U.S. flag

An official website of the United States government

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Center for Substance Abuse Treatment. Improving Treatment for Drug-Exposed Infants. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1993. (Treatment Improvement Protocol (TIP) Series, No. 5.)

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

Cover of Improving Treatment for Drug-Exposed Infants

Improving Treatment for Drug-Exposed Infants.

Show details

Chapter 6 - Quality Assurance Guidelines

Treatment programs have increasingly focused on quality assurance (QA) and improvement techniques as means to maintaining or improving the quality of care, while addressing the problems caused by rapidly escalating service costs. Because QA has often been mandated for reimbursement and licensure, this TIP assumes that treatment programs have an active QA program. The following, therefore, are suggestions for important areas for monitoring in programs that provide treatment for drug-exposed infants. These suggested areas alone should not be considered a complete QA program.

As noted in the previous protocols, the importance of linkage and collaboration is paramount for programs addressing treatment of drug-exposed infants. Entry into treatment can come from a variety of programs in the service continuum, requiring referral to other providers to ensure successful treatment. Therefore, several linkage areas are important for QA monitoring:

  • Documentation of referrals, sharing of information, and ensuring that linkages are made;
  • Compliance with Federal and State guidelines for confidentiality; and
  • Interagency agreements that clearly indicate responsibilities of each program.

The new Substance Abuse Block Grant regulations include many requirements regarding linkages, quality assurance, interagency agreements, and monitoring of these activities. Thus, AOD treatment programs receiving these funds will be greatly assisted by adhering to the quality assurance guidelines discussed in this section.

Documentation of Referral to Ensure Linkage

These guidelines are predicated on the concept of a continuum of care, based upon drawing from many community-based services. Experience has shown that merely making referrals ensures neither that services are received nor that the service provided is of high quality. Therefore, it is one of the functions of a QA program to monitor linkages to referral sources. A well-designed QA program will routinely monitor a sample of all patient records and all referral sources to ensure linkage. Results of monitoring and actions taken to correct problems and improve service must be documented. Some examples of monitoring are:

  • Monitoring patient records to ensure that proper referrals were made.
  • Monitoring to ensure that all appropriate and necessary information is shared with the referral agency (such as reason for referral and problems to be addressed).
  • Monitoring of referral logs, payment vouchers, or other referral documentation (such as payment appropriate to services provided).
  • Monitoring patient records to ensure that there is documentation of linkage (such as documentation that infant was evaluated and accepted for services).
  • Monitoring patient records for notes of treatment progress and / or continued service (such as regular documentation of treatment progress).
  • Documentation that services are no longer needed (such as documentation of why services are no longer needed and what aftercare services are being provided).

Compliance with Federal Guidelines For Confidentiality

Since confidentiality regulations vary among the States (State regulations can be more stringent than Federal regulations), it is important that each agency ensure that internal policies are in compliance with both Federal and State regulations on confidentiality and patient records. Once compliance is ensured through the development of agency confidentiality policies, a process of QA monitoring can be developed that routinely reviews a sample of all program records. The results of monitoring and actions taken to correct problems and improve service must be documented. Some examples of monitoring are:

  • Ensuring that there is documentation of providers informing patients of their right to confidentiality, and to information concerning laws relating to court involvement.
  • Ensuring that there is documentation that providers inform patients of all laws as they relate to all areas that affect individuals who are receiving services.
  • Ensuring that there is a written informed consent on file whenever there are discussions concerning the patient with individuals or organizations outside the treatment facility.
  • Ensuring that the written informed consent is time-limited, content-specific, person-to-person, signed, and witnessed. A sample consent form is included; see Exhibit 8 .

Box Icon

Box

Exhibit 8: Sample Consent Form - Release of Information in Criminal Justice Referral Context. I, (Name of defendant) hereby consent to communication between

Interagency Agreements

For interagency collaboration and linkage to be successful, a written document is needed that clearly delineates the responsibilities of each program to ensure service delivery. Interagency agreements should not only indicate the services to be provided, but should also state the referral process and the documentation requirements of both agencies. Interagency agreements should be reviewed by participating agencies on a regular basis and modified as necessary. Findings from data collection should be taken jointly. Results of monitoring, as well as actions taken to correct problems and improve service, must be documented. Some examples of monitoring are:

  • Ensuring that the referring agency has provided all appropriate and necessary patient data to the referral agency.
  • Ensuring that there is documentation that the referral agency has provided all agreed-upon services in a timely manner.
  • Ensuring that the referral agency provided to the referring agency documentation of patient progress, continued need for services, or readiness for termination of services.
  • Checking any important specific parts of the agreement required to maintain the continuity of care.

Other Important Areas for Monitoring

As noted above, because of the importance of continuity of care in this model for treating drug-exposed infants, the areas of linkage and collaboration should be paramount in designing quality assurance monitoring. The following are more examples for monitoring:

  • Ensuring linkage through the acceptance of patients for treatment.
  • For the patient not accepted for treatment, ensuring that there is proper documentation of the reasons why the patient was not appropriate for the facility, and that steps were taken to link the patient to appropriate services.
  • Although discharging pregnant patients is not recommended, occasions may arise that necessitate this course of action. In these cases, there must always be full documentation of the rationale for discharge and prior attempts to engage the patient in treatment. Similarly, there should be documentation of referring the patient to alternative treatment.
  • Ensuring that there is documentation of referral and linkage to appropriate programs if the agency is unable to provide necessary services.
  • Checking to determine if the primary treatment facility monitors whether patients have a treatment plan listing all required services, whether there is documentation that the patient is linked to all required services, and whether there is documentation of the patient's progress in all referred services.

Views

  • PubReader
  • Print View
  • Cite this Page

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...