PWS V 5.pdf

SCHEDULE OF SERVICES

The Contractor shall furnish all personnel to provide services necessary to perform onsite Multi-Specialty Registered Nurse (RN), Licensed Practical Nurse (LPN), Certified Nursing Assistant (CAN), Certified Registered Nurse Anesthetist (CRNA), Nurse Practitioner (NP), Monitor Watcher (MW), and Sitter Locum Services to eligible beneficiaries of the Department of Veterans Affairs;

Veterans Affairs Health Care System (VAPHS), (hereinafter referred to as VAPHS). The contractor’s nursing services care shall cover the range of Multi- Specialty RN, LPN, CNA, CRNA, NP, MW, and Sitter Locum Services as would be provided in a state-of-the-art civilian medical treatment facility and the standard of care shall be of a quality, meeting or exceeding currently recognized national standards.

Place of Performance: Services shall be provided on site, VAPHS University Drive Campus, University Drive C, Pittsburgh, PA 15240 and H.J. Heinz Campus, 1015 Delafield Road, Pittsburgh, PA 15215.

The contract type: Multiple Award IDIQ

Pricing Instructions:

The offeror is instructed to edit the number of sub-clins to correspond with the number of personnel submitted for the contract line item number (CLIN). Other commercial health care Offerors shall identify by title/position or level of experience the personnel submitted. Also, renumber SUB-CLINs if adding or removing Personnel.

The offeror is instructed to include all other than price and cost information supporting the proposed price as directed in Instructions to Offerors addendum to 52.212-1 and/or Section D- Contract Documents, Exhibits, or attachments.

Performance Work Statement

1. GENERAL:

Services Provided: The Contractor shall be able to provide the VA Pittsburgh Healthcare System with

Multi-Specialty RN, LPN, CNA, CRNA, NP, MW, and Sitter Services. Providers must be certified in their respective field according to VAPHS regulations in order to perform the requirements of these IDIQs which are expected to include a series of task orders to meet emergent needs of the medical center.

1.1. Place of Performance - Contractor shall furnish services On-site at VA Pittsburgh Healthcare System (VAPHS) UD Division, University Drive, Pittsburgh, PA 15240 and HJ Heinz Division, 1010 Delafield Road, Pittsburgh, PA 15215

1.2. Authority: Title 38 USC 8153

1.3. Policy/Handbooks:

1.3.1. VA Directive 1663: Health Care Resources Contracting - Buying https://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=969&FType=2

1.3.2. VHA Directive 2006-041 “Veterans’ Health Care Service Standards” (expired but still in effect pending revision) https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1443

1.3.3. VHA Directive 2010-018 “Facility Infrastructure”

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2227

1.3.4. VHA Directive 1192 “Seasonal Influenza Prevention Program” https://www.publichealth.va.gov/docs/flu/VHA_Directive_1192_Sep

1.3.5. VHA Handbook 1100.17: National Practitioner Data Bank Reports -https://www1.va.gov/vapubs/viewPublication.asp?Pub_ID=969&FType=2 https://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1443 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2227 https://www.publichealth.va.gov/docs/flu/VHA_Directive_1192_Sep https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135

1.3.6. VHA Handbook 1100.18 Reporting and Responding To State Licensing Boards - https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364

1.3.7. VHA Handbook 1100.19 Credentialing and Privileging -

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910

1.3.8. VHA Handbook 1400.01 Resident Supervision

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2847

1.3.9. VHA Handbook 1907.01 Health Information Management and Health Records: https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3088

1.3.10. Privacy Act of 1974 (5 U.S.C. 552a) as amended

http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm

1.3.11. VHA Handbook 5005-78 Part II Appendix G8 Physician Assistant Qualifications Standards https://vaww.va.gov/OHRM/Directives-Handbooks/Documents/5005- 78.pdf

1.4. Definitions/Acronyms- Terms used in this contract shall be interpreted as follows unless the context expressly requires a different construction and/or interpretation. In case of a conflict in language between the Definitions and other sections of this contract, the language in this section shall govern.

1.4.1. DEFINITIONS:

1.4.1.1. CONTRACTOR. A supplier or vendor awarded a Contract to provide specific supplies or services to the government. The term used in this Contract refers to the prime Contractor.

1.4.1.2. CONTRACTING OFFICER. A person with authority to enter into, administer, and or terminate Contracts, and make related determinations and findings on behalf of the government. Note: The only individual who can legally bind the government.

1.4.1.3. CONTRACTING OFFICER’S REPRESENTATIVE (COR). An employee of the U.S. Government appointed by the Contracting Officer to administer the Contract. Such appointment shall be in writing and shall state the scope of authority and limitations. This individual has authority to provide technical direction to the Contractor as long as that direction is within the scope of the Contract, does not constitute a change, and has no funding implications. This individual does NOT have authority to change the terms and conditions of the Contract.

1.4.1.4. CREDENTIALING. Credentialing is the systematic process of screening and evaluating qualification and other credentials, including licensure, required education, relevant training and experience and current competence and health status.

1.4.1.5. FULL TIME EQUIVALENT. VA’s definition for full time- working the equivalent of 80 hours every two weeks, 2080 hours per year. In calculating FTE, any hours not worked on national holidays shall not be included.

1.4.1.6. MEDICAL EMERGENCY.a sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity that the absence of immediate medical attention could reasonably result in: Permanently placing a patient's health in jeopardy, causing other serious medical consequences, causing impairments to body functions, or causing serious or permanent dysfunction of any body-organ or part.

1.4.1.7. NATIONAL PROVIDER IDENTIFIER.a standard, unique 10-digit numeric identifier required by HIPAA. The Veterans Health Administration must use NPIs in all HIPAA- standard electronic transactions for individual (health care practitioners) and organizational entities (medical centers).

1.4.1.8. NON-CONTRACT PROVIDER. any person, organization, agency, or entity that is not directly or indirectly employed by the Contractor or any of its https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2847 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3088 http://www.justice.gov/oip/foia_updates/Vol_XVII_4/page2.htm https://vaww.va.gov/OHRM/Directives-Handbooks/Documents/5005-78.pdf https://vaww.va.gov/OHRM/Directives-Handbooks/Documents/5005-78.pdf subcontractors

1.4.1.9. PRIVILEGING (CLINICAL PRIVILEGING). Privileging is the process by which a practitioner, licensed for 8independent practice; e.g., without supervision, direction, required sponsor, preceptor, mandatory collaboration, etc.; is permitted by law and the facility to practice independently, to provide specific medical or other patient care services within the scope of the individual’s license, based upon the individual’s clinical competence as determined by peer references, professional experience, health status, education, training and licensure. Clinical privileges must be facility-specific and provider-specific.

1.4.1.10. QUALITY ASSURANCE. The government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

1.4.1.11. QUALITY ASSURANCE SURVEILLANCE PLAN (QASP). An organized written document specifying the surveillance methodology to be used for surveillance of Contractor performance.

1.4.1.12. VETERANS’ HEALTH ADMINISTRATION. The central office for administration of the VA medical centers through throughout the United States. The VHA is located in Washington, D.C.

1.4.1.13. VETERANS INTEGRATED SERVICES NETWORK. The regional

oversight for the VA medical centers.

1.4.1.14. VETERANS INTEGRATED SYSTEMS TECHNOLOGY

ARCHITECTURE. A PC based system that will capture and store clinical imagery, scanned documents and other non-textual data files and integrates them into patient’s medical record and with the hospital information system.

1.4.2. ACRONYMS:

ACLS: Advanced Cardiac Life Support

1.4.2.1. AOD: Admitting Officer of the Day

1.4.2.2. BLS: Basic Life Support

1.4.2.3. CCNE: Commission on Collegiate Nursing Education:

www.aacn.nche.edu/accreditation

1.4.2.4. CDC: Centers for Disease Control and Prevention

1.4.2.5. CDR: Contract Discrepancy Report

1.4.2.6. CEU: Certified Education Unit

1.4.2.7. CME: Continuing Medical Education

1.4.2.8. CMS: Centers for Medicare and Medicaid Services

1.4.2.9. CO: Contracting Officer

1.4.2.10. (COR): Contracting Officer’s Representative

1.4.2.11. COS: Chief of Staff

1.4.2.12. CPARS: Contractor Performance Assessment Reporting System

1.4.2.13. CPRS: Computerized Patient Recordkeeping System- electronic health record system used by the VA.

1.4.2.14. DEA: Drug Enforcement Agency

1.4.2.15. FSMB: Federation of State Medical Boards

1.4.2.16. (FTE): Full Time Equivalent

1.4.2.17. HHS: Department of Health and Human Services

1.4.2.18. HIPAA: Health Insurance Portability and Accountability Act

1.4.2.19. HR: Human Resources

1.4.2.20. ISO: Information Security Officer

1.4.2.21. MOD: Medical Officer of the Day

1.4.2.22. NCCPA: National Commission on Certification of Physician Assistants

1.4.2.23. NPI: National Provider Identifier

1.4.2.24. NP: Nurse Practitioner

1.4.2.25. NPPES: National Plan and Provider Enumeration System

1.4.2.26. PA: Physician Assistant

1.4.2.27. PANCE: Physician Assistant National Certifying Examination

1.4.2.28. PALS: Pediatric Advanced Life Support

1.4.2.29. POP: Period of Performance

1.4.2.30. PPD: Purified Protein Derivative

1.4.2.31. PWS: Performance Work Statement

1.4.2.32. QA/QI: Quality Assurance/Quality Improvement

1.4.2.33. QM/PI: Quality Management/Performance Improvement

1.4.2.34. QASP: Quality Assurance Surveillance Plan

1.4.2.35. VAPHS: Veterans Affairs Pittsburgh Healthcare System Unless identified with the name of a different VA medical Center, for purposes of this contract, this term shall mean the VAPHS

1.4.2.36. VHA: Veterans’ Health Administration

1.4.2.37. VISN: Veterans Integrated Services Network

1.4.2.38. VISTA: Veterans Integrated Systems Technology Architecture

2. QUALIFICATIONS:

2.1. Staff/Facility

2.1.1. Registered Nurse (RN)

2.1.1.1. Qualifications: Each Basic RN shall:

2.1.1.1.1 Every RN shall Hold a Diploma, Associates Degree (AD) or Bachelor of

Science in Nursing (BSN) degree from an National League for Nurses (NLN) accredited program, college or university and hold a current license, (with no limitations, stipulations, or pending adverse actions) to practice as a Registered Nurse (RN) in any State. A BSN is preferred.

All licenses must be unencumbered and remain in effect during contract employment.

2.1.1.1.2 Have been actively practicing as a registered nurse in an acute or long-term setting for at least the last two years.

2.1.1.1.3 Be capable of providing complex and comprehensive nursing care for adult medical and surgical patients.

2.1.1.1.4 Have and maintain current Basic Cardiac Life Support (BCLS) and Advanced Cardiac Life Support (ACLS) certification.

2.1.1.1.5 Have no health or physical disability restrictions that interfere with the performance of assigned duties.

2.1.1.1.6 Have documented training and skills verification.

2.1.1.1.7 If a nurse’s NCCPA certification is suspended, revoked or expires, the nurse must be removed from the occupation which may result in termination of employment

2.1.1.2 RN-Operating Room (Circulator)-Surgery- The incumbent practices as a registered nurse in the Operating Rooms, Nursing Section of Surgical Services within VAPHS. The incumbent must demonstrate and maintain competencies required for all process, procedures and equipment used in the Operating Room. The VAPHS operating rooms specialize in caring for adult and geriatric veterans during the perioperative experience. The operating rooms provide the following services: General surgery, Gyne surgery, ear, nose and throat, ophthalmic, peripheral vascular, thoracic, urologic, plastic, podiatric, endoscopic and laparoscopic, Cardiac Open Heart, Neurosurgery, Transplant, Major Orthopedic, i.e. Total Joints. The nurse has the technical and operational knowledge and clinical skills to function as a circulating and scrub nurse in all the services. The nurse must demonstrate a variety of specialized diagnostic and treatment procedures.

2.1.1.3 RN-Same Day Surgery-(GI check in only) - The Same Day Procedure Unit provides pre- and post-procedural education and care to the medical and surgical patients who are processed through this area for their procedure. The admitting pre-procedure nurse is responsible for assisting the anesthesia staff with patients that require regional block anesthesia for their surgery or procedure. Discharge planning is initiated at the time of the nursing assessment, reassessed and revised throughout the same day process. The same day patient will be discharged when meeting established discharge criteria as outlined below. Patients will receive written discharge instructions upon discharge. A pre-procedural phone call will be made to outpatients the business day prior to their scheduled surgery. Nursing staff will function in the role of family liaison. Both of these responsibilities will be done following the SOP for SDPU Pre/call and Family Liaison Nurse Assignment. The patient will receive nursing care and continuous assessment based on written nursing standards of care and orders by the physician or PA-C/CRNP. The admitting pre-procedure nurse will be responsible for assessment, pre-procedure admission documentation, and approved point of care testing, verifying presence of necessary pre-procedure documentation, obtaining baseline vital signs, and carrying out all pre-procedure orders. The post procedure nurse will be responsible for assessment, pain management, obtaining vital signs every 15 minutes until discharge criteria have been met, discharge instructions, and post procedure patient education. Monitor, maintain, and/or improve respiratory function, circulatory function, and neurologic function to include level of consciousness. Monitor intake and output. Monitor sensory and motor function.

Promote normothermia. Promote and maintain effective pain relief, comfort management, and emotional comfort. Monitor surgical/procedure site.

Document assessment, nursing action/intervention, medication administration, discharge instructions/education, level of understanding and outcomes. Notify appropriate anesthesia to evaluate prior to discharge from SDPU when meeting discharge criteria. A post-procedure phone call is made by the SDPU nursing staff to each patient that underwent an invasive procedure and was discharged to home from SDPU on the first working day following discharge.

2.1.1.4 RN-Surgical Clinics-Surgery- Assesses patient post op meds and develops sound plan of care based on assessment. Knowledgeable of the nursing care needs of patients as it relates to medical/surgical diagnosis. Demonstrates knowledge of the principles of wound prevention of care. Provides IV care based on medical center policies. Performs accuchecks. Recognizes and responds to emergency situations to include Code Blue (cardiac arrest); Code White (aggressive patients); Code Red (fire); Code Black (disaster). Appropriately assess need for safety devices and utilizes same in accordance with policy.

Provides patient health education to patients and families with regard to current treatment, health issues, and patient/family concerns in accordance with educational level of patient/family. Complies with documentation standards.

Administers medications in accordance with medical center policies via B.C.M.A.

Provides guidance to paraprofessional and nonprofessional staff. Able to care for patients withdrawing from alcohol, responding to significant symptoms and maintaining patient safety during detoxification. Directs care of the patient in restraints, assessing for physical needs i.e. nutrition, hydration, toileting and range of motion exercises.

2.1.1.5 RN-(Short Stay)-Surgery- The nurse will provide nursing care and continuous assessment based on written nursing standards of care, policies and orders by the provider. The admitting pre-procedure nurse will be responsible for assessment, pre-procedure admission documentation, insertion of peripheral intravenous access, obtaining ordered bloodwork, obtaining baseline vital signs, and carrying out all pre-procedure orders. Post-procedurally, the nurse will be responsible for assessment, pain, management, obtaining vital signs as ordered, discharge instructions, and post procedure patient education. The nurse will monitor surgical/procedure site. The nurse will administer oral and intravenous medications as ordered by the provider. The nurse will provide care for cardiac monitored patients per TX-217, 9West Short Stay Unit and the 9W Cardiac

Monitoring SOP. The nurse will promote and maintain effective pain relief, comfort management, and emotional comfort. The nurse will conduct initial and ongoing assessment and document per TX-217. A post-procedure follow-up call will be made by the 9W nursing staff to each patient that underwent a surgical or electrophysiology procedure per the 9W Follow-Up Phone Call SOP. Other duties include, but are not limited to answering the telephone, paging physicians, paging ancillary departments for services, looking up physician orders, facilitating carrying orders out, printing lab labels and patient wristbands, taking verbal orders in an emergency, assisting with transportation, coordinating patient bed flow with bed coordinator, completing encounters, checking for expired supplies, and cleaning non-critical reusable medical equipment.

2.1.1.6 RN-Cardiac Catherization/EP Lab- Be capable of providing complex and comprehensive nursing care for adult medical and surgical patients

2.1.1.7 RN-Hemodialysis- Have been actively practicing as a registered nurse in a

Hemodialysis setting for the past two years. The Dialysis unit is an outpatient chronic dialysis facility providing hemodialysis. Staff also provides inpatient dialysis in the ICUs. The RN is accountable when assigned as a primary nurse for a defined group of patients for the entire episode of care. As the assigned caregiver for a specific shift, the RN is accountable for the care of defined groups of patients on that shift.

2.1.1.8 RN-Neurology- Documents information in EMR regarding assessment, diagnosis, treatment, and education for patients with acute and chronic neurological illnesses. Perform initial patient screenings via consult triage.

Coordinates neurology planning services and screening services. Coordinates diagnostic procedures, injections and pharmacological treatments. Prepare patients for medical procedures. Administers medication as necessary and ordered by prescribing clinicians within the Neurology Department. Maintains all skills and competencies necessary to promote and enhance the mission of the Neurology Department. Serve as the resource r/t patients need for ongoing care information, counseling and provide guidance for any patients with critical conditions. Procures and organizes patient handouts in a readily available manner for clinical use by professionals and patients in conjunction with the Ambulatory Care Medical Liaison and appropriate Quality Assurance team.

Responds to all Codes; expedites pt. disposition to appropriate level of care.

Facilitates admissions including ensuring report is called to receiving units and that transport is provided by licensed staff only. Monitors clinic wide schedules;

completes scheduled rounds in waiting area. Serves as point of contact for clinic walk-ins/phone calls/inquiries including telephone triage to increase access and promote good customer service. Collects and analyzes data to monitor nurse sensitive metrics for benchmarking; Participates in Quality Improvement.

Develops collaborative relationships with other departments, services, and community health care agencies to facilitate and support quality neurology care.

Maintains professional growth and development through seminars, workshops and professional affiliations to keep abreast of the latest trends in field of expertise. Completes Environment of Care Rounds as per facility policy

2.1.1.9 RN-Diabetes-Medicine- Must demonstrate comprehensive knowledge of and experience in diabetes management, prediabetes, and diabetes prevention and hold a current National Certification Board for Diabetes Educators certification.

Maintains equipment and supplies as per facility policy. Provides outpatient diabetes and self-management training and education to type 1, type2, and gestational diabetic patients. Education includes, but is not limited to, signs/symptoms and respective treatments for hyperglycemia, hypoglycemia, DKA, HHNK, and sick day therapies. Plans, develops, and implements individual and group diabetes education for adults, their families, and caregivers. Provides specialized counseling in self-care to individuals and groups. Instructs patients and family members on glucometers, lancets, syringes, insulin pens and insulin pumps to assure consistent technique and safety. Obtains, reviews, and analyzes information including laboratory findings, glucometer readings, and subject self-reports in collaboration with patients, family members, and health care team members to manage diabetes care and treatment. Monitors and evaluates short and long-term patient responses to therapeutic interventions in collaboration with providers; provides and maintains necessary follow-up for patients and families. Teaches patients about monitoring insulin levels and managing medications. Teach patients to develop long-term strategies for maintaining a healthy diet; informs patients about wise food choices, provide nutritional counseling for weight control and disease management. Coaches patients to increase physical activity Follows patient’s progress for control of blood sugar, lipids, renal function and prevention of diabetes complications.

Provides specialized training to other healthcare professionals in diabetes, health, and clinical procedures; coordinates in-service training, continuing education, and other related diabetes and clinical health training. Leads initiatives to promote evidence-based diabetes practice across the facility; assist in the development of policies and procedures for diabetes and health education guidelines. Collects and processes specimens to determine blood glucose, hemoglobin A1C, cholesterol, lipids, and urinalysis; maintain equipment and assist in ordering laboratory supplies as needed; maintains annual competencies in bench top laboratory assays. Procures and organizes patient handouts in a readily available manner for clinical use by professionals and patients in conjunction with the Ambulatory Care Medical Liaison and appropriate Quality Assurance team. Administers medication as necessary and ordered by prescribing clinicians within the Endocrinology Department.

Maintains all skills and competencies necessary to promote and enhance the mission of the Endocrinology Department. Participates in Quality Improvement.

Develops collaborative relationships with other departments, services, and community health care agencies to facilitate and support quality diabetes care.

Maintains professional growth and development through seminars, workshops and professional affiliations to keep abreast of the latest trends in field of expertise.

2.1.1.10 RN-Oncology/Chemotherapy-Medicine- Must demonstrate competence and hold a current Oncology Nursing Society (ONS) issued Chemotherapy/Biotherapy provider card or are an Oncology Certified Nurse (OCN) with recent experience administering cytotoxic agents by the intravenous (IV) infusion, IV push, intramuscular (IM), and subcutaneous routes. Provide an advanced level of specialized professional nursing care to the adult Hematology/Oncology patient and adult Bone Marrow Transplant patients. Maintain a cancer-specific knowledge base and clinical expertise in cancer care through the use and application of current VAPHS policies, evidence-based protocols/guidelines, and current research studies and reports. Formulate care plan based upon assessment of each patient's physical performance status, psychosocial functioning, cultural/ethnic background, spiritual/religious beliefs, and cognitive status. Perform comprehensive assessments, document and review physician orders. Educate patient and/or family members about their disease, treatments, and potential side effects/complications. Administer complex chemotherapy drugs such as Southwest Oncology Group regimens, biological response modifiers, and monoclonal antibody therapy in accordance with prescribed protocols using various routes, including oral, intravenous, intramuscular, subcutaneous, intradermal, and intraperitoneal. Monitors patient's response for side effects, toxicities, and contraindications. Provide specialized care for the most immunosuppressed patient population as the primary healthcare provider.

Communicate and collaborate with other staff members, health care providers, and inpatient units to maintain continuity of care. Assist in training nurses, residents and students to care for oncology patients and acts as preceptor for nurses undergoing chemotherapy certification. Perform or participate in a variety of procedures independently or in assistance of our physicians, fellows, and advance practice physician extenders. Initiates and manages a wide variety of central and peripheral access devices. Demonstrates excellent communication and collaboration skills.

2.1.1.11 RN-Pulmonary/Bronchoscopy-Medicine- Performs cardiopulmonary functions such as assistance with diagnostic/therapeutic bronchoscopies and other interventional/diagnostic cardiopulmonary procedures within the registered nurse scope of practice. Administers moderate sedation during bronchoscopy procedures; monitors patient condition and response to anesthesia throughout procedure; ensures patient safety and stability through recovery phase. Have and maintain current Advanced Cardiovascular Life Support (ACLS).

Administers conscious sedation during bronchoscopy procedures; monitors patient condition and response to anesthesia throughout procedure; ensures patient safety and stability through recovery phase. Applies knowledge of WAKE Scoring. Demonstrates skills and techniques needed for airway management.

Demonstrates appropriate care, handling, and cleaning of critical, semi critical and non-critical RME. Demonstrates skill in the insertion of intravenous lines and performs venipunctures. Administers IV medications. Performs 6-minute walk to determine oxygen needed at rest and with activity. Responsible for oxygen vendor communications, emailing and faxing. Responsible for quality assurance tracking and data input to prevent loss of rental equipment.

Coordinates home oxygen set up and delivery at primary residence and for travel. Manages oxygen delivery systems and supply. Ensures patients have appropriate oxygen prescription including initial and annual reassessments.

Teaches patients and families safe and proper use of home oxygen (including compressed gas, liquid, portable and stationary concentrators).

Manages and maintains respiratory care equipment and procedures, to include training, cleaning, documentation, infection control, quality improvement, and accountability. Performs arterial blood gas sampling. Administers breathing treatments. Teaches patients to use nebulizers and inhalers Assists with liquid oxygen refills. Collect, manages and reports quality improvement and safety data.

Administers medication as necessary and ordered by prescribing clinicians within the Pulmonary Department. Maintains all skills and competencies necessary to promote and enhance the mission of the Pulmonary Department. Participate in Quality Improvement. Develop collaborative relationships with other departments, services, and community health care agencies to facilitate and support quality pulmonary care. Maintain professional growth and development through seminars, workshops and professional affiliations to keep abreast of latest trends in field of expertise.

2.1.1.12 RN Charge Nurse-Medicine - Responds to all rapid response codes and leads team to expedite disposition to appropriate level of care. Provides direct patient care across multiple specialties. Provides care for complex patients, including but not limited to allergy injections, port flushes, therapeutic phlebotomy, wound care, suture removal, and oxygen evaluations as needed. Competency training will be provided. Monitors clinic wide schedules; completes observation rounds in waiting area. Facilitates admissions including ensuring report is called to receiving units and that transport is provided by licensed staff only. Works with administration to coordinate room grid to accommodate providers within scheduled clinics;

Coordination of provider room assignments daily. Serves as point of contact for clinic walk-ins/phone calls/inquiries including telephone triage to increase access and promote good customer service. Collects data to monitor nurse sensitive metrics for benchmarking. Makes daily staffing assignments. Oversees and mentors staff during assigned shift. Determines staffing level and assignments based on staff availability, staff abilities, census, and patient acuity. Floats between staff to assist with problem-solving. May take staffing assignments to meet patient needs across multiple clinics to ensure staff are assigned productively and efficiently throughout the course of the day. Evaluates the effectiveness of patient care, including formal evaluation, and identifies any issues that affect desired patient outcomes. Responds to complaints about patient care and related services and manages through established channels in accordance with VAPHS policies and industry standards. Responds to safety concerns throughout the clinic and any required related services and manages through established channels in accordance with VAPHS policies and industry standards.

Performs role-specific duties as assigned, including entering orders, coordinating transfers, and ensuring staff has necessary equipment and supplies to provide safe, quality patient care. Maintains all skills and competencies necessary to promote and enhance the mission of the Medical Specialty Clinics et al. including:

Allergy competency; CVAD access competency; Eligard competency; Home O2 evaluation competency; Moderate sedation competency; Therapeutic phlebotomy competency

2.1.1.13 RN-Med/Surg- Provide comprehensive nursing care within the professional scope of practice for a variety of diagnoses for adult through geriatric patients. Conduct initial assessment on patients; develop nursing care plans based on identified patient needs, coordinate with ancillary services to assure provision of care, document all plans, assessments and care provided. Provide patient and family education throughout the hospitalization. Initiate discharge planning. Administer oxygen, IV fluids, blood transfusions, prescribed medications and titrate medications in accordance with VA policy. Observe and assess patients' clinical condition, recognize and promptly report significant changes indicative of complications. Initiate resuscitative measures in emergency situations. Operate and monitor specialized equipment including, but not limited to: oxygen, hypothermia units, and various types of suction apparatus, infusion equipment, and patient controlled analgesia pumps (PCA), epidural pumps, sequential compression devices and vital sign monitors. Prepare patients for surgical and diagnostic procedures and assist with procedures as necessary. Provide post-procedure and post-operative recovery care. Ensure that all Joint Commission standards for professional nursing care are met during performance of care.

Complete appropriate medical record forms in compliance with VA guidelines and policies on each patient.

2.1.1.14 RN - Primary Care UD Campus- Participates in direct patient care surrounding scheduled and unscheduled visits. Triages walk-in/urgent visits and utilizes RN protocols to assist with triaging

Manages same day patient care needs and coordinates procedures, labs, transitions, education, and follow-up if indicated. Conducts telephone triaging and nurse health advice calls. Based on the daily huddle, identifies patients that will require special nursing care that day and collaborates with the team about how best to meet that patient’s needs. Manages secure messages assigned to RN.

Reviews and completes clinical reminders during RN visits. Provides patient-centered, evidence-based, patient-driven care in all patient interactions. Ensures patients are linked with all appropriate services, resources, and opportunities based on his or her needs. Educates patients to promote independence in navigating through the healthcare system. Initiates consults to extended team including mental health, Home Telehealth (HT), nutrition, social work, HBPC, OEF/OIF, palliative care, hospice, specialists, and non-VA care. Conducts follow up calls related to clinic visits if indicated. Conducts follow up calls for ER visits and hospitalizations, reviews records, and coordinates follow up procedures, labs, transitions, education, and follow-up visits if indicated. Acts as an advocate for patients to ensure their needs are met.

2.1.1.15 RN-Primary Care H.J. Heinz Campus- Same as 2.1.1.14.

2.1.2. Licensed Practical Nurse (LPN): Qualifications: Each LPN shall:

2.1.2.1 Possess a valid, current license (with no limitations, stipulations, or pending adverse actions) to practice nursing as an LPN and be licensed to practice in the commonwealth of Pennsylvania. All licenses must be unencumbered and remain in effect during contract employment.

2.1.2.2 Have been actively practicing as a licensed practical nurse for at least one year within the past three years.

2.1.2.3 Be capable of providing nursing care for adult medical and surgical patients.

2.1.2.4 Have and maintain current Basic Cardiac Life Support (BCLS) certification.

2.1.2.5 Have no health or physical disability restrictions that interfere with the performance of assigned duties.

2.1.2.6 Have documented training and skills verification.

2.1.3. Certified Nursing Assistant (C.NA): Qualifications: Each C.NA shall:

2.1.3.1. Be a certified nursing assistant in the commonwealth of Pennsylvania.

2.1.3.2. Be trained and experienced in hospital nursing.

2.1.3.3. Have at least one-year experience working as a CNA.

2.1.3.4. Be capable of providing nursing care for adult medical and surgical patients.

2.1.3.5. Have and maintain current Basic Cardiac Life Support (BCLS) certification.

2.1.3.6. Have no health or physical disability restrictions that interfere with the performance of assigned duties.

2.1.3.7. Have documented training and skills verification.

2.1.4. Certified Registered Nurse Anesthetist-CRNA: Qualifications: Each CRNA shall:

2.1.4.1. Graduate of an approved school of nursing and hold active current state registration as a graduate professional nurse in a state, territory, or commonwealth of the United States or District of Columbia.

2.1.4.2. Graduate from a nurse anesthesia education program accredited by the American Association of Nurse Anesthetists (AANA) Council on Accreditation of Nurse Anesthesia Education Program.

2.1.4.3. Successfully complete the certification examination administered by NBCRNA.

2.1.4.4. Comply with criteria for biennial recertification as defined by the NBCRNA. This criterion includes evidence of a current registered nurse license.

2.1.4.5. Entry Level Grade Nurse II is based on the level of education and experience in the

CRNA profession. The Grade II CRNA will:

2.1.4.5.1 Demonstrate knowledge, skills, and abilities at the minimum skill set expected of an Entry Level Nurse.

2.1.4.5.2 Demonstrate the ability to translate the principles of professional nursing practice in the care of assigned patients in order to provide appropriate care.

2.1.4.5.3 Demonstrate the ability to do a pre-anesthetic patient history and physical, which includes collecting pre-operative consults and data.

2.1.4.5.4 Demonstrate the ability to formulate an anesthetic plan and describe the anesthetic risks, benefits, and options to the patient.

2.1.4.5.5 Demonstrate the ability to administer inhalational, regional, intravenous, local, and topical anesthetics and to detect unfavorable reactions in order to continuously evaluate the patient’s physical status.

2.1.4.5.6 Demonstrate the ability to respond to emergency situations by providing airway management, administration of emergency fluids and drugs, and using appropriate resuscitation procedures for patient care.

2.1.4.5.7 Demonstrate the ability to provide patient care that is abreast of changing concepts and advancements in the profession.

2.1.4.5.8 Demonstrate the ability to work effectively in an interdisciplinary environment for the improvement of services for patient care.

2.1.4.5.9 Demonstrate the ability to practice nurse anesthesia with colleagues and peers utilizing a collaborative team concept of care.

2.1.4.5.10 Full performance is Nurse III. This CRNA will typically have 2 years of progressively responsible experience in the administration of anesthesia which includes demonstrated accomplishments in upgrading services to patients or involves program responsibilities.

2.1.4.6 Experience and Education. In addition to meeting the requirements for Entry Level, the CRNA has had progressively responsible experience in the administration of anesthetics as indicated in the knowledge, skills and abilities listed below. These individuals must demonstrate the ability to participate in a program for nurse anesthesia care and demonstrate knowledge of anesthetizing locations, methods, equipment and procedures. At this level, the CRNA has experience in the administration of anesthetics that has demonstrated the nurse anesthetist’s ability to participate in team programs that are technically challenging and/or complicated. Typically, candidates can demonstrate the knowledge, skills and abilities of Full Performance Level within 2 years from entering the occupation.

VA HANDBOOK 5005/37,PART II ,App G7

2.1.4.7 CRNAs are an advanced practice nurse who utilizes specialized clinical skills and education to administer anesthesia care throughout the medical center. The practice of nurse anesthesia is a recognized specialty within the profession of nursing. As independently licensed health professionals, CRNAs are responsible and accountable for their practice. The scope of practice includes direct patient care, administration, educational, and research activities.

2.1.4.8 CRNAs practice in collaboration with other health care professionals in a collegial relationship to achieve common goals for care, safety, and welfare of patients. In their position, CRNAs provide anesthetic services within four general categories:

2.1.4.8.1 Pre-anesthesia preparation and evaluation that includes a patient history, physical examination, and the collection of preoperative consults and data, from which an appropriate anesthetic plan can be formulated.

2.1.4.8.2 Anesthesia induction, maintenance and emergence.

2.1.4.8.3 Post anesthesia care

2.1.4.8.4 Peri-anesthetic and clinical support functions outside the OR suite.

2.1.5. Nurse Practitioner: Qualifications: Each Nurse Practitioner shall be an U.S. citizenship.

Non-citizens may be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy.Graduate of a school of professional nursing approved by the appropriate State- accrediting agency and accredited by one of the following accrediting bodies at the time the program was completed by the applicant: The Accreditation Commission for Education in Nursing (ACEN) or The Commission on Collegiate Nursing Education (CCNE). In cases of graduates of foreign schools of professional nursing, possession of current, full, active and unrestricted registration will meet the requirement of graduation from an approved school of professional nursing.

2.1.5.1. The completion of coursework equivalent to a nursing degree in an MSN Bridge

Program that qualifies for professional nursing registration constitutes the completion of an approved course of study of professional nursing. Students should submit the certificate of professional nursing to sit for the NCLEX to the

VA along with a copy of the MSN transcript. (Reference VA Handbook 5005, Appendix G6)

2.1.5.2. Current, full, active, and unrestricted registration as a graduate professional nurse in a State, Territory or Commonwealth (i.e., Puerto Rico) of the United States, or the District of Columbia.

2.1.6. Health Care Technician (HCT): Qualifications: Each HCT shall:

2.1.6.1. Be a certified nursing assistant or possess comparable certification in a related healthcare field including medical assistant, paramedic or emergency medical technician.

2.1.6.2. Have documented training and skills verification.

2.1.6.3. Be trained and experienced in patient care.

2.1.6.4. Have at least one-year experience working in direct patient care; ambulatory or emergency care preferred.

2.1.6.5. Be capable of providing nursing care for adult medical and surgical patients.

2.1.6.6. Have and maintain current Basic Life Support (BLS) certification.

2.1.6.7. Have no health or physical disability restrictions that interfere with the performance of assigned duties.

2.1.6.1.1. Gastro-intestinal (GI) Technician

2.1.7. Monitor Watcher: Qualifications: Each Monitor Watcher shall:

2.1.7.1. Specialized Experience: You must have 3 months of general experience OR,

2.1.7.2. Education: Applicants may substitute education for the required experience. To qualify based on education for this grade level you must have a high school diploma or equivalent from an accredited institution

2.1.8. Constant Observation Technician (COT)/Sitters: Qualifications: Each COT/Sitter shall:

2.1.8.1. No education, experience or certification requirements for these positions.

Contractor Agency sitters will be monitored by staff Registered Nurses.

2.1.8.2. SKILLS, KNOWLEDGE, AND ABILITIES:

2.1.8.2.1. Excellent verbal, written and interpersonal communication skills

2.1.8.2.2. Demonstrates an independent work initiative, sound judgment and attention to detail

2.1.8.2.3. Ability to organize workload and use effective time management

2.1.8.2.4. Ability to work effectively in a team environment

2.1.8.2.5. Basic knowledge of medical terminology

2.1.8.2.6. Demonstrate sensitivity to cultural diversity, race, gender, and others individual differences in the workplace

2.2. If one of the Multi-Specialty RN, LPN, CNA, CRNA, NP, MW, and Sitter certification is suspended, revoked or expires, the individual must be removed from the occupation which may result in termination of employment for the services on site in accordance with the specifications contained herein to beneficiaries of the Department of Veterans Affairs (VA) and the Veterans Affairs Health Care System (VAPHS).

2.3. Credentialing and Privileging –Credentialing and privileging is to be done in accordance with the provisions of VHA Handbook 1100.19 referenced above. The Contractor is responsible to ensure that proposed employee(s) possesses the requisite credentials enabling the granting of privileges. No services shall be provided by any contractor’s employee(s) prior to obtaining approval by VAPHS Professional Standards Board, Medical Executive Board and Medical Center Director.

2.3.1. If a contractor’s employee(s) is not credentialed and privileged or has credentials/ privileges suspended or revoked, the Contractor shall furnish an acceptable substitute without any additional cost to the government.

2.4. Technical Proficiency - Contractor’s employee (s) shall be technically proficient in the skills necessary to fulfill the government’s requirements, including the ability to speak, understand, read and write English fluently. Contractor shall provide documents upon request of the CO/COR to verify current and ongoing competency, skills, certification and/or licensure related to the provision of care, treatment and/or services performed. Contractor shall provide verifiable evidence of all educational and training experiences including any gaps in educational history for all contractor’s employee(s) and contractor’s employee(s) shall be responsible for abiding by the Facility's Medical Staff By-Laws, rules, and regulations (referenced herein) that govern medical staff behavior.

2.5. Continuing Medical Education (CME)/ Certified Education Unit (CEU) Requirements: Contractor shall provide the COR copies of current CMEs as required or requested by the VAPHS.

Contractor’s employee(s) registered or certified by national/medical associations shall continue to meet the minimum standards for CME to remain current. Contractor shall report CME hours to the credential’s office for tracking. These documents are required for both privileging and re-privileging. Failure to provide shall result in loss of privileges for contractor’s employee(s).

2.6. Training (ACLS, BLS, CPRS and VA MANDATORY): Contractor shall meet all VA educational requirements and mandatory course requirements defined herein; all training must be completed by the contractor’s employee(s) as required by the VA. Other training may become required. VA will communicate any changes to the training requirement to the contractor:

Training Frequency (once a year, etc.)

Annual Hours

Active Threat Training One Time Training 1.00 Blood Administration:

Complications

One Time Training 1.00

Blood Administration:

Administration ( all contract employees who administer blood components)

One Time Training 2.00

Government Ethics Bi-Annual 1.00 VA Privacy and Information Security Awareness and Rules of Behavior

Annual 1.00

VHA Privacy and HIPAA Focused Training

Annual 1.00

ACLS/BLS Bi-Annual 1.00 Patient Safety Annual 1.00 Patient Rights Annual .50 Patient Abuse Annual .50 Prevention/Management of Disruptive Behavior/Violence Prevention Level I

Bi-Annual 2.00

Suicide Prevention: Suicide Risk Management Training for Clinicians

One Time Training 4.50

SUX Infection Control and Blood Borne Pathogens

Annual 1.00

CPRS One Time Training 1.00 VISTA Imaging One Time Training 1.00 List other Training per local facility

One Time Training 1.00

2.7. Standard Personnel Testing (PPD, etc.): Contractor shall provide proof of the following tests for employees within five (5) calendar days after contract award and prior to the first duty shift to the COR and Contracting Officer. Tests shall be current within the past year.

2.7.1. TUBERCULOSIS TESTING: Contractor shall provide proof of a negative Tuberculosis

Skin Test (TST) or interferon-gamma release assays (IGRA) for all Contractor’s employee

(s) {This is applicable to all health care workers}. A negative chest radiographic report for active tuberculosis shall be provided in cases of positive TST or IGRA results. The TST or IGRA testing shall be repeated annually.

2.7.2. MEASLES, MUMPS, & RUBELLA TESTING: Contractors shall provide proof of immunity for all Contractor employees {This is applicable to all health care workers}.

2.7.3. VARICELLA: Contractors shall provide proof of immunity for all Contractor employees {This is applicable to all health care workers}.

2.7.3.1. ACELLULAR PERTUSSIS: Contractors shall provide proof of 1 dose of Tdap vaccination for all Contractor employees {This is applicable to all health care workers}.

2.7.3.2. INFLUENZA: Contractors shall provide proof that all Contractor employees have received the annual Influenza vaccine unless it is contraindicated. If the Contractor employee has a medical contraindication to the vaccine, they shall be required to wear a mask during the Influenza season . {This is applicable to all health care workers}.

2.7.3.3. OSHA REGULATION CONCERNING OCCUPATIONAL EXPOSURE TO

BLOODBORNE PATHOGENS: Contractor shall provide evidence of completing and passing generic self-study blood-borne pathogen training for all Contractor’s employee {This is applicable to all health care workers}; provide their own Hepatitis B vaccination series and hepatitis B surface antigen test results following the hepatitis B vaccination series; maintain an exposure determination and control plan; maintain required records; and ensure that proper follow-up evaluation is provided following an exposure incident.

2.7.3.4. The VAPHS shall notify the Contractor of any significant communicable disease exposures as appropriate. Contractor shall adhere to current CDC/HICPAC Guideline for Infection Control in health care personnel ( as published in American Journal for Infection Control- AJIC 1998; 26:289-354 http://www.cdc.gov/hicpac/pdf/InfectControl98.pdf) for disease control. Contractor shall provide follow up documentation of clearance to return to the workplace prior to their return.

2.7.4. National Provider Identifier (NPI): NPI is a standard, unique 10-digit numeric identifier required by HIPAA. The Veterans Health Administration must use NPIs in all HIPAA-standard electronic transactions for individual (health care practitioners) and organizational entities…