This Policy and Procedure Manual establishes the operational framework, clinical guidelines, and compliance standards for all services provided by Prime Care Nursing Services under the Georgia Pediatric Program.

1. All staff shall be oriented to this manual upon hire and annually thereafter.
2. The Administrator or designee shall ensure compliance with all policies and procedures.
3. This manual shall be made accessible to all clinical and administrative personnel.
4. Policies shall be reviewed annually and updated as needed to reflect regulatory changes.
5. All revisions shall be documented with an effective date and approved by the Administrator.

Prime Care Nursing Services provides comprehensive nursing care to pediatric clients enrolled in GAPP, including both skilled nursing services and unskilled personal care services.

1. All services must be authorized by the child's physician and approved by DCH/CMO.
2. Services must align with the individualized Plan of Care.
3. Skilled services shall be provided only by licensed nursing personnel (RN/LPN).
4. Unskilled services may be provided by trained caregivers under RN supervision.
5. Staff shall document all services rendered in accordance with documentation standards.
6. Any service outside the approved scope requires prior authorization from DCH.

All pediatric clients enrolled in GAPP must receive an in-person Start of Care (SOC) visit conducted by a Registered Nurse (RN) prior to the initiation of services. Telehealth is not an acceptable substitute for the initial SOC visit.

The Start of Care visit establishes baseline information, ensures safe care delivery, and confirms that the home environment is suitable for the provision of GAPP services.

1. Referral Review:
   • Verify GAPP eligibility and authorization
   • Obtain physician orders and Plan of Care
   • Review medical history, diagnoses, and current medications
   • Confirm insurance verification (Medicaid)
2. Scheduling the SOC Visit:
   • Coordinate with family/caregiver for in-person visit
   • Assign an RN to conduct the initial assessment
   • SOC must occur within 48 hours of service initiation or as clinically indicated
3. In-Person SOC Assessment (RN):
   • Comprehensive physical assessment
   • Review of all current medications and treatment regimens
   • Assessment of medical equipment (ventilator, feeding pump, oxygen, etc.)
   • Home safety evaluation
   • Caregiver/parent education needs assessment
   • Psychosocial and developmental assessment
   • Identification of emergency protocols and contacts
4. Plan of Care Development:
   • Develop individualized Plan of Care based on assessment findings
   • Establish goals and expected outcomes
   • Determine frequency and type of services needed
   • Obtain parent/guardian signature on Plan of Care
5. Documentation:
   • Complete SOC documentation within 24 hours of visit
   • Enter all assessment data into electronic medical record
   • Upload signed Plan of Care and consent forms

All GAPP services shall be provided in accordance with an individualized, physician-approved Plan of Care (POC) that is reviewed and updated at least every 60 days by a Registered Nurse and the child's physician.

The Plan of Care serves as the foundation for all nursing interventions and ensures coordination of care among healthcare providers, family, and caregivers.

1. Initial Plan of Care:
   • Developed by RN during Start of Care visit
   • Based on comprehensive assessment and physician orders
   • Reviewed with family/caregiver and signed by parent/guardian
   • Sent to physician for signature within 7 days
2. 60-Day Review:
   • RN conducts reassessment visit
   • POC updated to reflect changes in condition, goals, or services
   • Physician review and signature obtained
   • Parent/guardian signature obtained
3. As-Needed Updates:
   • POC revised immediately if there is a change in medical status
   • New physician orders integrated promptly
   • Medication changes documented and updated
4. Coordination with Physician:
   • RN communicates regularly with physician regarding client status
   • Obtain new orders as needed for changes in care
   • Ensure physician signature on all POC updates

Skilled nursing services shall be provided exclusively by licensed nursing personnel (Registered Nurses and Licensed Practical Nurses) in accordance with the Georgia Nurse Practice Act, physician orders, and the individualized Plan of Care.

1. All skilled services must be performed per physician orders and Plan of Care.
2. Nurses shall follow agency protocols and evidence-based clinical guidelines.
3. Documentation must be completed immediately after service delivery.
4. Any change in client condition must be reported to the RN Supervisor and physician.
5. Emergency situations require immediate intervention and notification per protocol.

Unskilled personal care services are provided to pediatric GAPP clients by trained caregivers under the supervision of a Registered Nurse. These services focus on activities of daily living (ADLs), safety supervision, and non-clinical support.

1. Caregivers must complete GAPP-specific training prior to providing services.
2. All unskilled services must be documented in the client's record.
3. Caregivers shall report any changes in client condition to the RN immediately.
4. RN supervision visits shall occur at least every 14 days (or per GAPP requirements).
5. Caregivers must follow the individualized Plan of Care and care instructions provided by the RN.

All GAPP services, both skilled and unskilled, are supervised by a Registered Nurse. The RN is responsible for clinical oversight, plan of care development, staff supervision, and ongoing assessment of client needs.

1. RN Supervisor schedules and conducts supervisory visits per policy.
2. Supervisory visits must be in-person unless telehealth is clinically appropriate (see Telehealth Policy).
3. RN documents all supervisory activities within 24 hours of the visit.
4. Any deficiencies identified during supervision are addressed immediately with education or corrective action.
5. RN communicates with physician regarding client status and any concerns.

All services provided to GAPP clients must be documented accurately, completely, and in a timely manner. Documentation serves as evidence of care rendered, supports billing and reimbursement, and ensures continuity of care.

1. Documentation must be completed within 24 hours of service delivery.
2. Use approved electronic medical record (EMR) system for all documentation.
3. Documentation must be legible, accurate, and free of subjective or judgmental language.
4. Corrections must be made per agency policy (no white-out or erasures; use strikethrough method in paper records).
5. Late entries must be clearly labeled with "late entry" and the date of documentation.
6. All documentation is subject to review during audits and surveys.

A comprehensive reassessment and 60-day summary must be completed by a Registered Nurse at least every 60 days for all pediatric GAPP clients. The reassessment evaluates the client's progress, updates the Plan of Care, and ensures continued appropriateness of services.

The 60-day summary ensures that care remains individualized, medically necessary, and aligned with the client's current needs and goals. It also fulfills GAPP regulatory requirements.

1. Schedule Reassessment Visit:
   • RN schedules visit no later than 60 days from Start of Care or previous reassessment
   • Coordinate with family/caregiver for in-person visit
2. Conduct Comprehensive Reassessment:
   • Perform physical assessment
   • Review all current medications and orders
   • Assess client's progress and response to interventions
   • Identify any new needs or concerns
3. Update Plan of Care:
   • Revise goals and interventions based on reassessment findings
   • Adjust frequency or type of services as needed
   • Document rationale for any changes
4. Obtain Signatures:
   • Parent/guardian signs updated Plan of Care
   • Submit Plan of Care to physician for review and signature within 7 days
5. Documentation:
   • Complete 60-day summary documentation within 24 hours
   • Upload signed Plan of Care to client's medical record

Prime Care Nursing Services maintains an emergency and disaster preparedness plan specific to pediatric GAPP clients. All staff, clients, and families are educated on emergency protocols to ensure safety during medical emergencies and natural disasters.

• • Agency maintains current contact information for all clients and staff
• • Emergency call tree activated during disasters
• • High-risk clients (ventilator-dependent, technology-dependent) prioritized for contact
• • Coordination with local emergency management and power companies
• • Annual disaster drills and staff training

1. RN reviews emergency plan with family during Start of Care and every 60 days.
2. Staff trained annually on pediatric emergency response and CPR.
3. Clients with life-sustaining equipment are flagged as high-priority during disasters.
4. Agency Administrator activates disaster plan as needed.
5. All emergency incidents documented and reviewed for quality improvement.

Prime Care Nursing Services adheres to standard precautions and infection control practices to prevent the transmission of infectious diseases and protect the health and safety of pediatric clients, staff, and families.

When a client has a known or suspected infection requiring additional precautions, staff shall implement appropriate transmission-based precautions:

• • Contact Precautions: For infections spread by direct contact (e.g., MRSA, C. diff)
• • Droplet Precautions: For infections spread by respiratory droplets (e.g., influenza, RSV)
• • Airborne Precautions: For infections spread by airborne particles (e.g., tuberculosis)

1. All staff complete infection control training during orientation and annually.
2. Hand hygiene must be performed per CDC guidelines.
3. PPE must be readily available and used appropriately.
4. Staff report any suspected infection or outbreak to RN Supervisor immediately.
5. Agency monitors infection rates and implements corrective actions as needed.

Prime Care Nursing Services is committed to protecting pediatric clients from abuse, neglect, and exploitation. All staff are mandatory reporters under Georgia law and must immediately report any suspected abuse or neglect to the appropriate authorities.

1. If Abuse or Neglect is Suspected:
   • Ensure child's immediate safety
   • Call Georgia DFCS Child Protective Services Hotline: 1-855-GACHILD (1-855-422-4453)
   • Notify RN Supervisor and Agency Administrator immediately
   • Do not confront the suspected perpetrator
   • Document observations objectively (facts only, no opinions)
2. Follow-Up:
   • Cooperate fully with DFCS investigation
   • Continue to provide care unless directed otherwise by authorities
   • Maintain confidentiality of the report
3. Staff Training:
   • All staff complete abuse/neglect training during orientation
   • Annual refresher training on recognizing and reporting abuse

Telehealth may be used by Registered Nurses for supportive oversight and consultation purposes only. Telehealth is NOT a substitute for in-person Start of Care visits, 60-day reassessments, or initial skilled nursing assessments required under GAPP regulations.

1. Telehealth visits must be scheduled in advance and agreed upon by family.
2. Use HIPAA-compliant telehealth platform for all virtual visits.
3. Document telehealth visit in client's record, noting purpose and outcomes.
4. Telehealth visits do not replace required in-person visits per GAPP regulations.
5. RN must assess clinical appropriateness of telehealth use on case-by-case basis.

Prime Care Nursing Services is committed to continuous quality improvement and the delivery of high-quality, safe, and effective care to all pediatric GAPP clients. The agency maintains a Quality Assurance and Performance Improvement (QAPI) program to monitor outcomes, identify areas for improvement, and implement corrective actions.

1. Quality Assurance Committee meets quarterly to review data and identify improvement opportunities.
2. Data is collected, analyzed, and trended to identify patterns.
3. Corrective Action Plans developed for areas not meeting benchmarks.
4. Staff educated on quality improvement initiatives and expected outcomes.
5. QAPI results reported to leadership and used to inform policy updates.

All clinical and non-clinical staff must complete comprehensive training and demonstrate competency in GAPP services, pediatric care, and agency policies prior to providing direct care. Ongoing education ensures staff remain current with clinical best practices and regulatory requirements.

1. All training must be documented with date, topic, and staff signature.
2. Clinical staff must demonstrate competency via skills validation before independent practice.
3. Continuing education opportunities provided to maintain licensure and enhance skills.
4. Staff who do not meet competency standards receive additional training and re-evaluation.
5. Training records maintained in personnel files and available for review during surveys.

Prime Care Nursing Services maintains accurate, complete, and confidential client records in compliance with HIPAA, Georgia state law, and GAPP requirements. All staff are responsible for protecting client health information and ensuring records are properly stored and accessible for authorized use.

• • Active Records: Maintained in secure electronic medical record system
• • Closed Records: Retained for minimum of 7 years after discharge or last service date
• • Pediatric Records: Retained until client reaches age 21, plus 7 years (per Georgia law)
• • Destruction: Records destroyed via secure shredding or electronic deletion after retention period

1. All documentation must be completed in electronic medical record system.
2. Access to client records limited to authorized personnel only.
3. Staff sign confidentiality agreement upon hire and annually thereafter.
4. Clients/families may request copies of records per HIPAA guidelines.
5. Records available for inspection during audits, surveys, and legal proceedings.

This Policy and Procedure Manual shall be reviewed annually by the Agency Administrator and updated as needed to reflect changes in regulations, clinical best practices, or agency operations. All revisions must be approved and documented with an effective date.

1. Annual review conducted by Administrator or designee
2. Policies evaluated for compliance with current GAPP regulations and DCH requirements
3. Input solicited from clinical staff and Quality Assurance Committee
4. Revisions documented with version control and effective date
5. Updated manual distributed to all staff with acknowledgment required