Facility Policies & Procedures

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Anti-Coagulation Policy - The use of Anticoagulation Therapy is one of the most commonly occurring modalities in geriatric medicine. The power of anticoagulation medications and their sheer frequency of use warrant effective policies and procedures to monitor patients during therapy. ECP Physicians recommend this or a similar control/monitoring system to be adopted by Nursing Facilities.  Anti-Coagulation Management Policy - 2008 Document.

MOST - is an acronym for 'Medical Orders for Scope of Treatment'. This form can replace our less comprehensive DNR form as the primary document to guide clinicians when treating seriously ill patients. ECP encourages learn how to use this form and adopt it in their procedures for documenting End of Life choices for patients. likelihood that an On-Call Physician will render treatment consistent with patient/family desires. To order the forms, follow this link:  http://www.ncdhhs.gov/dhsr/EMS/pdf/mostorderform2.pdf.

Use of Point of Care devices vs. Laboratory Measurement of Anticoagulation - ECP recommends the use of Point of Care devices for monitoring PT/INR values (see Anti-Coagulation policy).  This link takes you to the American Association for Clinical Chemistry' s Medical Practice Guidelines which recognize P-o-C testing for INR as a safe and effective alternative to Laboratory testing.

Controlled Substance Emergency Sheet - Updated 2008 - Recommends contents of the "Controlled Substance Emergency Kit" permitted under the NC Controlled Substances Act. The contents are designed to address the most common needs of patients with uncontrolled pain or terminal illness while remaining cost effective. The selection was chosen by a panel of Clinicians - SNF Medical Director, Hospice Medical Director, Consulting Pharmacist, Palliative Care Nurse. Each facility, its staff, and consulting pharmacist must review and adapt the contents to their situation.

ECP Guidelines for Lab and X-ray reports - Why the need for guidelines? The ECP caregivers have noticed a wide variation in the way LTC facilities handle laboratory and X-ray data. We have found, that at times, this data is not reported to the ordering physician/nurse practitioner in a timely, organized manner, or is lost altogether. We seek to improve patient care by savings time for both the LTC facility and the physicians/NPs in the handling and reporting of these data, decreasing the reporting errors, and improving communication with the lab and X-ray departments at the hospital. We believe following these guidelines risk exposure on everyone's part.

Palliative Care at ECP - Several ECP Physicians are Board Certified in Palliative Medicine. Palliative Medicine is a new term to many people. Our statement on the subject may help the reader better understand the philosophy behind this approach to care.

Recommendations for use of Advanced Directives and DNR Orders in the Nursing Facility - ECP staff observe that many facilities have antiquated policies regarding DNR orders. Over the past several years, NC State Law has changed. More changes are under consideration. This recommended policy is consistent with current law and anticipated future legislation.

MRSA Patient Management Guidelines from the CDC - Click here

Adult Care Home Prior Approval and Admissions - Medicaid will accept the signature of a physician, nurse practitioner, or physician assistant on an FL2 for use in an adult care home prior approval and/or admission, in order to comply with G.S. §90-18.3 of the Physician Practice Act, which states:

(a) Whenever a statute or State agency rule requires that a physical examination shall be conducted by a physician, the examination may be conducted and form signed by a nurse practitioner or a physician's assistant, and physician need not be present.  Nothing in this section shall otherwise change the scope of practice of a nurse practitioner or a physician's assistant, as defined by G.S. §90-18.2, respectively.

Who can sign Physician orders: 

Given in the table below are the requirements for physicians extenders to write orders, when this function is not permitted under the scope of practice for the state. §424.20(e)(2) states that NPs and CNSs who are not employed by the facility and are working in collaboration with a physician, when permitted under the scope of practice for the state, may sign the initial certifications and the required SNF re-certifications. PAs do not currently have the authority to sign either the initial certification or any re- certification.

Authority for Physician Extenders to Write Orders and Sign Certifications/Recertifications