Acts as a member of the interdisciplinary team for the assigned functions related to the coordination of services with internal and external referral sources. Responsible for processing inpatient referrals into hospice, ensuring continuity of care, and coordinating discharge planning in contract facilities.
Provides, assessment, planning and direct patient care to hospice patients in accordance with the agency policies and procedures and the plan of care established by the interdisciplinary team.
Actively engages and educates potential customers to the benefits and appropriateness of hospice care.
Ensures the patient and his/her family has adequate knowledge and understanding of the hospice benefit.
Processes inquiries for all new referrals (internal and external).
Performs daily assessment and contribute to the plan of care. Assesses patient for safety risks, abuse and neglect.
Under the direct supervision of an RN, assesses educational needs of patients and significant others considering cultural issues and other special challenges.
Ensures seamless transition from hospital to the community setting by coordinating the following hospice services at time of discharge:
ordering of medications within scope of practice,
ordering supplies and DME,
hand-off communication with field team, and
documentation in the electronic medical record
Knows action, usual dosage, indications and side effects of medications administered.
Flexibility in setting and revising priorities for one's daily assignment based on patient needs/acuity, family requests and available resources.
Documents changes in patient condition and effectiveness and timeliness of care/interventions
Graduate of an accredited practical or vocational nursing program.
Knowledgeable regarding JCAHO and Medicare standards and regulations.