as follows: Information updated October 2014

  24. What’s in the Procedure Manual? AANS nurse on rounds World War II

  25. Medication Administration – Clinical Care The entitled person must be classified under the Clinical Care Schedule and the care must be provided by an RN, or EN with approved qualification in administration of medications, if the entitled person requires the administration of: • prescribed medications (Schedule 4 and above); • Schedule 8 drugs if dispensed from a bottle/packet, including Schedule 8 transdermal patches; • cytotoxic drugs or creams; and/or • prescribed medicated eye drops (Schedule 4 and above). See section 6.3.1.5 of the Procedure Manual. Information updated October 2014

  26. Assistance with Medication – Personal Care An entitled person can be physically assisted with self-administered medication in the Personal Care Schedule by NSS under the following criteria: • the entitled person’s medical condition/s are stable; and • there is an established medication regime; and • there is a comprehensive care plan in place which includes medication contraindications and emergency contacts; and • there is a blister pack filled by a registered Pharmacist which meets the DVA Dose Administration Aid Service Procedure Manual; or • it is over-the-counter medication, or prescribed/non-prescribed cortisone cream; and Information updated October 2014

  27. Assistance with Medication – Personal Care CONTINUED from previous slide • the NSS has completed the required assistance with medication administration competencies, adheres to the relevant National and State based Drug Acts, and adheres to the CN Provider’s Medication Administration/Prompting Policy or Policies; • the RN, EN and NSS must adhere to the Delegation of Care principles and any change in health status is reported immediately to the RN; and • any assistance with the self-administration of Schedule 8 drugs is provided from a Dose Administration Aid; and • the RN (or an EN with an approved qualification in administration of medication) will conduct a face-to-face visit and review the entitled person on a weekly basis if assistance with the self-administration of Schedule 8 drugs are involved. See Section 6.4.3 of the Procedure Manual. If the entitled person does not fall within these criteria, they must be classified under the Clinical Care schedule. Information updated October 2014

  28. Requirements for Review of Care Information updated October 2014

  29. Requirements for Review of Care CONTINUED Please see section 7 of the Procedure Manual. Information updated October 2014

  30. PERSONNEL A CN Provider may use a mix of personnel to deliver community nursing services. These personnel include: • Registered Nurse (RN); • Enrolled Nurse (EN); and • Nursing Support Staff (NSS). When delivering community nursing services, all personnel must work within the framework of the relevant national standards and meet all State and Commonwealth statutory requirements. CN Providers must maintain current registration and continuing education documentation for all their personnel. Please see section 9 of the Procedure Manual. Information updated October 2014

  31. Delegation of Care A CN Provider must ensure that all community nursing services delivered by an EN and/or NSS are planned, delegated, supervised and documented by an RN. In line with the National Competency Standards for RNs, the RN must recognise the differences in accountability and responsibility between RNs, ENs and unlicensed care workers (i.e. NSS). More information can be found at the following link: http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Codes-Guidelines.aspx#competencystandards Please see section 9.2.5 of the Procedure Manual. Information updated October 2014

  32. Continuing education for personnel The CN Provider should ensure that its personnel have access to, and undertake, appropriate continuing education and professional development, particularly in relation to the provision of community nursing services, on a regular and on-going basis. The CN Provider must maintain current education and professional development records for all its personnel. This is in line with the Australian Health Practitioner Regulation Agency (AHPRA) Standards for Nursing. More information can be found at the following link: http://www.nursingmidwiferyboard.gov.au/Registration-Standards.aspx Please see section 9.2.6 of the Procedure Manual. Information updated October 2014

  33. Clinical and administrative policies A CN Provider must have written clinical and administrative policies in place which adhere to the provisions contained in the relevant State or Territory legislation and which are appropriate for a community nursing setting. At a minimum, these policies must include: • Work Health and Safety; • Incident, Accidents and Dangerous Occurrence Management; • Infection Control; • Medication Management; • Entitled Person Not Responding; and • Delegation of Care. Please see section 10.1 of the Procedure Manual. Information updated October 2014

  34. CARE DOCUMENTATION A CN Provider must develop and maintain an appropriate care documentation framework for a community nursing setting based on the principles of the community nursing industry recognised evidence based best practice. An entitled person’s care documentation must be developed in conjunction with the entitled person and, if applicable, the carer and the family. The entitled person must be provided with, or be able to access in a timely manner, an up-to-date copy of the care documentation. Please see section 10.2 of the Procedure Manual. Information updated October 2014

  35. Care Plans and Care Documentation Following an assessment, a care plan must be completed by a RN. A care plan must include the: • Clinical and Personal Care activities identified from the assessment • Goal/s of care (short and long term) • Nursing intervention/s • Desired outcome/s • Delegation of care • Review dates Clinical nursing notes and assessment documentation must remain current and up to date and based on current community nursing industry best practice standards. See Section 10.2 of the Procedure Manual Information updated October 2014

  36. DVA’s right to access records The CN Provider must make the care, administrative and/or claiming documentation (copies or electronic) available to DVA, or any person or organisation authorised by an authorised DVA delegate, and provide reasonable access to the documentation upon request. As a component of the Community Nursing program’s Quality Management Framework or Post-Payment Monitoring processes DVA may request copies of the care, administrative, and/or claiming documentation to be sent to DVA to enable these Quality Management Framework or Post-Payment Monitoring processes to occur. DVA will retain copies of this documentation where required. Please see section 10.2.2 of the Procedure Manual. Information updated October 2014

  37. Privacy, documentation and record keeping All CN Providers must develop, maintain and store appropriate documentation relating to the claiming, administrative, and clinical aspects of the entitled person’s episode of care. CN Providers must ensure that the storage and security of personal information regarding an entitled person is in accordance with the Australian Privacy Principles, which came into effect on 12 March 2014. The Australian Privacy Principles (APPs) replace the Information Privacy Principles (IPPs) that previously applied to Australian Government agencies and the National Privacy Principles (NPPs) that previously applied to businesses. Please see section 10.2.1 of the Procedure Manual Information updated October 2014

  38. CONTINUOUS IMPROVEMENT A CN Provider must have a continuous improvement framework in place. A continuous improvement framework is made up of quality systems and at a minimum, includes systems for: • the management of risk, including health and safety risks to an entitled person; • the management of feedback to other health professionals; • the management of complaints and feedback from entitled persons and other individuals; • the evaluation of continuous improvement outcomes; and • the management of records to ensure maintenance and appropriate access. Please see section 13 of the Procedure Manual. Information updated October 2014

  39. Performance Monitoring and the Quality Management Framework (QMF) A CN Provider is subject to assessment under Performance Monitoring and the CN QMF. Claiming and MDS data are used for monitoring. Post-Payment Monitoring is an ongoing process and CN Providers receive feedback by phone and in writing. An ongoing program of desk reviews of entitled persons files and performance monitoring visits are undertaken. Please see section 13.2 of the Procedure Manual. Information updated October 2014

  40. QMF CYCLE As part of the QMF cycle: • CN Providers complete a questionnaire. • A risk assessment is completed by DVA using all available information. A plan of performance monitoring activities is developed by DVA and CN Providers may be contacted regarding: • Performance review visit to CN Provider site/s; • Visiting a sample of entitled persons in their home to review care; • Desk reviews of entitled persons documentation; and • Post-Payment Monitoring. Please see section 13.3 of the Procedure Manual. Information updated October 2014

  41. SECURE EMAIL This is the Department’s preferred method for written communication. The DVA’s Secure Mail Facility has been introduced to enable the secure communication of Sensitive information between DVA and Providers. Sensitive emails sent via this facility have been encrypted to ensure the information within remains private and secure. If you receive Sensitive information from DVA, you must be aware of your obligations under the Privacy Act. More information can be found at the following link: http://www.dva.gov.au/help/sensitive/Pages/faq.aspx Information updated October 2014

  42. ONLINE CLAIMING Online claiming is the preferred method for the Department. CN Providers are encouraged to use this form of claiming. To find out more call Medicare’s eBusiness Service Centre on 1800 700 199 or go to: http://www.medicareaustralia.gov.au/provider/business/online/eclipse/index.jsp Information updated October 2014

  43. Interaction with other Community Support Service Providers • Veterans’ Home Care (VHC ) Program • Rehabilitation Appliances Programme (RAP) • HomeFront • DVA Contracted Diabetes Educators • Veterans and Veterans Families Counselling Service (VVCS) • Home Care Packages Programme • Commonwealth Home Support Programme • Transition Care Program • State or local based community services Please see section 15 of the Procedure Manual. Information updated October 2014

  44. End of Session 1 Vietnam War

  45. DVA Community Nursing Education Package for 1 October 2014 Part 2 How to classify entitled persons under the newClassification System Information updated October 2014

  46. Session Objectives At the end of this session the participants will have: • A good understanding of the Department’s requirements for the referral, assessment and care plan procedures, including documentation requirements. • A good understanding of how to apply the Community Nursing Classification System to claim services for entitled persons. • An understanding of how the core and add-on classification and fee structure works. • An understanding of the whole process, from referral to claiming, and the requirements set by the Department. Information updated October 2014

  47. The Classification System A CN Provider must classify an entitled person under the appropriate classification in the DVA Community Nursing Classification System (Classification System). The Classification System is based on an episode of care model where a provider claims for payment at the end of the 28-day claim period. The Classification System is based on groupings of visit types and is organised into three separate schedules: • the Clinical Care Schedule • the Personal Care Schedule • the Other Items Schedule Information updated October 2014

  48. Combinations of Care CN Providers can claim a core item number is claimed under the ‘majority of care’ principle. An item number can also be claimed from the opposing schedule as an ‘add-on’, for example if the: • core item is from the Clinical Care Schedule, a Personal Care add-on can also be claimed • core item is from the Personal Care Schedule, a Clinical Care add-on can also be claimed See section 6.2 of the Procedure Manual Information updated October 2014

  49. Majority of Care Principle Majority of care principle will determine the ‘core’ classification: • From the Clinical or Personal Care Schedule (N.B. do not include Palliative Care in the calculation); • Would be generally based on visit count; • Although, there may be situations when the time factor for each visit may represent the majority of care. Majority of care based on the time factor is determined by: • Calculating the total minutes of the same visit type provided in the 28-day claim period and divide this by the number of visits provided to determine the correct core item number. Where equal time and visits has been spent on both personal and Clinical Care, the entitled person should then be classified under the Clinical Care Schedule. Information updated October 2014

  50. Clinical Care Schedule Matron Grace Wilson on rounds in Lemnos, 1915 There are 3 visit types within in the Clinical Care Schedule: Clinical Support Clinical (Short or Long) Post-Operative Eye Drops