APPENDIX I

Policy No: Page Number:

2451 1 of 5

Effective Date: Board Motion No:

03/2016 n/a

POLICY AND REGULATIONS MANUAL TITLE: TAKE HOME SUPPLIES PURPOSE:

To define the process for maintaining a standardized list for take home supplies including quantities; and to define the criteria and procedure for dispensing and obtaining approvals for take home supplies. POLICY STATEMENT: Harris Health System (Harris Health) strives to optimize patient care and promote cost and clinical efficiencies by selecting products that will optimize care and provide a continuum of care post discharge. POLICY ELABORATION: The Harris Health Take Home Supplies Committee is a functional subgroup of the Standardization Committee. I.

III.

SCOPE OF PROCESS: A.

Harris Health System provides take home supplies for patients discharged from one of our system hospitals or receiving services in the Outpatient Service areas for a maximum of three days regardless of financial class.

B.

Requests for supplies not included in the three-day rule require approval from Clinical Case Management. Exceptions include IV Antibiotics; Total Parental Nutrition (TPN) or Tracheostomy supplies (see Addendum A).

PROCESS TO OBTAIN THREE (3) DAY TAKE HOME SUPPLIES: A.

Nursing: 1. 2. 3.

Obtain physician order. Completes the take home supply form “Central Supply Charge Summary” using the check box beside each item requested to supply the needed items for 3 calendar days. The “Central Supply Charge Summary,” a three (3)-part form that is distributed as follows:

Policy No: Page Number:

2451 2 of 5

Effective Date: Board Motion No:

03/2016 n/a

POLICY AND REGULATIONS MANUAL 1. Top two copies are given to the patient to be taken to the Central Supply Department. 2. Bottom copy is retained by the discharging unit for monitoring. B.

Supply Chain Management: 1. 2. 3. 4.

IV.

Receives “Central Supply Charge Summary” form from the patient. Dispenses the items as indicated on the form. If supplies are not in stock, the patient is informed of the next available time and date to return for the balance remaining. Supply Chain Management will retain a copy of the “Central Supply Charge Summary” form for monitoring and recordkeeping.

DISCHARGE TAKE HOME SUPPLY FORMULARY: *(Note: Denied requests can be re-submitted to the Take Home Supply Committee after one year): A.

Requester: 1. 2. 3.

B.

Supply Chain Management Administration reviews requests for: 1. 2. 3. 4.

C.

Completes a request for Supply/ Equipment Formulary Form number 280064. Must complete a “Formulary Request” and specify the items. Submits the completed request to Supply Chain Management Administration office.

Standardization; Product costs; Vendor information; and Dispensing quantity.

Standardization Committee: 1. 2.

Reviews and analyzes recommendations to add, delete, or modify the Harris Health System Take Home Supply Formulary. Approves or denies requests.

Policy No: Page Number:

2451 3 of 5

Effective Date: Board Motion No:

03/2016 n/a

POLICY AND REGULATIONS MANUAL D. Supply Chain Management Administration: 1. 2. V.

Communicates approval/denial to requester. Adds, deletes, or modifies Take Home Supply Formulary for approved requests.

CRITERIA FOR APPROVAL OF EXEMPTION SUPPLIES: A.

Harris Health Clinical Case Management is the lead department in the implementation of this process.

B.

A patient may be referred to Clinical Case Management by any health professional in order to be considered for an exemption items. These items include: 1. IV Antibiotics; 2. Total Parental Nutrition (TPN); and 3. Tracheostomy Supplies.

VI.

PLAN COVERAGE: A.

Patients under Financial Plan 1 and Plan2: Supplies will be provided for IV Antibiotic, TPN medications or Tracheostomy supplies for the duration of treatment.

B.

Patients under Financial Plan 3, Plan 4 or Self Pay: Supplies will be provided for two (2) weeks IV Antibiotic TPN medications or Tracheostomy supplies. For fourteen (14) days of the treatment2. If additional pharmaceutical treatments are purchased after the fourteen (14) days of treatment, additional supplies required for the treatment course can be provided by Central Supply when the patient presents a receipt of purchase of IV Antibiotics or TPN.

C.

If the patient does not meet criteria listed in the exceptions, the three (3)-day rule should be followed by the discharging patient care area.

Policy No: Page Number:

2451 4 of 5

Effective Date: Board Motion No:

03/2016 n/a

POLICY AND REGULATIONS MANUAL D. When the patient does not meet criteria for an exception to the (3) three-day supply, and is requesting more supplies, the Clinical Case Manager will: 1. 2.

Educate and/or re-educate the patient, family, or significant other on Harris Health System’s policy regarding provision of supplies. Discuss community resources and redirect the patient, family, or significant other to these resources.

Policy No: Page Number:

2451 5 of 5

Effective Date: Board Motion No:

03/2016 n/a

POLICY AND REGULATIONS MANUAL REFERENCES/BIBLIOGRAPHY: Harris Health System Policy and Procedures 3.07 Product Standardization OFFICE OF PRIMARY RESPONSIBILITY: Harris Health System Supply Chain Management Harris Health System Clinical Case Management REVISION HISTORY: Effective Date 03/8/2016

Version# (If Applicable) 1.0

Review or Revision Date (Indicate Reviewed or Revised) Approved 03/08/2016

Reviewed or Approved by: (If Board of Managers Approved, include Board Motion#) Operations Policy Committee

POLICY AND REGULATIONS MANUAL ATTACHMENT A

Policy No: Page Number:

2451 6 of 5

Effective Date: Board Motion No:

03/2016 n/a