Coordination of Services, Significant Change Notification, and Case Conferences
Sets the Agency’s policies stating when notification is required for a significant change in a patient’s condition (22 CCR §74697(d)), who notifies the attending practitioner and the team and how fast, and how notifications are recorded (§74697(e)); how the Director of Patient Care Services and the registered nurse coordinate all services (§§74703(a), 74707(a)(4)); how therapists, social workers, and dietitians report (§§74711(b)(4), 74713(c)(3), 74715(b)(3)); case conferences, including contracted staff (§74719(b)(3)(D)); and, if the Agency is Medicare-certified, prompt alerts to the practitioner and coordination of care (42 CFR §484.60(c)-(d)).
- Policy number
- CA-HH-CC-01
- Version
- 1.0
- Main rule
- 22 CCR §74697(d)
- Library
- California home health · 58 policies
- Category
- Service delivery
- Sections
- 17
In short
- In an emergency, call 911 first, then the nurse supervisor.
- Report any fall, new pain, breathing trouble, confusion, infection, medication problem, or hospital visit to the nurse supervisor right away by phone.
- Aides: call your supervising nurse or therapist about any change. A text or voicemail alone is not enough.
- Nurses: tell the doctor within the times in Table 1 and record who you told, when, and what they said.
- Read the other disciplines’ latest notes before each visit, and take part in case conferences.
What's inside
17 sections. The full text comes with the One-time Policy Pack.
- Terms of Reference
- 1. Purpose
- 2. Scope
- 3. Definitions
- 4. Policy Statement (22 CCR §74697(d))
- 5. When Notification Is Required
- 6. How to Notify and Record
- 7. Coordinating Services
- 8. Contracted Staff and Other Providers
- 9. Case Conferences
- 10. Responsibilities
- 11. Records and Compliance Monitoring
- 12. Staff Training
- 13. References
- 14. Related Policies and Forms
- 15. Approval
- 16. Revision History
An inspector may ask
- Show me your policy on when staff must notify the physician of a significant change.
- This patient fell last month. Show me when the physician was told and how it is recorded.
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