Report Submission
Policies/Regulations
Documentation
Miscellaneous
Mixed Bag
100

The email address that you submit Initial/Baseline assessments to

45day@dhcamd.com 

100
The regulations that outline the criteria for the delegation of nursing functions

COMAR 10.27.11

100

Per DHCA policy, this is how staff should document on the front of the MAR when an individual is hospitalized

A circled 'H'

100

In order of prioritization, these items should appear at the end of the nursing care plan

Activities of daily living

100

The timeframe in which the nurse must update the HRST when notified of a change in status

5 days

200

The appropriate time to submit a "Not Available" form

When unable to enter a home/program to review the books, medications, etc. OR During a baseline visit

200

The frequency that you must assess an individual when staff are performing topical wound care to stage 3 or 4 wounds

Every 7 days

200

When documenting repeat requests on nursing visit reports, this must be documented next to each repeat request

The title of the person notified of the repeat request

200
Agency Management must be notified via telephone if a change to the nursing visit schedule will occur within what timeframe of the scheduled visit

2 weeks

200

Name 2 types of wound care that cannot be delegated

-Packing

-Sterile dressings

-Wet-to-dry

-Wound vac

300

The appropriate form to submit when assessing an individual after submitting a "Not Available" form

A nursing visit form/Baseline form

300

The frequency in which an individual must be assessed if they are a Level 3 for routine medications, but a Level 2 for PRN medications

Every 45 days

300

If there are two staff on duty when insulin is being administered, this must occur on the MAR

The second staff member must act as a witness and document on the MAR.

300

Name 3 of the criteria used by DHCA to recommend Nursing Health Case Management

  • HRST score of 3 or above
  • Q score of 4
  • 3 or above in 2 or more HRST Rating Items
  • Diabetes
  • Seizure Disorder
  • Dysphagia
  • History of Choking (any in lifetime)
  • History of Aspiration Pneumonia (any in lifetime)
  • History of Bowel Impaction (any in lifetime)
  • History of Sepsis (any in lifetime)
  • History of Hospitalization due to Dehydration (any in lifetime)
300

The only time that it is appropriate to delegate a PRN medication for anxiety

When an individual is receiving hospice care

400

An All-In-One Training form must be on file for each individual supported within this timeframe when a nurse takes over an entirely new caseload

4 months

400

The care plan must be updated within this timeframe of notification of change in status

48 hours

400

When the nurse administers an IM injection, these items related to the medication must be documented on the interim form in addition to the individual's physical assessment and the injection location.

Manufacturer, Lot#, Expiration date

400

If an individual self-medicates medical marijuana, this must be placed in writing by the physician 

A document indicating awareness and if there are any concerns related to interaction between marijuana and other medications/treatments. 

400

Individuals that have these two (2) medical needs require annual nutritional evaluations

-G-tube

-Insulin

500

The timeframe in which you must submit your initial reports (Baseline, POC, CRST/FP, Self-Med) when taking over a partial caseload

5 business days

500

If an individual supported is served both residentially and at the day program, and experiences a choking episode at the day program, this person(s) is responsible for completing the CRST

Both the day program nurse (48 business hours) and the residential nurse (48 hours).

500

By definition, when administering/documenting for a STAT medication, this medication is to be given within this timeframe of being ordered

Within 20 minutes

500

If an individual requires oxygen during hospitalization and will be discharged on room air, how long does the individual need to be on room air prior to discharge and what is the minimum SaO2

The individual must be on room air with no oxygen requirements and a SaO2 of 92% or above for 24 hours prior to approving discharge.

500

How many days since the last bowel movement requires an ER visit if the individual does not have a protocol/PRN medication from the MD?

5 or more days