Plan of Care, Plan of Care Review and Caregiver Education
Sets out how the hospice care team establishes a written plan of care before providing care, with an initial plan within 24 hours of admission, with the input of the patient, family, facility caregivers and representative; what the plan must contain; review as a group at intervals of no more than 15 days with the attending physician’s opportunity to approve (or the medical director’s written approval); and education of the patient and primary caregiver at each home visit.
About this policy
- Policy number
- GA-HSP-IDG-02
- Version
- 1.0
- Main rule
- Ga. Comp. R. & Regs. 111-8-37-.15(4)-(5)
- Library
- Georgia hospice · 60 policies
- Category
- Hospice care
- Sections
- 18
In short
- Write the immediate plan before giving care, and finish the initial plan of care within 24 hours of admission.
- Build the plan with the patient, family, facility caregivers and representative. Record their goals and agreement.
- The team reviews each plan as a group at least every 15 days and records who took part.
- Send every revised plan to the attending physician. If they do not approve it in writing, the medical director signs it.
- Teach the patient and caregiver at every home visit and write down what you taught.
What's inside
18 sections. The full text comes with the One-time Policy Pack.
- Terms of Reference
- 1. Purpose
- 2. Scope
- 3. Definitions
- 4. Policy Statement (Ga. Comp. R. & Regs. 111-8-37-.15(4)-(5))
- 5. Initial Plan of Care
- 6. Who Takes Part
- 7. Content of the Plan of Care
- 8. Review and Update
- 9. Following the Plan of Care
- 10. Education of the Patient and Primary Caregiver
- 11. Responsibilities
- 12. Records and Compliance Monitoring
- 13. Staff Training
- 14. References
- 15. Related Policies and Forms
- 16. Approval
- 17. Revision History
An inspector may ask
- Show me the initial plan of care for this patient and when it was made in relation to the admission.
- Where does the plan show the scope and frequency of each service, measurable outcomes, drugs, supplies and the patient’s understanding and agreement?
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