Module 5
Module 5: Policies, Procedures, and Protocols in Primary Care
Introduction
This module reviews common policies, procedures, and protocols that registered nurses need to be aware of to work effectively in the primary care setting. These include laboratory regulations and how to maintain a safe laboratory setting using standard regulatory interventions. In addition, it reviews how to effectively ensure that patients with special needs are cared for meeting state and federal standards. Common office emergencies are also reviewed, and the role of the RN is reviewed along with standard interventions. An overview of financial, licensing, and accrediting regulations and primary care licensure.
Learning Outcomes
Upon completion of this module, you will be able to:
- describe common fundamentals and safety precautions in reception and administrative areas
- review regulations related to maintenance of a safe and effective laboratory in the primary care setting
- explain the ADA and its impact on assisting patients with special needs in the primary care setting (accessibility, mobility, hearing, vision)
- review common emergencies and review standard procedures to treat the emergencies
- provide an overview of concepts and the RN responsibility related to finance and regulation in the primary care setting:
- medical billing and coding overview
- overview of regulatory guidelines
- HIPAA regulations
- review common accrediting bodies related to primary care
- discuss how primary care settings are licensed
Reading Assignment
Module 5: Policies, Procedures, and Protocols in Primary Care Nursing
Read the chapter in your textbook, then review the content in this online module. When you are ready, take the final exam for this module in Sakai.
Reception and Administrative
It is important to develop standards for all areas of the office for efficiency, quality, patient satisfaction, reimbursement, and regulatory compliance. Please review the following article written by Joy Hicks, Medical Office Expert, entitled “Managing Office Procedures.”
Scheduling
Scheduling policies clarify the types of appointments and the amount of time needed for the providers to provide quality care and for patients to feel that they are able to discuss their healthcare needs. See the following scheduling template examples at the right.
HIPAA
HIPAA in Practical Terms: What Does it Mean?
- Only discuss patients with others who need to care for the patient, and NEVER outside of the workplace.
- Do not remove any files, forms, or other patient information from the office.
Image Source: Scheduling Template - Do not include any information about any patient from your workplace on any notes that would identify the patient.
- Never provide PHI to a company or vendor seeking information about patients.
- Make sure you are speaking to the patient or the patient’s designee when calling a phone.
- Do not leave personal information on an answering machine.
- Log-off your computer when you walk away from the screen.
- Follow the rules in your workplace reagarding privacy and use of telephones, computers, faxes and emails.
- Do not leave printed documents or files where unauthorized persons can see them.
- Position computer screens so they cnnot be seen by unauthorized persons.
- Do not share your passwords with others.
- Report suspected or known breaches of confidentiality to the organizations privacy officer.
The following document (PDF) gives specifics for handling personal health information (PHI) and gives specific information for provider offices.
Record Maintenance
Many offices still have paper charts that must be maintained and protected. There are no current federal laws that dictate the proper maintenance, retention, and disposition of medical records. The North Carolina Board of Medicine offered the following guidelines assist licensees in meeting their ethical and legal obligations.
Fundamentals of the Medical Laboratory
All health care facilities must adhere to rules and regulations regarding lab testing, blood handling, and potential exposure to infectious agents.
CLIA Waived Tests (Low Complexity)
The following document (PDF) is the CDC’s Morbidity and Mortality Weekly Report on Good Laboratory Practices for Waived Testing Sites. Please read the section starting on page 11 entitled “Developing Procedures and Training Personnel” through page 14.
Point-of-Care Testing
Point-of-care tests fall under the term of “CLIA Waived” tests. Examples of CLIA waived tests are fecal occult blood tests, spun hematocrits, and strep A tests. Any waived test much be performed as directed by the manufacturer, quality controls tested, and documentation of quality control results.
Safety Procedures
It is important to be aware of the hazards in the laboratory and to prevent them. OSHA has many resources to develop a safety manual. Educating staff is the key to safety to prevent an accident and to prepare for when an accident occurs. Review the following OSHA Manual (PDF) on hazard identification.
Review the following video by SafetyInfo, Inc. regarding office safety.
Bloodborne Pathogens
Review the following sample bloodborne pathogens sample video. Many are available for purchase and should be a part of your staff policy and training.
On OSHA’s website this helpful reference guide can be found: Quick Reference Guide to the Bloodborne Pathogens Standard.
Infection Control
All staff should be educated about infection control strategies. The most important being proper hand hygiene. The following video demonstrates proper hand-washing with soap and water and with antibacterial hand wash solution.
Occupational Safety and Health Administration (OSHA)
The following two-part video series discusses OSHA and specifics pertaining to a medical office.
Assisting Patients with Special Needs
The ADA makes it illegal to discriminate against people with disabilities. Review these tips for providing equal access to people who are deaf or hard of hearing.
Common Emergency Procedures
Most primary care physicians report at least one emergency presenting to their office per year. By preparing for medical emergencies with the correct equipment, education, and protocols, offices can greatly decrease the risk of an unfavorable outcome. Read the following articles for more information on preparing for office emergencies:
- A Practical Guide to Emergency Preparedness for Office-Based Family Physicians
- Dealing with Office Emergencies: Stepwise Approach for Family Physicians
- Managing Medical Emergencies in the Office Practice Setting: A Three-Pronged Approach
Finance and Regulation
Medical Billing and Coding Overview
View the following video for medical billing, coding and ICD 10.
Overview of Regulatory Guidelines
The following document (PDF) is a very informative fact sheet from the Medicare Learning Network regarding regulatory guidelines and preventing provider fraud.
Accrediting Bodies and Facility Licensing
Primary care offices may be required to be accredited by certain accrediting bodies based on insurance or other affiliations. They also may choose to be accredited to demonstrate standard or quality of care.
This article discusses PCMH Incentive, Recognition, and Accreditation Programs.
Key Points
- Best practice for primary care is to develop policies, procedures and protocols for patient care. Some are based on government agencies setting the standard for health and safety.
- The Health Information Portability and Accountability (HIPAA) Privacy Rules dictate how we communicate with and about patients.
- The Clinical Laboratory Improvement Amendments (CLIA) ensure quality laboratory testing.
- The Bloodbourne Pathogens standard sets rules for the protection of healthcare workers against health hazards caused by blood or body fluid exposure.
- Infection Control strategies prevent the transmission of infection to patients and staff.
- The Occupational Safety and Health Administration (OSHA) sets standards to protect the lives and health of American workers.
- The American with Disabilities Act protects from discrimination against people with disabilities.
- Correct medical billing and coding ensures proper reimbursement for medical services in a primary care office.
- The Office of Inspector General (OIG) protects the public from insurance fraud and has developed a compliance program for physician practices to follow.
Additional Sites
The following websites include information that expands on the information contained in this module and may be helpful in understanding it.
- Guide to Privacy and Security of Electronic Health Information
- Clinical Laboratory Improvement Amendments (CLIA)
- CLIA – Clinical Laboratory Improvement Amendments – Currently Waived Analytes
- Limited English Proficiency (LEP)
- Occupational Safety and Health Administration (OSHA)
- Center for Medicare and Medicaid Services (CMS)
References
A Roadmap for Physicians. Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Avoiding_Medicare_FandA_Physicians_FactSheet_905645.pdf
AACC. (2015, December 7). Point-of Care Testing [Video file]. Retrieved from https://www.youtube.com/watch?v=pBJpt3f7OZw
ADA National Network. (2014). ADA Quick Tips – Sign Language Interpreters. Retrieved from https://adata.org/factsheet/sign-language-interpreters
Allscripts. (n.d.). scheduling template . Retrieved from https://cdn2.hubspot.net/hub/166672/file-18399900-jpg/images/pf_scheduling_allscripts.jpg
American Academy of Family Physicians. (n.d.). PCMH Incentive, Recognition, and Accreditation Programs. Retrieved from http://www.aafp.org/practice-management/transformation/pcmh/recognition.html
Bloodbourne Pathogen Training.com. (2012, April 17). OSHA Bloodborne Pathogen Training, Bloodborne Pathogen Video [Video file]. Retrieved from https://www.youtube.com/watch?v=gLeTNOVfh8o&index=4&list=PLoFG-PxPjv7JL_agii4zt6YzN8XJuUj-N
Cascella, L. (n.d.). Managing Medical Emergencies in the Office Practice Setting: A Three-Pronged Approach. Retrieved from https://www.medpro.com/documents/10502/2820774/Managing+Medical+Emergencies+in+the+Office+Practice+Setting.pdf
Center for Disease Control. (2005, November 11). Good Laboratory Practices for Waived Testing Sites. Mortality and Morbidity Weekly Report, 54(RR-13), 11-14. Retrieved from http://www.cdc.gov/mmwr/PDF/rr/rr5413.pdf
CMSHHSgov. (2015). What is the HIPAA Privacy Rule? [Video file]. Retrieved from https://www.youtube.com/watch?v=xDYqYnQ7K7Q&index=20&list=PLaV7m2-zFKpihHxb4AiWNjbsIUUKCGljK
duanecurby. (2009, May 18). Hand Hygiene Interactive Education CDC xvid [Video file]. Retrieved from https://www.youtube.com/watch?v=jmUZdW2cIUk
Hicks, J. (2016). Managing Office Procedures. Retrieved from http://medicaloffice.about.com/od/revenuecycle/tp/Managing-Office-Procedures.htm
L & C Medical Billing Incorporated. (n.d.). Day at a glance . Retrieved from http://www.landcmedicalbilling.com/images/Day-at-a-Glance.jpg
Learning247online. (2015, February 23). Medical Coding and Billing ICD-10 Training from Learning247 [Video file]. Retrieved from https://www.youtube.com/watch?v=F7IztZw4xFg
North Carolina Medical Board. (2009). Retention of medical records. Retrieved from www.ncmedboard.org/resources-information/professional-resources/laws-rules-position-statements/position-statements/retention_of_medical_records
Occupational Safety and Health Administration. (n.d.). Hazard identification and prevention [Participant manual]. Retrieved from https://www.osha.gov/dte/grant_materials/fy10/sh-20854-10/hazard_id_participant_manual.pdf
Rothkopf, L., & Wirshup, M. (2013). A Practical Guide to Emergency Preparedness for Office-Based Family Physicians. Retrieved from http://www.aafp.org/fpm/2013/0300/p13.html
SafetyInfo, Inc. (2015, August 16). Office-Safety Training Video [Video file]. Retrieved from https://www.youtube.com/watch?v=T2jI-ePVyxM
Sempowski, I., & Brison, R. (2002). Dealing with office emergencies Stepwise approach for family physicians. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2214108/pdf/12371305.pdf
The Office of the National Coordinator for Health Information Technology. (2015). Chapter 2 Your practice and the HIPAA rules. Retrieved from https://www.healthit.gov/sites/default/files/pdf/privacy/privacy-and-security-guide-chapter-2.pdf
United States Department of Health and Human Services (2016) Protected Health Information Retrieved from: http://www.hhs.gov/hipaa/for-professionals/privacy/special-topics/de-identification/index.html
Vagh, J. (2013, May 9). OSHA Training Part 2 [Video file]. Retrieved from https://www.youtube.com/watch?v=a4tekyH8fyM
Vagh, J. (2013, May 9). OSHA Training-Part 1 [Video file]. Retrieved from https://www.youtube.com/watch?v=e-PQiLegq3c
Watson, S. (2014, January 25). Americans with Disabilities Act A Quick Overview [Video file]. Retrieved from https://www.youtube.com/watch?v=vZ4daCQmOKo
