Mobile Medication and Monitoring Assistance



Mobile Medication and Monitoring AssistanceCrystal Bendele, Christina Bookheimer, Susan Headley, Kristen Lintjer, Tracie PetersonFerris State UniversityAbstractThe mobile medication and monitoring services are committed to helping the elderly that are unable to get to the lab or need help setting up their medications. This paper explains the staff and their job duties, as well as the mission, philosophy, and objectives of the business. It also explains the internal and external factors of the services. Advertising is a big part of starting a new business so this is also included. Finally, the budget is included for the first year of service. IntroductionIn a world of soaring health care cost and shrinking budgets it is important to have programs in place that meet the needs of the less fortunate or those that cannot access the system easily. This is especially true in our elderly population. Many are unable to get out of the house for basic services and because of this poor control of chronic illnesses and re-hospitalizations can be the result. Mobile Medication and Monitoring Assistance is a program developed to address providing services such as medication management and phlebotomy in the patients’ home. It is believed that this basic care can have a valuable and worthwhile impact on those served.Assessment of External and Internal EnvironmentEnvironmental Scan and BackgroundThe rapidly changing healthcare environment is forcing nurses and health care organizations to provide care more efficiently without sacrificing quality. A major focus for acute care hospitals in today’s society is readmission rates. This is concerning for organizations because as healthcare moves forward with changes, reimbursement for readmissions may be jeopardized. With that said, hospitals are obviously focusing on ways to reduce or prevent readmissions. While home care agencies and sub-acute rehab facilities are in place to facilitate care post discharge, some patients may not have a skilled need. Acute care hospitals may benefit from an external support service that helps those patients in need of health care services not covered by insurance; a service such as this could be beneficial in preventing a percentage of readmissions. If patients have a skilled need such as nursing for wound care or physical therapy, those services are easily obtainable and covered by insurance. However, there are certain tasks that the Centers for Medicare and Medicaid Services (CMS) do not feel are skilled therefore, they do not provide reimbursement. These stand-alone services are medication set up and lab draws. These services alone or in combination, if not followed after discharge could result in extra physician visits, emergency room visits, or hospital readmissions. This planning group has identified the need for a medication set up and lab draw service for patients that do not meet the skilled need post discharge from an acute care hospital, home nursing service, or sub-acute rehab facility. Senior patients often have multiple medications which may contribute to confusion in taking their medications correctly. Additionally, some patients may forget to take their medications if not arranged in a manner to assure compliance. If a CHF patient misses even one dose of Lasix this could potentially lead to an emergency room visit or hospital admission. Having medications set up already could potentially increase compliance and prevent such a visit. A second service is assistance in drawing blood samples and delivering the samples to the lab. Patients could face challenges in remembering that a lab draw is due or have difficulty with obtaining transportation to the lab. It has been identified that medication set up and lab draws can be two very challenging tasks for some of the elderly population. The focus of this project will offer these two basic services to patients living in their own homes as well as those patients in Assisted Living Facilities and Adult Foster Care Homes. As a group, the decision was made to name our service Mobile Medication and Monitoring Assistance.Internal EnvironmentInternal environment needs for this service was also examined. Because the program is starting with services in one county, it was decided to pursue an office space at the contracted hospital in the county of service. The one county service program would serve as the pilot. As the pilot program becomes successful, plans would be to proceed with services in additional counties. The pilot county chosen was Alcona County because 31.4% of the population is 65 years or older (U.S. Census Bureau, 2010). The goal would be to add two to three counties within a year. To help pay for overhead expenses, our group would pursue a grant from the participating hospital. This would be in exchange for a decreased readmission rate. Additionally, plans to contract with the participating hospital for an office space would be negotiated. Initially, this would be a non-profit program staffed with a receptionist and a nurse. The receptionist would maintain the office and obtain the referrals. The nurse would be responsible for seeing the patients and providing the services. As this organization grows, the plans would be to add additional staff. Case management and discharge planning of the contracted hospital can contact our service with referrals for potential patients in need of either of these services. Additionally, local nursing facilities and home care agencies could provide referrals for patients being discharged that may need additional assistance at home. In summary, this group has identified a need for medication set up and lab draw service post-acute care, sub-acute care, or discharge from home nursing services in elderly patients. Our goal is to service those patients in need to help prevent additional physician office visits, emergency room visits, or readmissions to the hospital. Hopefully, this will enhance the quality of life for participating seniors.Mission StatementMobile Medication and Monitoring Assistance is a non-profit service organization serving the elderly population in Alcona County. Our mission is to provide services not covered by Medicare/Medicaid for the homebound population. Our staff is committed to reducing unnecessary emergency room visits, physician office visits, and hospitalizations by assisting in managing medication administration and laboratory services.Philosophy The staff of Mobile Medication and Monitoring Assistance strives to aid a segment of the aging population that presently is underserved by existing insurance coverage and area services. Our vision is to reduce hospital readmissions and unnecessary health care encounters by providing timely intervention and support within the home while protecting the safety of our clients. All staff value and respect the individuality and self-determination of our clients. Our vision is to assist the senior community while being wise stewards of healthcare resources. Our clients and area health care providers are partners in our mission and participate in the planning, decision making and implementation of services. Our goal is to become an indispensable member of the health care team in Alcona County.Mobile Medication and Monitoring Assistance GoalsProtect the safety of the elderly, homebound population in Michigan.Support the elderly population to remain in their homes by assisting them to maintain their functional independence.Cover a gap which exists in healthcare by providing a service which is not covered by insurance.Decrease the cost of healthcare by decreasing the risk of preventable causes of healthcare encounters.Responsibly use our limited healthcare resources.Expand the provision of these services to elderly, homebound patients throughout Michigan. Decrease fatalities which are due to preventable causes.Nurture relationships amongst healthcare providers and offer options for the provision of needed healthcare.Mobile Medication and Monitoring Assistance ObjectivesTo evaluate the effectiveness and outcomes of the pilot program.To provide the highest quality services to the elderly population in Alcona County.To decrease the number of preventable readmissions and unnecessary health care encounters.To serve as a model for innovative, cost effective methods of health care delivery.To provide medication set up and lab draw services for elderly, homebound patients that are not covered by Medicare/Medicaid Services.To expand our service area.To maintain the elderly population’s ability to safely stay in their own homes.To demonstrate our value in the healthcare environment.Job Descriptions The Mobile Medication and Monitoring Assistance organization is overseen and governed by a Board of Trustees (see appendix A for organizational chart).Members of the Board of Trustees are as follows:PhysicianRegistered NurseSocial WorkerMember of the communityPhysician/Board memberThis position will be a volunteer lead position that will oversee the overall functioning of the non-profit organization.Education Requirements:MD or DO, with a minimum of 5 years medical experience, preferably with the geriatric population and is currently licensed in the State of Michigan with no restrictions to their license.Responsibilities:Volunteer position that oversees the functioning of the organization.Participates and runs the Board meetings monthly.Actively educates the community on what the organization is and what they can offer.Registered Nurse/Board memberThis position is a volunteer position that will oversee the overall clinical nursing aspects of the organization.Education Requirements:BSN preferred with 10 years of nursing experience with 5 years of it in management and holds a current license in the State of Michigan.Responsibilities:Volunteer position that participates and attends monthly board meetings.Oversees the staff nurse and their training.Participates in writing of grants to help fund the organization.Actively participates in educating the community on what the organization has to offer.Social Worker/Board memberThis position is a volunteer position that will make sure that the staff nurse has all the community resources for the clients that are needed.Education Requirements:Master’s degree with current licensure within the State of Michigan and at least 2 years of experience.Responsibilities:Volunteer position that participates and attends monthly board meetings.Research and provide education resources for staff nurse on the community resources that are available for the clients.Actively participates in educating the community on what the organization has to munity Member/Board memberThis position is a volunteer position to be able to provide necessary input as to what the needs are of the community and how the organization can assist.Education Requirements:Medical professional that is an active part of the medical community.Responsibilities:Volunteer position that participates and attends monthly board meetings.Actively participates in educating the community on what the organization has to offer.Staff NurseThis position will be filled by a Registered Nurse that will be able to work closely with physicians, patients, referral sources and other members of the community. They will be goal driven and be able to work not only independently but also as an active team player in the medical community.Education Requirements:Minimum associate degree or diploma in nursing from an accredited nursing program with 2 years of experience in the nursing field and maintains a current licensure in the State of Michigan.Responsibilities:Reports directly to the Board of Trustees.Participates and attends monthly board meetings.Assists with the writing of grants for funding of the organization.Assesses patients with a head to toe assessment.Sets up patients medications for them for a 2 week period.Admits patients to the service and assesses what their needs are.Draw lab work as needed via venipuncture with physician order.Follows universal municates with physicians, nurses, referral sources, and other medical professionals regularly.Maintains patient confidentiality at all times.Supervises the Administrative Assistant.Actively participates in educating the community on what the organization has to offer.Administrative AssistantThis position will take care of the everyday operations of the office and will work closely as a team member with the staff nurse.Education Requirements:Minimum of a high school diploma, GED, or equivalent with at least 2 years of experience in the medical field.Responsibilities:Works under the supervision of the staff RN.Answers phone calls and directs them appropriately.Gathers intake information from the referral sources and provides the staff RN with all the pertinent information.Provides any administrative support that is municates with referral sources as needed.Actively participates in educating the community on what the organization has to offer.Job AdvertisementAdvertising and ultimately selecting the appropriate employees is crucial to the success of an organization. “Health care is centered on caring for people, and nurses with appropriate people skills are essential for producing satisfied patients and families” (Yoder-Wise, 2011, p. 296) is applicable to the mission and goals of Mobile Medication and Monitoring Assistance. The position chosen by the group to advertise for is that of the staff nurse. Information considered was advertising in a major nursing journal, local newspaper, and other sources that would be appropriate. Nursing JournalThe American Journal of Nursing (AJN) has been considered the leading voice of nursing since 1900 and is currently the oldest nursing journal in circulation. Published monthly and with a circulation of approximately 340,000 it has the ability to reach many potential candidates for our position (AJN, 2012). The closing date for publishing in the May edition would be April 2, 2012. Our ad must be digitally submitted with appropriate format (Appendix B). The advertisement size chosen will be half page vertical presentation at 3 3/8”x9 5/8 in size. The cost will be $5,270.00 for one month (Lippincott Williams & Wilkins, 2012). It is our hope that this will allow for enough exposure to fulfill the position of staff nurse. Local NewspaperA search for local newspapers in and around the Alcona County area found limited resources. The Alcona County Review was judged to be the best local option for advertising for the staff nurse position. The newspaper has a weekly format and is circulated to eleven areas in Alcona County (Alcona Review, 2012).No stipulations were found as to the overall size of the ad. A basic classified advertisement will be utilized (Appendix C) at the rate of $4.50 for the first ten words and fifteen cents for each word thereafter. This resulted in a total of $22.65 per week with a projected run time of four weeks. It was decided that this would allow for increased exposure to potential job applicants. Alternate Advertising ResourceThe Michigan Talent Bank is an excellent resource that could be considered in filling the staff nurse position. This is an on-line resource that employers can go and search resumes that have been posted by those seeking employment. The search can be narrowed according to profession and job duties. Job postings can be created for this resource however it would be easier for us to use the Talent Scout application (Michigan Works, 2011) that is offered. As a free resource this would be beneficial to our organization in reducing start-up cost. Employee BudgetThe mobile medication and monitoring services will need two full time employees. The first will be the administrative assistant. This person will work 8am to 5pm Monday thru Friday. Starting salary will be $30,000 per year with room for advancement in the future. The second person will be the registered nurse. This person will also work 8am to 5pm Monday thru Friday. The starting salary for this person will be $45,000 per year with room for advancement in the future as well. Both employees will be full time and will be offered benefits. Benefits will be approximately $8,000 per person per year. Both employees will have the option to decline the benefits but then will need to prove that they have benefits through another source. Both employees will start with 40 hours of personal time off (PTO) per year. They will be able to take personal time but will need to work that around the clinic needs. In the future there will be room to expand the staff to include two administrative assistants and two registered nurses. When that happens, each person will be able to cover the job duties of the other without having to close services for a day. There will be six paid holidays during the year. They include Christmas day, New Years day, Thanksgiving, Labor Day, Memorial Day, and Fourth of July. If the holiday falls on a weekday the clinic will be closed on that day. If the holiday falls on the weekend, Saturday or Sunday, the clinic will be closed either Friday or Monday in observance of the holiday. There will not be any on-call time with the start of the business although that could be a possibility with future growth. The other members of the team will be voluntary. They will set their own hours they will just need to be during the normal business hours.Hours of OperationThe hours of operation will be Monday thru Friday 8 am until 5 pm. There will need to be some flexibility with the morning hours as there will be times that there needs to be an early morning fasting lab drawn. If this is the case the nurse will come in early and then be able to leave early as well. The administrative assistant will call the patient at least one day in advance to schedule an appointment for the next day or sometime in the week. If the patient needs medication set up they will be put on a weekly schedule without the need to call for an appointment. The final appointment for each day will be between 3 pm and 4 pm so that the nurse will be able to come back to the office and have time to do any necessary paper work before the end of the day. Supplies and Operating BudgetThere will be supplies and operating costs for the clinic. Both will be covered by a grant that has been made possible by anonymous foundations. The patient’s insurance will be billed with the first visit, some may reimburse for services and others will not. If insurance will not reimburse, the patient will not be charged out of pocket. Those costs will be absorbed with the grant money. The cost for each service will depend on what is needed. For medication set up, it will be the cost of a pill box approximately $3.99 to $12.99 per box depending on the size that is needed. There will be a greater cost for phlebotomy supplies. Some are start up costs and some are patient costs. The nurse will need a blood transport cooler bag which will be $19.99. There will also be a need for a phlebotomy tray where the nurse can store needles, lab tubes, and prep supplies, this be a cost of $57.50. Sharps containers will also be needed which will be at a cost of $12.50 for five containers. A tourniquet will also be needed at a cost of $15.95; this will be a reusable item between patients. As far as patient costs it will vary depending on what and how many labs need to be drawn. The estimated cost for each patient will be approximately $1.89 to $3.00 for lab supplies. That includes the prep supplies, gloves, lab tubes, needle, and band-aids. The nurse will need to fill out an expense sheet for each patient visit. This will track exactly how many supplies are being used (Appendix D); the budget can then be adjusted based on that data. We expect the patient referrals to increase in the first year of operation.The administrative assistant will need an office space to work from. This space is going to be in the main hospital and donated by it as well. The hospital staff will then be able to walk the referral forms to the administrative assistant so that appointments can be made. There is also going to be a need for office supplies. There will be a need for a computer at an approximate cost of $641.97. There will also be a need for paper, pens, a printer/copier/fax machine, a paper shredder, and a phone. An approximate start cost for those supplies is $540.97. There will be a monthly fee for additional supplies such as paper and printer ink with an approximate cost of $100.00 per month. The nurse will also need to have a laptop or a tablet to take along to the patient’s home. This is where all of the patient charting will be done. The hospital will add on the same program that they use for charting so that all files can be crossed over and doctors can see all results. The cost of the nurse’s computer will be approximately $700.00 total.There will also be an expense for the nurse’s traveling. Currently the plan is to have the nurse drive his/her vehicle with the business reimbursing for mileage. The current rate for reimbursement is approximately $0.52 per mile. It will be the nurse’s responsibility to keep track of the mileage and submit the appropriate form for reimbursement (appendix E). The nurse is going to be traveling different amount of miles every day but we are going to average that it will be about 100 miles per day for a total reimbursement of $52 per day and $260 per week. That is averaging four patients per day for five days, for a total of 80-100 patients per month.Overall the first fiscal year (May 1, 2012-April 30, 2013) will be a trial to see what the actual operating expenses are going to be. There will be quarterly and yearly expense sheets that will need to be filled out (appendix F) by the nurse or administrative assistant. The budget will then need to be proposed for the following year. The board of directors will be in monthly contact with the employees to see how things are going. There will be at least one monthly meeting to review the data from the previous month. In the beginning, they may decide to meet weekly to go over operating expenses. ConclusionThe mobile medication and monitoring assistance is focused on providing quality care for the aging population and in turn decreasing hospital readmissions. Hospital readmissions are costly; using this service will provide quality care at home leading to a decrease in costs. Our staff is committed to exemplifying compassion and professionalism as we endeavor to assist our clients to maintain functional independence. By using the mobile medication and monitoring services, the aging population will be able to stay at home more and feel more independent with their medical needs.ReferencesAlcona Review (2012). Classifieds. As retrieved from Williams & Wilkins (2012). American Journal of Nursing—Recruitment. As retrieved from Works (2011). Michigan Talent Bank. As retrieved from . S. Census Bureau. State and County Quick Facts. (2010). Retrieved from , P. S. (2011). Leading and managing in nursing. (5th ed.). St. Louis: Mosby.Appendix AMobile Medication and Monitoring AssistanceOrganizational Chart1866900272415Board of Trustees00Board of Trustees3018789463550002200275111760Registered Nurse00Registered Nurse30378391390650045046893467100016376643422650030130753416300016256003422640077152537465AdministrativeAssistant00AdministrativeAssistant371792537465Patients00PatientsAppendix BAppendix CMobile Medication and Monitoring Assistance is a non-profit service organization serving the elderly population in Alcona County. We are currently seeking a Registered Nurse to become an intricate part of our organization. Candidate must be able to work closely with physicians, patients, referral sources and other members of the community. Requirements include a minimum of an Associate Degree from an accredited nursing program with 2 years of experience and current licensure in the State of Michigan.Duties will include patient assessment and admissions to program, in home visits to provide medication set up and management, venipuncture services, as well as reporting to Board of Trustees, grant writing, monthly board meetings, supervision of administrative assistant and community education.Interested candidates may contact Chris Bookheimer at (231) 555-1212 or by email at nursebookheimer@Appendix DExpense Report--SuppliesPatient NumberNumber of lab tubesLab Supplies$1.75/patientMedication BoxTotal$1.75$1.75$1.75$1.75$1.75 Patient Total: Appendix EMileage Reimbursement FormPatient NumberMileagex$0.52Totalx$0.52x$0.52x$0.52x$0.52x$0.52 Grand Total for the Week:Appendix FQuarterly Budget WorksheetMobile Medication and Monitoring ServicesFirst QuarterSecond QuarterThirdQuarterFourth QuarterTotalSalaries 18,75018,75018,75018,75075,000Fringe Benefits1,0001,0001,0001,0004,000Office Supplies1,982.94Patient Supplies1,250.00MileageTotal ................
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