Wound Management Program Adoption and Approval Governing Body Review Wound Management Program
Attachment 2. A Clinical Guidelines Review and Approval
Attachment 2. B Wound Management Program Educational Modules and Competency Quizzes
Attachment 2. B Module 1 Wound Care Basics
Common Terms and Concepts in Wound Assessment
Attachment 2. B Module 2 Wound Assessment
The Wound Bed Preparation Paradigm
Pressure Injury Assessment and Management
Bates-Jensen Wound Assessment Tool
Attachment 2. B Module 3 Wound Cleansing, Irrigation, and Product
Selection
Wound Cleansing, Irrigation, and Product Selection
Wound Products Overview and Selection
Wound Dressing Application Procedure
Attachment 2. B Module 4 Negative Pressure Wound Therapy
Negative Pressure Wound Therapy
Attachment 2. B Module 5 Nutritional Strategies for Wound Healing
Nutritional Strategies for Wound Healing
Patient Education Handouts and Teaching Tools
Attachment 2. B Module 6 Comprehensive Assessment (RN’s only)
Comprehensive Assessment Policy Wound
Wound Management Program Comprehensive Assessment Checklist
Patient Education and Health Literacy Assessment
Wound Management Program Policy
OASIS References for Agencies Completing
OASIS Assessment
OASIS E Section M: Skin Conditions Guidelines
Attachment 2. B Module 7 Infection Control
Infection Control Policy Wound Management Program Addendum
Bag Technique Policy and Procedure
Attachment 2. B Module 8 Patient Education
Patient Education and Health Literacy
Patient Education and Self-Management Plan
Patient Lifestyle Education Handouts
Attachment 2. B Module 9 Additional Wound Management Program Policies
Wound Management Program Reassessment Policy
Wound Management Program Reassessment Checklist
Plan of Care Policy Wound Management Program Addendum
Coordination of Care Policy Addendum
Discharge and Transfer Policy Addendum
Attachment 2. C Wound Management Program Nursing Competency Evaluation
Attachment 2. D Wound Management Competency Evaluation Form
Attachment 2. E Wound Management Program In-Service Agenda
Attachment 2. F Policy W2.10 Infection Control Policy
Wound Management Program Addendum
Attachment 2. G Bag Technique Policy and Procedure
Attachment 2. H Clinical Practice Guidelines and References
Attachment 2. I Wound Management Program
Assessment of Patients and Risk Factors
Initial Comprehensive Assessment
Reassessments of Patients and Wounds
Attachment 3. A Policy W3.01 Comprehensive Assessment Policy
Attachment 3. B Wound Management Program Comprehensive Assessment Checklist
Attachment 3. C Policy W3.02 Wound Management Program Reassessment Policy
Attachment 3. D Wound Management Program Reassessment Checklist
Bates-Jensen Wound Assessment Tool
Provision and Coordination of Care
Attachment 4. A Policy W4.01 Plan of Care Policy
Attachment 4. B Policy W4.02 Coordination of Care Policy
Attachment 4. C Discharge and Transfer Policy
Patient and Family Education Regarding Disease Management
Attachment 5. A Policy W5.01 Patient Education and Health Literacy Assessment Policy
Attachment 5. B Patient Education and Self-Management Plan
Attachment 6. A Wound Management Program Disease Management Policy
Patient Education Handouts and Teaching Tools
Performance Measurement and Improvement
Attachment 7. A PI/QAPI Policy
Attachment 7. B Wound Management Program Performance Improvement Project (Blank form)
Attachment 7. C Wound Management Program Performance Improvement Project (Samples 1 and 2)
A. Performance Improvement Project (template)
B. QAPI Committee Meeting Minutes (template)
C. Annual Performance Improvement (PI) Report (template)
D. Governing Body QAPI Review (template)
E. Governing BOdy orientation checklist
F. QAPI Self-Assessment tool (template)
G. Patient Record Audit Tool (template)
H. Personnel File Audit Form (template)
I. Patient Satisfaction Surveys (template)
J. Employee satisfaction survey (template)
K. Physician/Referral Source/Community Partner Satisfaction Survey (template)
L. Ethics Reports Log (template)
M. Ethics Report form (template)
Section 1 – Organization and Administration
Legal and Regulatory Compliance
Disclosure of Ownership and Management
Professional Standards and Principles
Governing Body Responsibilities and Requirements
Collection and Transmission of OASIS Data
Reporting Negative Agency Outcomes
services furnished under written agreement/contract
Attachment
Governing Body Orientation checklist
Conflict of Interest Attestation Statement
Designation of Alternate Administrator
Designation of Alternate Clinical Manager
Section 2 – PROGRAM AND SERVICE OPERATIONS
Description of Care and Services
Patient Rights and Responsibilities
Reporting and Investigating Abuse and Neglect
Patient Grievances and Complaints
Patient Confidentiality and Protected Health Information
Emergency Care and Resuscitation
Communication and Language Barriers
Provision of Patient-CEntered Care
Supervisor and Nursing Availability
Approved Treatments and Procedures
Attachment
Patient Rights and Responsibilities
Financial Management and Business Practices
Financial Records Retention and Review
Disclosure of Rates for Care and Services
Attachment
Section 4 – Human Resource ManagemenT
TB Screening and Vaccination Policies
Driver’s License and MVR Checks
Employee Handbook and Personnel Policies
Annual Performance Evaluations
Continuing Education and In-Service Requirements
Home Health Aide Training, Competency, and Supervision Requirements
Specialty Training and Certification for Nurses
Attachment
Sample Job Descriptions
Licensed Practical/Vocational Nurse
Occupational Therapist Assistant
Quality Assurance Coordinator/QAPI Coordinator
acknowledgement Of receipt of Employee Handbook
Sample Performance Evaluations
Licensed Practical/Vocational Nurse
Occupational Therapist Assistant
Quality Assurance Coordinator/QAPI Coordinator
Sample Competency Assessments
Licensed Practical/Vocational Nurse
Occupational Therapist Assistant
Sample Annual Education/Inservice Agenda
Section 5 – Provision of Care and Record Management
Storage and Access of Patient Records
Initial Assessment and Plan of Care Development
Therapy and Medical Social Work Services Assessments
Drug Regimen Review and Medication Management
First Dose in the Home Setting
Written Instructions for Patients and Caregivers
Transfer/Discharge Criteria and Process
Patient and Caregiver Education
Referral and Acceptance Process
Face-to-Face Encounter and Certification
Credential Verification for Physicians and
Attachment
drugs and solutions approved for home administration
patient referral and acceptance process policy revision flow sheet
Home health referral and admission availability assessment tool
Physician and Allowed Practitioner License Verification
Section 6 – QUALITY OUTCOMES AND PERFORMANCE IMPROVEMENT
Quality Assessment and Performance Improvement (QAPI) plan
Oversight and approval of the QAPI Program
Incidents and Occurrences Reporting and Documentation
Attachment
Sample Incident/Occurrence Report
Section 7 – RISK MANAGEMENT: INFECTION CONTROL, SAFETY and emergency preparedness
Exposure Control and Standard Precautions
Tuberculosis Screening and Prevention Plan
Employee and Patient Infection Control Training
Employee and Patient Infection Control Tracking
Employee Personal Safety Education
Office and Workplace Safety Plan
Hazardous Waste and Materials Use, Storage, and Disposal
Incident and Occurrence Reporting for Personnel
Point-of-Care Laboratory Testing: PT/INR
Point-of-Care Laboratory Testing: Blood glucose monitors
Safe Use of Equipment and Supplies
Experimental Therapies and Clinical Research
Workplace violence prevention plan
Attachment
Agency TB Screening Assessment
Employee TB Screening Assessment
Annual Office Environment Assessment
