Verify patient's unique identifier used in documentation
4
Assess current documentation procedures for GIP care
5
Crosscheck recorded symptoms with GIP qualifying criteria
6
Assess whether documentation support patient's elevated level of care
7
Analyze frequency and intensity of comfort measures
8
Review recorded Nurse's assessments
9
Inspect documentation of family members' inability to manage patient's symptoms
10
Examine records of the interdisciplinary team's involvement
11
Review all medication administration records
12
Review copies of any communication with the primary care physician
13
Identify any documented change in the patient's condition
14
Review documentation of GIP discharge or transition to routine
15
Compile audit findings and observations
16
Identify areas of non-compliance and potential improvement
17
Prepare preliminary audit report
18
Approval: Initial audit report by Quality Assurance Manager
19
Submit final audit report to head of hospice services
20
Recommend procedural adjustments based on audit findings
Identify patient's records for the audit
This task involves identifying the patient's records that will be included in the audit. It is crucial to ensure that all relevant records are considered to obtain an accurate assessment of the hospice GIP care. The results of this task will serve as the foundation for the audit process. Do you have access to the necessary patient records? Are there any specific criteria or guidelines for selecting the records?
Review patient's hospice benefit periods
In this task, you will review the patient's hospice benefit periods. The objective is to ensure that the patient meets the eligibility criteria for receiving GIP care based on their hospice benefit periods. Have the patient's hospice benefit periods been clearly documented? Are there any discrepancies or issues that need to be addressed?
1
Active
2
Expired
3
Unknown
Verify patient's unique identifier used in documentation
This task involves verifying the patient's unique identifier used in documentation. The unique identifier is important for accurately identifying and tracking the patient's records throughout the audit process. Is the patient's unique identifier consistently used and properly documented? What challenges or issues may arise in verifying the unique identifier?
Assess current documentation procedures for GIP care
In this task, you will assess the current documentation procedures for GIP care. Evaluating the documentation procedures is essential to ensure that they are efficient, accurate, and in compliance with the necessary standards. Have there been any recent changes or updates to the documentation procedures? Are there any difficulties or challenges in assessing the documentation procedures?
Crosscheck recorded symptoms with GIP qualifying criteria
This task involves crosschecking the recorded symptoms with the GIP qualifying criteria. It is important to verify if the documented symptoms meet the criteria for GIP care. Are all the relevant symptoms and criteria clearly documented? Are there any discrepancies or issues in crosschecking the symptoms and criteria?
1
1. Uncontrolled pain
2
2. Severe nausea
3
3. Acute shortness of breath
4
4. Intractable seizures
5
5. Active hemorrhage
Assess whether documentation support patient's elevated level of care
This task involves assessing whether the documentation supports the patient's elevated level of care. It is essential to ensure that the documentation accurately reflects the level of care provided to the patient. Is the documentation comprehensive and detailed enough to support the patient's elevated level of care? Are there any challenges in assessing the documentation?
1
Routine Care
2
General Inpatient Care
3
Continuous Care
Analyze frequency and intensity of comfort measures
In this task, you will analyze the frequency and intensity of comfort measures provided to the patient. Analyzing these measures will give insights into the effectiveness of the care provided. How frequently and intensely are the comfort measures implemented? Are there any challenges or difficulties in analyzing the frequency and intensity of comfort measures?
Review recorded Nurse's assessments
This task involves reviewing the recorded Nurse's assessments. The Nurse's assessments provide valuable insights into the patient's condition and the care provided. Are the Nurse's assessments comprehensive, accurate, and up to date? Are there any challenges or issues in reviewing the Nurse's assessments?
Inspect documentation of family members' inability to manage patient's symptoms
In this task, you will inspect the documentation of family members' inability to manage the patient's symptoms. It is important to assess whether the family members are actively involved in managing the patient's symptoms. Is there documented evidence of the family members' inability to manage the patient's symptoms? Are there any challenges or difficulties in inspecting the documentation?
1
Yes
2
No
3
Unknown
Examine records of the interdisciplinary team's involvement
This task involves examining the records of the interdisciplinary team's involvement in the patient's care. The involvement of the interdisciplinary team is crucial for the overall quality of care provided. Are there clear records documenting the interdisciplinary team's involvement? Are there any challenges or difficulties in examining the records?
Review all medication administration records
In this task, you will review all medication administration records. Reviewing these records ensures that the medications are administered accurately and in compliance with the required protocols. Are the medication administration records complete, accurate, and up to date? Are there any challenges or issues in reviewing the records?
Review copies of any communication with the primary care physician
This task involves reviewing copies of any communication with the primary care physician. Communication with the primary care physician is essential for coordinated and comprehensive care. Are there copies of all relevant communication with the primary care physician? Are there any challenges or difficulties in reviewing the copies?
Identify any documented change in the patient's condition
In this task, you will identify any documented change in the patient's condition. Documenting changes in the patient's condition is important for evaluating the effectiveness of the care provided. Are there clear and detailed records documenting any changes in the patient's condition? Are there any challenges or difficulties in identifying the documented changes?
1
Improvement
2
Deterioration
3
Stable
Review documentation of GIP discharge or transition to routine
This task involves reviewing the documentation of GIP discharge or transition to routine care. It is important to ensure that the patient's discharge or transition is properly documented and follows the necessary protocols. Is there clear documentation of the GIP discharge or transition to routine care? Are there any challenges or difficulties in reviewing the documentation?
Compile audit findings and observations
In this task, you will compile the audit findings and observations. Compiling these findings is crucial for providing a comprehensive and detailed report of the audit results. How will you organize and present the audit findings? Are there any challenges or difficulties in compiling the findings and observations?
Identify areas of non-compliance and potential improvement
This task involves identifying areas of non-compliance and potential improvement based on the audit findings. Identifying these areas will help in developing strategies for enhancing the quality of GIP care. Have you identified areas of non-compliance and potential improvement? Are there any challenges or difficulties in identifying these areas?
Prepare preliminary audit report
In this task, you will prepare the preliminary audit report. The preliminary report is an initial overview of the audit findings and serves as a basis for further analysis and refinement. How will you structure and format the preliminary audit report? Are there any challenges or difficulties in preparing the report?
Approval: Initial audit report by Quality Assurance Manager
Will be submitted for approval:
Compile audit findings and observations
Will be submitted
Submit final audit report to head of hospice services
This task involves submitting the final audit report to the head of hospice services. The final report provides a comprehensive analysis of the audit findings and recommendations for improvement. How will you present and deliver the final audit report? Are there any challenges or difficulties in submitting the report?
Recommend procedural adjustments based on audit findings
In this task, you will recommend procedural adjustments based on the audit findings. It is important to propose actionable recommendations that address the identified areas of improvement. What procedural adjustments do you recommend based on the audit findings? Are there any challenges or difficulties in formulating the recommendations?
