Policies

Policies and Procedures

Anti-Coagulation Policy - The use of Anticoagulation Therapy is one of the most commonly occurring modalitncyies in geriatric medicine. The power of anticoagulation medications and their sheer freque 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.

MOST- is an acronym for 'Medical Orders for Scope of Treatment'. This form can replace our less comprehensive State approved DNR form as the primary document to guide clinicians when treating seriously ill patients. ECP encourages Nursing Facilities to learn how to use this form and adopt it in their procedures for documenting End of Life choices for patients. This will increase the 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

Additional MOST Documents:
Guide for Public Education JAN2009
MOST Procedures
MOSTGuide B - Guide for Patients DEC2008
NC MOST Form

Clinical Impact of Point-of-Care 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 a 2005 article from the American Journal of Clinical Pathology, reprinted in Medscape. It contrasts the accuracy of one of the machines with that of clinical laboratories. You will need to use this username: ecpmd2006 and this password: ecpmd.

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 emergency 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 saving 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 decreases risk exposure on everyone's part.

HIPPA Privacy Notice - We are required by law to keep patients Medical Information confidential. This notice outlines our commitment to our patients in this regard.

CMS guidance to clinicians about HIPPA This link takes you to a CMS (Office of Civil Rights) web publication which attempts to explain HIPPA in plain English. This is useful because it clearly describes a broader latitude in your ability to disclose Protected Health Information (PHI) than was implied original regulations. Hence, you (the provider) are able to discuss an incapacitated patient’s specific condition with family, friends, or others as long as the health care provider determines, based on professional judgment, that it is in the best interest of the patient

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.

Position Paper on 'Treatment in Place' for Nursing Facility Residents - ECP Physicians are increasingly convinced that a 'treat in place' strategy is the best way to care for the majority of acute episodes for nursing facility residents. In most cases, clinical outcomes are similar and patients experience a better quality of life in familiar surroundings. This paper can help facilities interested in a 'treat in place' model get a program started.