Begin a pediatric quality assurance program with your first referral
Begin a pediatric quality assurance program with your first referral
Don’t forget the service side of the business
Private duty home health agencies trying to branch into pediatric care might be intimidated by this special patient population, especially when it comes to evaluating standards of care. Don’t be, advises one provider. The key is to start a quality assurance (QA) program from the first referral."QA should be done from day one, even if you have just one patient," says Cyndy Byrne, president and founder of Kaleidoscope Kids in Mt. Pleasant, SC. Kaleidoscope Kids is a nonprofit organization that serves children who are handicapped, chronically ill, terminally ill, or grieving. The organization sets up pediatric programs within existing hospices and home health agencies and acts as a resource for established pediatric programs. Byrne says Kaleidoscope gets a lot of panic calls from agencies that are receiving their first referral on a child. "They have nothing in place, and most don’t want help beyond that one patient." (For more information about Kaleidoscope Kids’ programs, see p. 62.)
Until your agency gains experience providing pediatric care, Byrne recommends having specific pediatric policies in place and focusing your QA topics on service. "It is as important as any physical indicator," she says. "You will never have the opportunity to provide the care and to deal with the physical indicators if you don’t do a good job in accessing care." (For details on how to set up a pediatric hospice quality assurance program, see insert.)
Normally in QA, everyone wants to address physical and psychosocial topics, she adds. "While it’s important to deal with the physical aspects of care, it’s also important to determine appropriate access to care. Often, when you are starting a new population of care, you want to look at how the program is marketed to referral sources and how services are received by the community."
For example, if an agency gets 10 referrals a month but only ends up admitting one, what is wrong? Through the quality assurance process, the agency can go back and see that something has gone wrong between the referral, evaluation, and admission processes. "That usually indicates a problem in the initial staff presentation of services or the family’s misinterpretation of the services to be provided," Byrne says.
Every topic an agency chooses to evaluate through QA will have its own indicators, she adds. "Pain has its own, continuity of care has its own. If you develop one for referral/admission, that would have its own indicator. For pain, one of your indicators might be that 95% of all patients have pain that is controlled."
Some of the service topics an agency might consider for QA include:
• how referrals were handled;
• the timeliness of the care;
• whether the program was explained correctly;
• the number of callbacks from clients who do not understand something.
When setting up quality indicators, agencies must look at each topic from a broad perspective, says Byrne. "Look at both the negative and the positive aspects of each topic."
For evaluating on-call performance, for example, an agency might want to look at how many families say they ran out of medications and supplies over the weekend. The agency can then set up a system for patients and families to be contacted by an RN on Friday morning to make sure they have the equipment and supplies needed for the weekend.
Focus on what the concerns are with each topic, and then decide which of these concerns is the most important, says Byrne.
"You can’t go wrong as long as you are thinking of the welfare of the patient and family as a unit of care — not just focusing on the physical components of care."
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