AROKA ONLY- NEED BY SATURDAY AT 2 PM EST

It's time to put your two compliance plans all together into one unified Word document. Be sure to implement your faculty member's suggestions throughout and proofread all your work one last time. In addition, check the requirements in the original assignment in Module 02 Course Project - Introduction.

Be sure to write a summary statement and insert it at the end of the project before the References Page. (See outline below.) In your summary statement, describe your own journey in working on this project. Explain how this project has strengthened your understanding of compliance rules and regulations.

Your final plan should include the following. Note the overview at the beginning and the summary statement at the end. Remember to check details to insure that your plans will be understood by all employees at a large medical facility where you are the Compliance Officer.

Cover Page Overview of Compliance First Compliance Plan

· Policies

· Procedures

· Monitoring Tools

Second Compliance Plan

· Policies

· Procedures

· Monitoring Tools

Summary Statement

· How this project has strengthened your understanding of compliance rules and regulations.

References Page

· At least twelve research references for both compliance plans.

ALL I NEED IS THE SUMMARY STATEMENT

The paper is included for you to go by

Overview of Compliance Plans

The first compliance plan incorporates the implementation of a hand hygiene program which targets clinics, hospitals and other sort of health centers where patients are treated accordingly. This plan is meant to sensitize the clinical health practitioners to always ensure that they wash their hands regularly and effectually prior to handling any medicine and/or medical equipment while handling patients. Moreover, it is aimed at facilitating the improvement of hygienic standards in these health centers. In order to effectively deploy the plan, there are several prerequisites which must be put in place in every facility so as to optimally execute the plan for maximal productivity. For example, putting up of rub dispensers (alcohol based) and antibacterial soaps just at the immediate exterior of every room for the purpose of encouraging the patients as well as health practitioners to wash hands regularly. (Mayo Clinic, 2016) Once this is successful, they would gain a hand washing culture which will immensely perk up their hygienic standards in conformation to the WHO guidelines.

The hand hygiene compliance plan is essential in many ways. Firstly, it will ensure that the employees are well shielded from bacterial infections which might result to coming into contact with contaminated surfaces. These include medical equipment, beddings and patients’ skin among others. An importance from adhering to the response and prevention element of the compliance plan is that the patients will have a smooth time recovering from infections. This is because they will be treated in an absolutely safe environment without further exposure to infections. The employees will have better interactive relationship with their patients in following the compliance plan which would encourage the patients to offer more unbiased details without any fear. (Healthdirect, 2014) Employees will gain a more sense of personal responsibility which will benefit the facility’s management in that it will have less stress in monitoring the employees on whether they are professional and hygienic. Consequently the employees will have a more profound discipline in observing and adhering to the preset objectives of the compliance plan. Adhering to this plan would eventually instill wide educative knowledge on issues of how best to improve the hygienic standards of the facility.

The second compliance plan is involved with the implementation of fraud prevention, detection and elimination in conducting the daily monetary transactions. This compliance plan has been formulated due to the observation that there is prevalent existence of fraudulent and deceitful health care practitioners who tend to overcharge the patients on various occasions. The reason behind this malicious action is greed and selfishness to gain more wealth via unjust ways. I have studied the main reasons as to why this is so common. These include the fact that many employees tend to have low levels of job satisfaction in their working places mainly because of low payment and absence of adequate benefits. Unwavering adherence to the compliance plan’s elements will greatly benefit the health institution in that it will be able to respond quickly to block fraudulent actions that might compromise the facility’s quality of service.

Another importance of this compliance plan is that the employees will be effectively monitored on a regular basis which will lead to the improvement of personal discipline in avoiding fraud intentions. The management will be able to communicate with the employees more during the regular visits and assessments. Additionally, the employees will gain essential education on the penalties and punishments associated with fraudulent acts. (Eramo, 2016) Once this is achieved, the employees will be forced to uphold obedience and be highly responsible in monitoring each other in the line of business. The compliance plan will further benefit the health facility in that the patients will be able to afford the services and feel appreciated.

Compliance Plan A: Clinical staff members are not washing their hands between patients

Policies for Compliance Plan

Introduction

Washing hands as part of good hygiene is one of the most important initiatives health care workers should take to in the process of minimizing the spread of infection and also protect patients. Hand washing is the most efficient and at the same time the least expensive means of preventing healthcare-associated infections.

Hand washing or hygiene includes two primary actions:

a) Washing the hands by using soap and water. It ensures limitation of colonization of transient flora accompanied by dirt, soil, and loose flora.

b) Rubbing hands with a fast-acting antiseptic agent known as the hand sanitizer.

The following are the policies for this compliance.

Before patient contact: All the medical attendants to clean their hands before touching a patient when approaching him or her. The core reason for this is to protect the patient against any harmful germs carried along with the attendant’s hands.

Before an aseptic task: Medical attendants to clean their hands immediately before application or use of any aseptic task. The reason for this is shielding the patients against any harmful germs, including germs from the patient. (Institute for Healthcare Improvement, 2016)

After a body fluid exposure risk: The affected person should clean hands immediately after an exposure to such risk of body fluids, even after glove removal. The reason for this is it offers protection on the own body and the healthcare environment against any harmful germs or pathogens.

After contact with patient surroundings: Hands should be cleaned after touching any object such as bending or furniture in the patient’s immediate surroundings. The reason is to protect yourself and the healthcare environment against any harmful patient germs. (Hamilton, 2014)

After patient contact: Hands should be cleaned after touching a patient and his or her immediate surroundings. The reason for this is to protect you against any germs and pathogens from the environment.

Procedures for Compliance Plan

Introduction

Based on the two compliance policies in the healthcare setting, this paper will develop procedures for both hand washing and diabetes management education as the physician visit.

Hand washing procedure

First, the antiseptic handwashing detergents that are to be used by Healthcare Workers (HCWs) are verified to ensure they are regulated by the Division of Over-the-Counter drugs and detergents (OTC) (Rotter, 2009). Secondly, the products to be used by HCW to clean their hands should not be in direct conduct of any other party except medical attends. Before handling a patient, the HCW should wet his/her hands, apply sufficient amount of soap or any baseline detergent to cover every hand surface, preferably 5 mL of a standard suspension of the Serratia marcescens detergent should be applied on the hands and then the medical attendants rub their hands against each other in a friction (Rotter, 2009). A measured volume of the soap or detergent material being used must be dispensed onto the attendant’s hands and should be spread all over the hands and possibly over the lower part of their forearms.

The hands are then rubbed palm to palm, the between fingers by interlacing, and then rub the palms when fingers are interlaced. Rub the back of the fingers with the left and right-hand palms interlock (Rotter, 2009). The medical attend should rationally rub the clasped left thumb on the right palm and vice versa, do the same rubbing, forwards and backward parts of the hand with the clasped fingers of the right hand on the left palm and do vice versa. After the rubbing procedure, a small amount of faucet water is run over the hands for rinsing, and the hands must be lathered for 5 seconds, having covered all the hand surfaces and the lower part of both forearms. Medical attends the dry their hands using a clean towel then immerse them just halfway to the metacarpals for utmost 5 seconds. The medical attendant should then turn off the running water using the cleaning towel, dry the hands for 5 seconds and put on the gloves. The hands are safe to handle patients. The same procedure is repeated for patients to avoid recontamination (Rotter, 2009).

Monitoring Tools for Compliance Plan

Introduction

The goal of this part of the plan is to establish that there are risks of diseases spreading from patient to patient and maybe the staff. This plan will show that through thorough cleaning of hands between patients you greatly minimize the risk of spreading the disease.

Hand washing monitoring tools

The first compliance plan incorporates the strategy of ensuring that all health practitioners within the medical facility take hid in washing their hands regularly while attending to patients. The main aim of this compliance plan is to ascertain that the risk of spreading a particular sort of disease from one patient to the other as well as infecting the clinicians will be greatly minimized and eventually eliminated. Exhaustive research on multiple surveys and findings’ documentations has brought more light to the importance of thorough cleaning of hands between patients. In order to be certain that the health practitioners are effectively adhering to the regulatory guidelines stipulated in this compliance plan, several monitoring tools should be put in place. They include physical supervision, surveys and measure of product utilization. These tools will assist the organization as well as the government to properly evaluate the rate of improvement in the health/medical care domain. The first tool is supervision which calls for the participation of individuals with managerial and observation skills. Supervision involves carefully observing and taking note of every little detail perceived (Haas, 2007)

Back to the subject matter, the supervisors will directly observe the health practitioners closely in order to deduce whether they are operating in conformance to guidelines specified in this compliance plan. Supervisors will conduct an analysis on the products utilized such as antiseptic soaps and antibacterial detergents with the aim of determining whether they are original or expired (Harrington, 2007). Also, drying towels and hand gloves will be evaluated too. Monitoring the products used will be important since it will prevent spread of infections without the consent of the workers and management regardless of their adherence to the hand washing hygiene instructive. Moreover, this tool will enable easy pinpointing of those individuals who aren’t following the rules.

The health workers will also be able to properly understand the best way to utilize the equipment and improve hand hygiene since they can directly consult the supervisors who will offer immediate assistance and elaborations (Haas, 2007). It is not right to assume that everybody in the facility knows the time to wash their hands since their minds are often bombarded with lots of thoughts associated with work-related stress. This presumption emanates from the conclusive claims of the most renowned and trusted health care centers such as CDC (Centers for Disease Control and Prevention) and the WHO (World Health Organization). These organizations have realized that the ordinary advisory rules to uphold hand hygiene in medical facilities are insufficient and incentives to improve the manner with which patients are handled hygienically are normally futile. For this reason, surveys will be utilized to monitor compliance of health workers towards embracing a proper hand washing culture (WHO, 2005).

This practice will involve face-to-face questioning of every health worker in pursuit of capturing their concerns, thoughts, feelings, attitudes and opinions about the compliance plan in its entirety (Gould, 2007). The workers will be expected to suggest ways of improving the standards of hand hygiene as well as air their grievances and reasons as to why they can’t oblige to certain guidelines. Another tool for monitoring is measuring the product utilization. This encompasses checking the amount of antiseptic soap, hand wash detergent, drying towels and gloves used up within a particular time interval by the health practitioners (Joint Commission, 2009). For instance, if the soap containers are still full or nearly full after sometime, it means that the workers are not washing their hands regularly as instructed by this compliance plan. So as to effectively execute this compliance plan, the entire staff should be ready to be actively involved in checking others and reporting non-adherence individuals.

Compliance Plan B: Nurse charges for Diabetes Management Education as a Physician Visit

Policies for Compliance Plan

The following is a list of policies to be adhered to this plan: (American Association of Diabetes Educators: 7 Self Care Behaviors Goal Sheet, 2005)

1). Policies should show structured recordings of demographics, medications, problems, medication allergies, and the creation of a structured clinical are to be clearly shown for every patient suffering from diabetes. Records are to be shown in a summary. The records indicated must inform the care plan and also the ongoing clinical plan.

2). Care management for chronic like diseases such as diabetes, should ensure the timely receipt of all recommended preventive care.

3). The medical attendant should provide the beneficiary with clear written or electronic copy of the care plan. The plan must be documented to offer provision in the medical electronic record.

4). Regarding the beneficiary consent, the recipient should be informed that only one practitioner can furnish and therefore be paid for the services administered during a calendar month.

5). Another policy in improving adherence is by identifying when patients are not adhering to the drug regimen. Fighting to achieve the desired blood glucose goals, the medical attendants should distinguish poor glycemic control having a poor adherence from a failure.

6). Patients should be identified with evidence of personal obstacles before reassuring them or employing another strategy. One of the methods used could be the use of questions, to collect more information. For example, “Can you tell me the reason why taking insulin in most preferred?” the doctors should give a brief and self-report questionnaire concerning the insulin resistance. (McCraig, 2006)

7). Medical attendants need to help the patient gain confidence especially in giving information by demonstrating the insulin use. The patients should be allowed to practice before leaving the clinic or the medical center. Self-regime should be limited at the first place. (Wagner, 2001)

Procedure for Compliance Plan

First and foremost, the patients should be informed about the education program through the office staff, signs posted around and providers in a healthcare facility (Emerson, 2006). They must also be informed that the CDE and RD are incorporated in the Diabetes Management Education (DSME) instructional health team and patients should freely see all be made eligible to meet the specialists in all office meant for diabetes-related education programs upon the physician's order (AADE, 2010).

An initial physician visit must start with a description and introduction of the role of a nurse, the charges involved and the dietitian educator (AADE, 2010). Then, the patients should be asked what they hoped and expected to gain from the physician visit, the patient’s health care knowledge, health history, and behaviors are then assessed. The physician will then evaluate the patients' utilization of the blood glucose meter, injection technique, insulin preparation and other skills (Sharlene, 2006). The education required are prioritized and identified and the diabetes management education should be initiated at that first visit.

After those activities, patients should be afforded some time to reflect on what was learned and can be asked to give a behavior, skill, goal or problem that they think they can work on. At the end of the visit, the patients should be asked to write a patient goal for behavior change in the worksheet being used in the DME health systems (Emerson, 2006).

Monitoring tools for Compliance Plan

The second compliance plan whose monitoring tools will be discussed is the procedure for DSME (diabetes management education) which involves the providence of essential instructions to patients on the effective way of dealing with diabetes. Patients often encounter adverse health situations whenever their illness advances to the chronic stage due to low level of knowledge on how to manage and prevent the diabetes from causing more suffering. This compliance plan will be very effective in assisting diabetes patients who are normally misguided on how to take medication and make clinic visits. Implementation of the plan is very possible in all health facilities but ensuring that everyone complies with its instructive is not guaranteed unless monitoring for conformance is employed (Indian Health Service, 2011).

It is very crucial to monitor the adherence of workers to this compliance plan since if not conducted properly, fraudulent health practitioners can act opportunistically and grab funds from patients who aren’t aware of the actual cost of the education programs (AADE, 2016) In fact, such practitioners might not offer the best and recommendable advice to patients in order to evade getting tired and to gain free money. One monitoring tool that will be adopted for this compliance plan is interviewing the patients one by one without the knowledge of those specialists who offered the initial training.

This will ensure that all the patients are carefully assessed to deduce whether they possess professional and standard knowledge on how to take medications and fight diabetes. The patients will be asked various questions related to the number of visits they have made to their respective specialist/physician and also their views about whether their health is improving or deteriorating. They will also be requested to offer receipts of payments for the DSME programs they have already taken. This monitoring activity will be conducted at unpredictable periods which the specialists and patients don’t know of. The clinic’s head manager and customer care department manager will be some individuals who will act as interviewers. This activity expects all patients to be extremely confident and free to ask any question that they might be bothering their mind. Additionally, they will be required to rate their trainers in terms of explanation skills, professionalism, openness and interpersonal communication skills.

The other monitoring tool that will be utilized for this compliance plan is meticulous analysis of patient visit reports. This will incorporate the active collection of daily and/or weekly reports which contain patients’ visits information to the facility. The finance secretary and patients’ receptionist are some individuals who will be assigned the task of composing these reports with great accuracy (Coffey, 2014). The head health care officer chairing the organization will be expected to thoroughly study these reports and ascertain that the patients are paying the correct amount of money for the diabetes education programs. Moreover, this tool will ensure that there are sufficient resources and funds allocated to support the education programs without any sort of embezzlement whatsoever (Poirier, 1999).

The other essential monitoring tool that will be utilized in this plan is the surveillance cameras which will be installed within strategic positions in the facility in order to capture all the happenings. This will enable the management to accurately calculate the time spent by each patient in a single session of training with the specialist. Therefore, lazy specialists who normally teach fewer concepts than expected will be easily identified and dealt with accordingly. Furthermore, the management will be able to determine the frequency of visits for every patient and check whether they are served appropriately. In fact, voice recorders will be appended to the cameras in order to clearly listen and analyze the specialist-patient conversation.

References

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American Association of Diabetes Educators. (2005). 7 self- care behaviors goal sheet.

Retrieved from http://www.patienteducationupdate.com/2005-05-01/article7.asp

American Association of Diabetes Educators (AADE). (2016). Ask the reimbursement Q&A.

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expert/reimbursement-q-a

Coffey, J. (2014). Pharmacist Billing for Ambulatory Pharmacy Patient Care Services in a

Physician Based Clinic and Other Non-Hospital-Based Environments – FAQ.

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http://www.ashp.org/doclibrary/policy/ambulatory-care/pharmacist-billing-in-physician-

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Emerson, S. (2006). Introducing the Diabetes Management Education in health Care. Diabetes Spectrum 2006 Apr; 19(2): 79-83

Eramo, L. A. (2016). Stopping fraud: detecting and preventing fraud in the e-health era.

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