{"ref":"CA-HSP-IDG-03","title":"Coordination of Care, Communication System, Orders and Significant Change Notification","category":"Hospice care","summary":"Sets out the Agency's documented system of communication among everyone who cares for a patient, in every setting and with non-hospice providers; the significant change rule (any staff member or volunteer who observes a significant change must see that the attending physician, Medical Director or Designee is told as soon as possible within 24 hours), with the required list of changes, people to notify, methods and timelines; and how physician orders, including verbal orders, are received and documented.","inShort":["Sudden confusion, loss of appetite or weight, new behavior problems or more pain are significant changes. So are falls and trouble breathing.","Call the patient's nurse (or the on-call nurse) right away, and within one hour at most.","A physician must be told as soon as possible and within 24 hours of when you saw the change.","If you cannot reach a nurse within one hour, call the Medical Director or Designee.","Write down what you saw, when, and who you told."],"primaryCitation":"22 CCR §74868(h)","citations":["22 CCR §74868(d), (h), (i)","22 CCR §74892(g), (l), (p), (q)","22 CCR §74868(g)"],"federalCitations":["42 CFR §418.56(e)","42 CFR §418.104(a)(7), (b)"],"surveyorAsks":["What is a significant change at your agency? Show me your list.","A hospice aide sees that a patient has suddenly become confused. What does the aide do, and how quickly is the physician told?"],"forms":[{"ref":"CA-HSP-IDG-03-A","title":"Significant Change Notification Record"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (22 CCR §74868(h))","5. The Communication System","6. Significant Changes That Must Be Reported","7. Who Is Notified, How and When","8. After Notification","9. Physician Orders","10. Responsibilities","11. Records and Compliance Monitoring","12. Staff Training","13. References","14. Related Policies and Forms","15. Approval","16. Revision History"],"version":"1.0","sample":false,"pack":"ca-hospice","state":"California","service":"Hospice","guides":[{"path":"/guides/hospice-policies/","h1":"What policies are required for hospice?"},{"path":"/guides/hospice-conditions-of-participation/","h1":"Hospice Conditions of Participation: which policies each one needs"}],"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}