mobile medication and monitoring assistance · web viewmobile medication and monitoring assistance...

Running head: MOBILE MEDICATION AND MONITORING ASSISTANCE 1

Mobile Medication and Monitoring Assistance

Crystal Bendele, Christina Bookheimer, Susan Headley, Kristen Lintjer, Tracie Peterson

Ferris State University

MOBILE MEDICATION AND MONITORING ASSISTANCE 2

Abstract

The 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.


Introduction

In 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 Environment

Environmental Scan and Background

The 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 Environment

Internal 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 Statement

Mobile 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 Goals

Protect 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 Objectives

To 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:

Physician

Registered Nurse

Social Worker

Member of the community

Physician/Board member


This 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 member

This position is a volunteer position that will oversee the overall clinical nursing aspects of the

organization.


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 member

This position is a volunteer position that will make sure that the staff nurse has all the

community resources for the clients that are needed.


Master’s degree with current licensure within the State of Michigan and at least 2

years of experience.

Responsibilities:


Research and provide education resources for staff nurse on the community

resources that are available for the clients.


offer.

Community Member/Board member

This 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.


Medical professional that is an active part of the medical community.

Responsibilities:



offer.


Staff Nurse

This 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.


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 precautions.

Communicates with physicians, nurses, referral sources, and other medical

professionals regularly.

Maintains patient confidentiality at all times.

Supervises the Administrative Assistant.



offer.

Administrative Assistant

This position will take care of the everyday operations of the office and will work closely as a

team member with the staff nurse.


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 needed.

Communicates with referral sources as needed.


offer.

Job Advertisement

Advertising 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 Journal

The 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 Newspaper

A 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 Resource


The 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 Budget

The 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 Operation

The 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 Budget

There 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.

Conclusion

The 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.


References

Alcona Review (2012). Classifieds. As retrieved from http://www.alconareview.com

Lippincott Williams & Wilkins (2012). American Journal of Nursing—Recruitment. As retrieved

from http://www.lwwratecards.com/journal.php?journal=215

Michigan Works (2011). Michigan Talent Bank. As retrieved from

http://www.michworks.org/mtb/user/MTB_EMPL.employerMainMenu

U. S. Census Bureau. State and County Quick Facts. (2010). Retrieved from

http://quickfacts.census.gov/qfd/states/26/26001.html

Yoder-Wise, P. S. (2011). Leading and managing in nursing. (5th ed.). St. Louis: Mosby.

http://www.michworks.org/mtb/user/MTB_EMPL.employerMainMenu


Appendix A

Mobile Medication and Monitoring Assistance

Organizational Chart

Board of Trustees

Registered Nurse

Administrative

AssistantPatients


Appendix B


Appendix C

Mobile 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 [email protected]


Appendix D

Expense Report--Supplies

Patient Number Number of lab tubes

Lab Supplies$1.75/patient

Medication Box Total

$1.75

$1.75

$1.75

$1.75

$1.75

Patient Total:


Appendix E

Mileage Reimbursement Form

Patient Number Mileage x$0.52 Total

x$0.52

x$0.52

x$0.52

x$0.52

x$0.52

Grand Total for the Week:


Appendix F

Quarterly Budget Worksheet

Mobile Medication and Monitoring Services

First Quarter

Second Quarter

ThirdQuarter

Fourth Quarter Total

Salaries 18,750 18,750 18,750 18,750 75,000

Fringe Benefits 1,000 1,000 1,000 1,000 4,000

Office Supplies 1,982.94

Patient Supplies 1,250.00

Mileage

Total

mobile medication and monitoring assistance · web viewmobile medication and monitoring assistance...

Documents