Babies First! Program Review Tool



Babies First! Program Review Tool

|LPHA: |      |Reviewer: |      |

|LPH administrator: |      |Review participants: |      |

|Date(s) of review (mm/dd/yyyy): |      -       |Date of report (mm/dd/yyyy): |      |

A client record review is conducted to ensure Babies First! Program and Nursing Practice documentation standards are met. Babies First! Program Guidance (defined in the Babies First! Program Manual) is intended to provide direction and standardization to the Babies First! program implemented by LPHA’s in Oregon. The chart review is also intended to provide a framework for evaluating the practice of Babies First! Home Visiting and to define the professional home visitor's accountability to the public and to the client to whom the profession is responsible. The Babies First! Chart Review Tool will be used for the review of records. Any section below labeled with “to be demonstrated by review of client records” will receive a compliance finding if less than 80% of all records reviewed have not met the criteria.

|Criteria for Compliance |Compliant? |Comments/Documentation/Explanation/Timeline |

| |Yes |No | |

|Babies First! Program Elements |

| LPHA or LPHA’s subcontractor, if applicable, has designated a staff member as its Babies First! supervisor. | | |      |

|(PE-42 (4)(e)(1)(a)(i)) | | | |

|Babies First! services are delivered by or under the direction of a registered nurse/public health nurse. | | |      |

|(PE-42 (4)(e)(1)(a)(ii)) | | | |

|Minimum staffing (.5 FTE RN/PHN) and caseload (caseload of 20) requirements are met or an approved variance is| | |      |

|in place. (PE-42 (4)(e)(1)(a)(ii)) | | | |

|Babies First! services are provided to eligible perinatal women, infants and children through four years of | | |      |

|age, and parents/primary caregivers of eligible children as defined in the Program Guidance (Babies First! | | | |

|Program Manual). (PE-42 (4)(e)(2)(a)) | | | |

|Services are delivered in accordance with Babies First! Program Guidance (Babies First! Program Manual) | | |      |

|provided by the Maternal and Child Health Section. (PE-42 (4)(e)(2)(a)) | | | |

|Administrative Policies and Procedures that support implementation of the Babies First! program are in place. | | |      |

|(Babies First! Program Manual) | | | |

|Minimum reflective supervision requirements are met. (Babies First! Program Manual) | | |      |

|Team meetings occur at least one time per month. (Babies First! Program Manual) | | |      |

|The minimum home visit schedule is followed (to be demonstrated by review of client records). (Babies First! | | |      |

|Program Manual) | | | |

|A signed release of information and signed consent for services are on file for each client (to be | | |      |

|demonstrated by review of client records). (Babies First! Program Manual) | | | |

|Screenings and Assessments are completed at the recommended times (to be demonstrated by review of client | | |      |

|records). (Babies First! Program Manual) | | | |

|Interventions are completed per program guidelines (to be demonstrated by review of client records). (Babies | | |      |

|First! Program Manual) | | | |

|Babies First! Home Visitors and Supervisors have participated in the recommended orientation activities and | | |      |

|training. (Babies First! Program Manual) | | | |

|Babies First! program receives notifications made by OHA for Early Hearing Detection and Intervention and | | |      |

|reports back to OHA on planned follow-up. (PE-42 (4)(e)(6)) and Oregon Revised Statute ORS 433.321-327) | | | |

|Nursing Practice | | | |

|All RN/PHNs working in the Babies First! program must adhere to nursing practice standards as defined by the | | |      |

|Oregon State Board of Nursing. (PE-42 (4)(e)(4)) | | | |

|Initial and ongoing PHN nursing assessments reflect the collection of subjective and objective data (to be | | |      |

|demonstrated by review of client records). (OAR 851-045-0060) | | | |

|Nursing Diagnosis or Client Problem is documented (to be demonstrated by review of client records). (OAR | | |      |

|851-045-0060) | | | |

|PHN plan of care identifies priorities and sets realistic and measurable goals (to be demonstrated by review | | |      |

|of client records). (OAR 851-045-0060) | | | |

|PHNs implement the plan of care and document nursing interventions (to be demonstrated by review of client | | |      |

|records). (OAR 851-045-0060) | | | |

|PHNs implement the plan of care and document client responses to nursing interventions and progress toward | | |      |

|identified goals (to be demonstrated by review of client records). (OAR 851-045-0060) | | | |

|General Documentation | | | |

|Documentation is timely, thorough and clear (to be demonstrated by review of records). (OAR 851-045-0060) | | |      |

|Initial entry includes referral source and reason for referral and there is evidence of referral feedback | | |      |

|documented. (to be demonstrated by review of client records). (QA) | | | |

|Targeted Case Management (Section only applicable if LPHA is a provider of TCM billable services. If LPHA does not provide TCM services, enter N/A in comments column for A-E below) |

|All Targeted Case Management (TCM) case managers are employees of the local public health authority, or other | | |      |

|public or private agency contracted by the local public health authority. (OAR 410-138-0060) | | | |

|All TCM case managers are licensed registered nurses. All community health workers, family advocates or | | |      |

|promotorads work under the direction of the RN. (OAR 410-138-0060) | | | |

|TCM services are billed only for clients enrolled in the Babies First!, program. (OAR 410-138-0020) | | |      |

|Documentation for all TCM services includes all elements included in the most current version of the TCM | | |      |

|Assessment Form, TCM Service Plan Form and TCM Visit Form (to be demonstrated by review of client records). | | | |

|(PE-42 (4)(e)(5)) | | | |

|TCM services billed to Medicaid include one or more of the following components: Assessment to determine need | | |      |

|for medical, educational, social or other services; Development of a care plan based on assessment; Referral, | | | |

|linking, and coordination of services and related activities; Monitoring of the above components (to be | | | |

|demonstrated by review of client records). (OAR 410-138-0007) | | | |

|IV. Data Collection |

|For all individuals who receive MCH PHN Home Visiting Services, LPHA must ensure that Supervisors and Home | | |      |

|Visitors collect required data on client visits and enter it into the state-designated data system in a timely| | | |

|manner that is aligned with expectations defined by the program and within no more than thirty (30) business | | | |

|days of visiting the client and 45 days of case closure. (PE-42 (6)(d)) | | | |

|LPHA must take all appropriate steps to maintain client confidentiality and obtain any necessary written | | |      |

|permissions or agreements for data analysis or disclosure of protected health information, in accordance with | | | |

|HIPAA (Health Insurance Portability and Accountability Act of 1996) regulations (to be demonstrated by review | | | |

|of client records). (PE-42 (6)(d)) | | | |

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