Hot Topics in Health and Wellness: How Much Can You Share ...

Hot Topics in Health and Wellness: How Much Can You Share ...

Hot Topics in Health and Wellness: How Much Can You Share?, Essentials of Charting, Community Connections, and Medication Management Shannon Bentley, RN Melissa Cusey, RN, BSN Authorizations and Releases: How Much Can You Say? Learning Objectives List four required documents that must be in the SHR.

Name two PRH documents that instructs on confidentiality of student records. List three things that must be listed on a Disclosure Log. Articulate how long records of disclosures need to be kept. Student Health Record Each student health record (SHR) must have a copy of the following:

HIPAA Authorization HIPAA Notice Consent to receive Mental Health Care treatment ETA 6-53 signature page Other Consents, Authorizations and Releases

Supplemental HIPAA Authorization Consent for emergency services Consent for dental or medical care beyond basic Authorization for release of medical information Request for medical information Dental declination form (optional) Flu consent/declination form (optional) Authorizations

What the PRH says about HIPAA Notice and Authorizations (Consent for Treatment): 6.10, R1 (j): Explain and have the student sign, on the first visit to health services, the Notice describing how medical information about students may be used and disclosed, and how students can get access to this information (see Exhibit 6-10). 6.12, R2: Centers shall ensure that proper authorizations are obtained prior to delivery of health services to students. The signed consent form (ETA-653) serves as authorization for basic routine health care. Each time a student requires services not covered on the ETA 6-53 an informed consent for services will have to be obtained

from the student or their parent/guardian for a minor. In the case of an emergency the center director can give consent. Release of Information PRH 6.3, R7 Centers and OA/CTS providers shall respond to requests from former students or third parties for information concerning their enrollments, must have: Written request A signed release of information Be in accordance with provisions of Appendix 601

This shall apply as long as the center has custody of the record. Outreach and Admissions The following documents are obtained by the Outreach and Admissions Counselors: Exhibit 1-3 HIPAA Authorization: Condition of Enrollment. Make sure the entire document (not just the signature page) is placed in the student health record (SHR). Authorization informs applicants how, to whom, and why their health information will be shared.

Outreach and Admissions ETA 6-53 Job Corps Basic Health Questionnaire I (we) authorize Job Corps to provide the above-named individual with basic routine health care and emergency health care while he/she is enrolled in the Job Corps program. The types of care that are considered basic routine health care are listed in the Policy and Requirements Handbook, Exhibit 6-4. I (we) authorize Job Corps to provide the above-named individual with basic oral care, which may include procedures such as teeth cleaning, fillings, and extractions that will relieve pain and help prevent or decrease dental problems.

Consent for Mental Health Treatment Authorization for Release of Medical Information It is a standard of care that Authorization for Release of Medical Information forms are signed only after they are completely filled out, so that the person signing and dating the form is aware of what medical information he/ she is consenting to have released and to whom it will be sent. According to the CDC, in order to be HIPAA compliant, a release of medical information form must: Specifically identify the Protected Health Information (PHI) to be

used or disclosed; Authorization for Release of Medical Information Under HIPAA, the form may not be blank and must contain all of the information above. A blank form is a HIPAA violation. Make sure the following information is included: Names of persons, organizations, or classes of persons or organizations who will receive, use, or disclose the PHI; State the purpose for each request;

Be signed and dated by the individual or the individual's personal representative; Be written in plain language Authorization for Release of Medical Information Include an expiration date or event; Notify the individual in writing of the right to revoke authorization at any time, how to exercise that right, and any applicable exceptions to that right under the privacy rule; and Explain the potential for the information to be

subject to redisclosure by the recipient and no longer protected by the Privacy Rule. Health and Wellness The following documents are obtained by the HWC: Exhibit 6-10 HIPAA Notice: PRH 6.10, R1 (j) states, Explain and have the student sign on the first visit to wellness the Notice describing how medical information about students may be used and disclosed, and how students can get access to this information. The entire document should be placed in the SHR. If the student is a minor, a copy of the HIPAA Notice should be sent to the parent/legal guardian for their signature. Make a note in the SHR this was sent for signature.

Supplemental HIPAA Authorizations: Must be completed for disclosure of protected health information not covered in the Authorization. Health and Wellness Exhibit 6-12 HIV Testing Information Sheet: HWC staff should explain, counsel and have the student sign prior to drawing blood for testing. Other Consents: Completed on an individual basis depending on the needs of the student, that are beyond basic care listed in Exhibit 6-4 and consent from ETA 6-53.

Request for medical records Authorization to release medical records Confidentiality of Student Records PRH 6.3, R5: Confidentiality and safeguarding student records is your responsibility Be aware of state, federal, and local laws Refer to Appendix 601 (Student Rights to Privacy and Disclosure of Information) and Appendix 607 (Transmission, Storage, and Confidentiality of Medical, Health, and Disability-Related Information)

Access to Student Records PRH 6.3, R6 Centers and OA/CTS contractors shall provide students and parents/guardians of minors with access to their records on request. Access to medical records can be denied in accordance with the HIPAA Notice (Exhibit 610) and HIPAA Authorization (Exhibit 1-3). Appendix 601 Access to Student Records: When the center has custody of the record, designated center staff shall respond to requests from former students or third parties, for information

concerning their enrollments, only upon receipt of a written signed release of information, and in accordance with the provisions of this appendix, the Notice, and the Authorization. Disclosure Log The Privacy Rule requires that you document, on a Disclosure Log, certain kinds of disclosures. The log must be retained for 6 years. When disclosing Personal Health Records (PHI), document: 1. date of the disclosure 2. name (and address if known) of the entity/person

receiving the PHI 3. brief description of the PHI 4. brief statement of the purpose for disclosure Subpoenas for Student Records PRH 6.3, R9: Centers and OA/CTS contractors shall forward all subpoenas to produce a student record or to testify regarding a student record to the Regional Office. Essentials of Job Corps Health & Wellness Charting

(Medical, Oral Health, Mental Health, and TEAP Charting) Student Health Record Learning Objectives List where documents belong in the SHR. Describe what goes on the front of the SHR. Discuss the four parts of a SOAP note. Name three required SHR forms. Student Health Record Each center may design its own formatbut

that format must be consistently used for all SHRs on the center. Every record documents continuity of care by nursing, medical, dental, and mental health. ta en M lth

ea H l h alt e H al Or b La s

te no l ica ed M lts su e R Sticker

indicates that Joe has insurance. y or st i H oe J ,

in l nt 6 l e i 5 ic ud 234 t x o

S 1 m # ID :A s e gi r le Al

May put allergies on the cover Health records are confidential, chronological accounts of medical care provided Health and wellness staff should review the record each time a student reports to the Health and

Wellness Center! The center physician and the HWM should review student health records for completeness on a regular basis (excellent quality awareness project). oeent ntt,uJd de tu S

S e o J Student, Joe 11/11/08 7:00am S = Joe in at open hours. Says, I dont feel well. My head hurts. My chest hurts. I am freezing and burning up and cant stop coughing. I have got worse for the last 2 days. O = Rales bilaterally. Pulse 82, Respirations 22 and labored. Wheeze noted on inspiration. Skin dry and hot to the touch.

Temperature 102 F. Coughing during exam and phlegm green tinged. Denies vomiting/diarrhea, has no appetite. A = Alterations in Comfort, URI P = Per URI HCG, gave Keflex 500mg TID, po. Guituss cough syrup 1 tsp every 4 hours, Tylenol 500 mg. po every 4 hours. Instructed on benefits, possible side effects and need to complete antibiotics. Instructed to increase fluids, esp. H2O and to report back to Wellness if no improvement or gets worse in 2-3 days. Student verbalized understanding. Medication Handout provided. F/U in 1 week. Linda Goodnurse, RN

11/11/08 Student in and feels bad. Been coughing, head hurts. Has a cold. Gave antibiotics, Tylenol and cough syrup. LG, RN Example 11/11/08, 7:00 am S - I have a cold O - Temp: 101, BP 112/74, Resp 20, Non-productive cough, lungs clear

A - Upper Respiratory Symptoms P - Put to bed in HWCForce fluids, Ibuprofen 400 mg. Q 6 hours, cough syrup, if needed, Monitor for sore throat, rash, ear ache or persistent temp > 101. Re-evaluate before sending to dorm when HWC closes. Re-evaluate in AM. Required Forms Job Corps Immunization Record PPD Testing Job Corps History Form Job Corps Physical Exam Form SF-600 Chronological Record Of

Medical Care Job Corps Oral Examination Record ETA 6-53 Know Where To Go: Your Community Connections Goal

Participants will be aware of and able to use local and national community resources to provide enhanced services to students Learning Objectives Name three local community resources that will enhance the health and wellness services to students. Identify three cost-saving strategies. Describe two ways cost-saving strategies will benefit quality of basic services to students. Local Community

Resources Local health departments and social service agencies Local mental health agencies Area hospitals Local colleges/universities Community action programs Nutrition and Physical Activity Partnerships

Wholesale food providers Local food growers and farmers markets Personal trainers and fitness centers Retired local teachers and staff Local organizations Hospitals Health departments

Local universities and colleges Free/Low-Cost Dental Services Consider: oral surgery residency programs oral surgeons Indian Health Services/tribal programs for eligible students National Resources The Job Accommodations Network (JAN):

Community Federally-Funded Health Centers: arch_HCC.aspx National Resources Free/Low-Cost Medications: Partnership for Prescription Assistance: Prescription programs: and GlaxoSmithKline Tips: -cost-savings.html ; Programs: -our-programs.html Retail store discount prescription plans National Resources Free/Low-Cost Vaccines: For youth: Vaccine for Children's Program m

For adults: Merck: GlaxoSmithKline: ms/gsk-vaccines.html or Sanofi Pasteur: Free Health Education Materials HRSA Information Center: National Institute of Mental Health: ex.shtml Womens Health: Food and Drug Administration: rwomen/freepublications/ucm116718.htm Harvard Health Publications: Free National Resources American Cancer Society: AIDS Healthcare Foundation: American Diabetes Foundation: Office of Population Affairs: Title X Program: Center for Disease Control and Prevention: Medication SOPs Appendix 611: Medication Management Guidelines MEDICATION POLICY

SOPS Controlled Substances Non-Controlled Medications Over The Counter (OTC) Medications SOPs Must include information from your state Practice Acts for pharmacy and nurses or a reference to your current copies of practice acts Must be individualized and center specific

SOPs will vary greatly from center to center and state to state based on practice acts OTC SOP Must include how OTCs are available during HWC hours, after hours and on weekends. Include who provides OTC medications outside of HWC. OTC medications must be provided in individually packaged single doses in a properly sealed and properly labeled container. SOP must outline centers individual steps.

Process for a sign out sheet and return of OTC boxes to HWC must be included. Non-Controlled SOP Based on Practice Acts determine who can prescribe, dispense and administer, include in SOP or reference documents available Must include monthly case conference and documented in the SHR Include how medication is provided during HWC hours, after hours, and on weekends Other Points: Make sure students understand accountability and

your centers medication policies Provide students with required consumer medication information Example Authorization for medication administration is found in KRS 314.011(10)(c) which states,the administration of medication or treatment as authorized by a physician, physician assistant, dentist, or advanced practice registered nurse and as further authorized or limited by the board which is consistent with the National Federation of Licensed Practical Nurses or with Standards of

Practice established by nationally accepted organizations of licensed practical nurses. Continued It is the advisory opinion of the Board that: Nurses may implement qualified provider issued protocols and standing/routine orders, including administration of medications, following nursing assessment. Components of medication administration include, but are not limited to: 1. Preparing and giving medication in the prescribed dosage, route, and frequency; 2. Observing, recording, and reporting desired effects, untoward reactions, and side effects of drug therapy; 3. Intervening when emergency care is required as a result of drug therapy; 4. Recognizing accepted prescribing

limits and reporting deviations to the prescribing individual; 5. Recognizing drug incompatibilities and reporting interactions or potential interactions to the prescribing individual; and 6. Instructing an individual regarding medications. Example Student Self-Management of Medication: For other prescribed non-controlled medications, once a student demonstrates competence in taking his/her medication, he/she may be eligible to participate in selfmedication, where the student is given doses for a select number of days. Eligibility should be determined at a case conference or medication check for psychotropic medications. It is the responsibility of the HWC administering practitioner

to explain possible consequences of not taking medications as prescribed and note that medication compliance will be monitored closely. The consequences of diversion, using inappropriately, losing, trading, or trying to sell their medications to others should also be explained to the student. Example Self-management of medication includes : All medication made available for self-management must be properly labeled and packaged. Packaging must meet applicable states laws for distribution. (Kentucky State Pharmacy Laws).(ref law or source)

Student may self-select under the observation of a staff nurse or staff that have been properly trained by the center RN. The number of doses made available for self-management will be determined by the administering practitioner based on type of medication and reliability of the student based on past compliance. Documentation will be made on the MAR. The MAR will be filed in the SHR by the RN or LPN at least monthly. If there is additional narrative, document on the Chronological Summary of Medical Care (SF-600). Example

POLICY The Health and Wellness Manager (HWM) will determine which center licensed health staff may legally be authorized to prescribe, dispense, and/ or administer a prescription medication in accordance to state and federal laws. Please refer to current copies of state practice acts for nursing and pharmacy retained in the HWC for complete details. Self-Administering Medications

Epi Pen Birth Control Pills Insulin Asthma Inhalers Controlled Medication SOP Center specific policies that comply with Federal and state laws must be outlined in the

SOP for prescribed controlled substances Includes how provided during HWC hours and outside of HWC Should be detailed with how controlled medications are received, provided, counted, and disposed of. Must include monthly case conference and documented in the SHR Separating Students If possible give to students when exit the program Send medications as soon as

possible Be aware of states laws on mailing medications Points To Remember Know and adhere to your states pharmacy practice laws for dispensing, administering, packaging, and observing. Know your Practice Acts for LPNs/RNs and follow your scope of practice. Long-term medications including psychotropics must have monthly case conferences documented in the SHR. Medications must be provided or sent promptly to

separating students in compliance with various state laws. Medication errors must be reported immediately to the Regional Office and Nurse Specialist. Center specific policies will vary greatly from state to state based on practice laws; SOPs must be individualized. Safety is the student is the priority of all center staff! Questions?

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