Windrose Health Network, Inc

Windrose Health Network, Inc.

ADMINISTRATIVE POLICYCODE: AD 1.16

Reviewed/Revised
Date: 4/21/09 /

Next Review Date:4/11

Approved by:

/ Date:Date: / Effective Date: 6/17/09

Windrose Health Network

6/16/09

Board of Directors

med-levElPractitioner chart review

PURPOSE:In order to ensure high-quality clinical care and to comply with the regulatory requirements of the State of Indiana.

SCOPE:All WHN Mid-level Practitioners

POLICY STATEMENT: Windrose Health Network (WHN) will establish and maintain a system that

continuously monitors the prescribing practices of the Mid-level Practitioners, (i.e., Nurse Practitioners,

Nurse Midwives and Physician Assistants), who deliver patient care services.

PROCEDURE:

1.Frequency of Reviews Quantity of Charts.

a.Frequency: Depending upon the time frame delineated by Indiana Statute for each specific Mid-level discipline, a review of medical records will be conducted by a licensed, WHN Physician or physician consultant. Preferably, reviews will be completed by the Physician who has signed a Collaborative Agreement with a specific Mid-level Practitioner. Listed below are the criteria for

conducting medical chart reviews forMid-level Practitioners.

b.Quantity of Charts Reviewed: To comply with the State of Indiana’s requirements for this process, a Physician reviewer will examine at least five percent (5%) of the Medical Records of patients seen by a Mid-level Practitioner. If a Mid-level Practitioner treatsless than twenty (20) patients in a 24 hour period, at least one (1) medical record will be reviewed.

MID-LEVEL PRACTITIONERCHART REVIEW CRITERIA:

Discipline / Time Line re:
Date of Service / Number / Reviewer
Nurse Practitioner / within 7 calendar days / 5% of charts / Collaborating Physician or consultant
Nurse Midwife / within 7 calendar days / 5% of charts / Collaborating Physician or consultant
Physician Assistant / within 24 hours / 5% of charts / Collaborating Physician or consultant

3.Follow-up: The reviewing Physician will complete and sign a review form, (a copy of the Mid-Level Chart Review form is attached to this policy). He/she will forward all reviews to the Director of Quality & Disease Management. The Director, or her designee’, will review the documents and notify the WHN’s Medical Director of any concerns. The Medical Director, along with the WHN’s Executive Director, will address any concerns via the Risk Management Committee.

4.Reporting: Each year in June and December, the Chairperson of the Risk Management Committee will compile and submit a report on these reviews to the Quality Committee of the Board of Directors. An annual report on the findings on this practice will be presented to the Quality Committee in its first meeting of the calendar year.

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WHNMID-LEVEL CHART REVIEW FORM

Chart No: Date of Service:

Mid-Level Provider (Name & Trng):

AREAS REVIEWED / Yes / No / REVIEWER’S COMMENTS
GENERAL ITEMS:
The Chief Complaint (CC) is clearly indicated?
The Hx of Present Illness (HPI) is clearly indicated?
The Past Medical Hx (PMH) - - if pertinent - - is addressed?
DIAGNOSIS, MEDICATIONS & TREATMENT:
All mediations are congruent with the diagnosis (es) and patient’s
health concern(s)?
All medications and dosages are clearly listed?
Treatment is consistent with the assessment & diagnosis (es)?

Additional Comments:

I have reviewed the Medical Record (listed above) followed up with the Provider (listed above), if indicated.

Reviewer’s Name & DegreeDate