Service Description
Loving Kindness Healthcare Systems (LKHS) shall provide skilled nursing services by a Registered Nurse (RN) or Licensed Practical Nurse (LPN) under the direction of the supervising nurse. Professional nursing services shall be performed in accordance with the attending physician’s Plan of Care and shall include but not be limited to:
- The first visit is made within 48 hours to determine the immediate care and support needs of the client, and for Medicare clients, to determine eligibility for the Medicare home health benefit, including homebound status, unless otherwise specified by the physician or requested by the client (with permission by the physician)
- Initial and ongoing comprehensive assessment at appropriate points
- Assessment and regular reassessment of the nursing needs of the client throughout the course of care including planning for discharge
- Development, implementation, review and revision of the OASIS document and Plan of Care
- Provision of nursing services including treatments, diagnostic and preventative procedures
- Initiation of preventative and rehabilitative nursing procedures as appropriate for the client’s care and safety
- Observation of physical and emotional signs and symptoms and reporting to the physician of all reactions to treatments, including medication administration
- Teaching, supervising and counseling of the client and family regarding the client’s nursing care needs and related problems at home (including nutritional guidance and dietary teaching per agency policy)
- Supervision and teaching of other nursing service personnel such as Licensed Practical Nurse and Home Health Aides, per state regulations
- Coordination of total client care
- Notification of the physician and other member of the care team of client’s progress and needs
- Assisting the physician in the development/renewal of the Plan of Care
- Preparation of clinical progress notes, summary reports, medication profiles, discharge summaries and other documentation
- Participation in case conferences, staff meetings, and in-service programs as required by the Agency
- Referral to other services, as needed
- Evaluating outcomes of care