HCS 456 Week 3 Regulatory Requirements and Risk Factors Unique to Health Care Example

No Hallway, No Security Desk, No Nurse Next Door: The Regulations and Risk Factors That Make Home Health and Hospice Risk Management Different

[Student Name]

University of Phoenix

HCS/456: Risk Management

Week 3 Assignment

[Instructor Name]

[Date]

The agency and its survey history are composites written for a model paper; regulatory requirements and guidance come from the sources listed.

At its most recent state survey, a composite home health and hospice agency received a deficiency: surveyors reviewed 20 patient records and found that four patients on home oxygen had no individual plan for power outages or evacuation. The agency's risk manager used the finding to review every regulation that shapes the agency's risk program and every risk factor that sets home care apart. This paper presents that review.

The Conditions of Participation

Home health agencies certified by Medicare must meet federal conditions of participation, which were substantially revised in a final rule published in 2017 (Centers for Medicare & Medicaid Services, 2017). The conditions cover patient rights, including the right to be informed and to make complaints; a comprehensive assessment of each patient; an individualized plan of care; coordination of services; infection prevention; and a data-driven quality assessment and performance improvement program that tracks adverse events and acts on them. State surveyors or accrediting organizations with deemed status check compliance, and serious deficiencies can lead to penalties or loss of certification.

Quality Assessment and Performance Improvement

For the risk manager, the quality requirement is the most important link between regulation and risk. It requires the agency to measure, analyze and track quality indicators, including adverse patient events, and to take action to improve. The agency's falls at home, medication events and infections now flow into one program that the governing body reviews, rather than sitting in separate files.

Emergency Preparedness

A separate federal rule added emergency preparedness requirements for providers participating in Medicare and Medicaid, including home health agencies and hospices (Centers for Medicare & Medicaid Services, 2016). Agencies must have an emergency plan based on a risk assessment, policies and procedures, a communication plan and training and testing. For home health, the plan must include procedures to inform officials about patients who need help during an emergency and individual plans for patients. The survey finding concerned exactly this requirement: patients on oxygen without an individual plan.

Workplace Violence Guidance

The Occupational Safety and Health Administration (2016) issued guidelines for preventing workplace violence against health care and social service workers, including home health workers. Their program has five parts: leaders who commit resources and involve workers; a look at where and when violence occurs; controls that remove or reduce the hazard; training so staff recognize warning signs; and records that show whether the program is working. The guidelines are advisory, but the agency adopted them because home care workers enter unfamiliar households alone. A hospital nurse who feels threatened can call security; a home health nurse has her phone, her car keys and her judgment.

Liability and the Duty of Care

When a patient is harmed, liability usually rests on negligence: the agency or clinician owed a duty of care, breached the expected standard, and the breach caused harm. In home care, the standard includes teaching patients and families safely, following up on changes in condition and acting on information from the hospital. A nurse who does not reconcile a discharge medication list against the medicines in the home may fall below that standard.

Risk Factor One: Unverified Information at Handoff

Patients arrive from hospitals with discharge lists that may conflict with pharmacy records and the bottles on the kitchen table. Every first visit begins with unverified information.

Risk Factor Two: The Uncontrolled Environment

Homes have loose rugs, steep stairs, pets, smoking near oxygen and no emergency equipment. The agency cannot redesign the building as a hospital can.

Risk Factor Three: Working Alone

Staff visit alone, often in the evening, sometimes in homes with weapons, drugs or conflict. Help may be 30 minutes away.

Risk Factor Four: Rural Travel

Staff drive long distances in all weather, making vehicle crashes one of the agency's most likely serious injuries.

Risk Factor Five: Dependence on Families

Families give medications, change dressings and call for help. Their skill, health and availability vary, and caregivers may be exhausted.

Hospice Adds Its Own Rules

The agency's hospice program faces additional requirements. Hospice conditions of participation require an interdisciplinary group, including a physician, nurse, social worker and pastoral or other counselor, to review each plan of care, and they set rules for managing controlled drugs in the home, including policies for safe use and disposal and for explaining these to families. Those drug rules address a risk unique to hospice: strong opioids kept in homes where visitors, grandchildren or struggling relatives may take them. The risk manager added a disposal log and a family teaching sheet after a hospice aide found a bottle of morphine solution in a guest bathroom.

From Rules to Practice

The review linked each requirement to daily work. The comprehensive assessment requirement becomes medication reconciliation and a home safety check at the first visit. The quality program becomes monthly review of falls, medication events and infections. Emergency preparedness becomes an individual emergency plan for every patient on oxygen, ventilators or infusions, with the local utility notified of patients who depend on electricity. Workplace violence guidance becomes a pre-visit safety check, a check-in system for evening visits and training in de-escalation. Patient rights become a complaint process that families understand.

Responding to the Survey

The agency's plan of correction required every nurse to complete an individual emergency plan for patients on home oxygen within 30 days, added the plan to the admission checklist and set monthly audits of 10 records until three consecutive audits showed full compliance. The risk manager also used the finding to test the agency's emergency communication plan with a tabletop exercise on a three-day winter power outage.

Conclusion

Home health and hospice risk management is shaped by regulations written for care that happens in people's homes: federal conditions of participation, emergency preparedness rules and workplace safety guidance, backed by liability law. The risks they address come from handoffs, uncontrolled environments, working alone, rural travel and reliance on families. Turning each rule into a daily practice is how the agency both passes surveys and protects the people it serves.

References

Centers for Medicare & Medicaid Services. (2016). Medicare and Medicaid programs; Emergency preparedness requirements for Medicare and Medicaid participating providers and suppliers. Federal Register, 81, 63860. https://www.federalregister.gov/d/2016-21404

Centers for Medicare & Medicaid Services. (2017). Medicare and Medicaid program: Conditions of participation for home health agencies. Federal Register, 82, 4504. https://www.federalregister.gov/d/2017-00283

Occupational Safety and Health Administration. (2016). Guidelines for preventing workplace violence for healthcare and social service workers (OSHA 3148-06R). U.S. Department of Labor. https://www.osha.gov/sites/default/files/publications/OSHA3148.pdf