Type of observation and/or review being completed: (check one):
Performance Area
Yes
No
N/A
Comments

1. Maintains professional demeanor and appearance (dress, identification badge, etc.).

2. Communicates effectively with patient/family/ caregiver.

3. Identifies and responds to patient needs.

4. Reviews and follows plan of care/treatment

5. Completes patient assessment/reassessment and documents appropriately.

6. Involves patient in service planning.

7. Provides patient/family teaching and instruction.

8. Practices appropriate infection control techniques (hand washing, bag technique, CPR mask, gloves etc.) throughout entire visit.

9. Practices safety procedures and assesses home and environment for all hazards including falls.

10. Complete review of medications including:
a. Review of home medication list
b. Matches home medication list with the medication schedule that agency has on file in the medical record
c. Reconciliation of medication in the home versus physician orders
d. Orders obtained for additional medications noted under reconciliation .

11. Schedules next visit and completes discharge planning (as appropriate).

12. Exhibits skill/equipment proficiency.

13. Completes documentation during the visit as possible, noting all vital signs and key data.

14. Contacts physician for any orders needed or that require clarification.

15. Homebound status and patient eligibility for services is verified and confirmed each visit .

16. Other: