ATTACHMENT A - Performance Work Statement.pdf

PWS No. GIMC-13-02 26 Sept 2012

Performance Work Statement (PWS) for Personal Services

Respiratory Therapy Services

Table of Contents

Section Page

1.0 General 1

2.0 Definitions 3-5

3.0 Government Furnished Information, Property, & Services 6

4.0 Contractor Furnished Equipment 7

5.0 Performance-Based Requirements 8-9

6.0 Contractor Qualification Requirements 9-11

7.0 Federal Tort Coverage Act 11

8.0 Challenges to Conflicts 11

9.0 52.249-12 Termination (Personal Services) (Apr 1984) 11

10.0 Performance based Matrix 12

11.0 List of Attachments and Exhibits 13-14

1.0 General: This performance work statement describes the requirements for personal service Respiratory Therapy services to support the mission of the Indian Health Service (IHS).

1.1 Background: IHS is an agency within the U.S. Department of Health and Human Services and is responsible for providing federal health services to American Indians and Alaska Natives. The provision of health services to members of federally recognized tribes grew out of the special government to government relationship between the federal government and Indian tribes. The IHS is the principal federal health care provider and health advocate for the Indian people. The goal is to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indians and Alaska Natives. The IHS currently provides health services to approximately 1.5 million American Indians and Alaska Natives who belong to more than 557 federally recognized tribes in 34 states.

1.1.1 Navajo Area Indian Health Service (NAIHS) administers health centers and hospitals providing health care to approximately 201,583 members of the Navajo Nation. The Navajo Nation is the largest Indian tribe in the United States and has the largest reservation, which encompasses more than 25,516 square miles in northern Arizona, western New Mexico, and southern Utah, with three satellite communities in central New Mexico. The NAIHS is the primary provider of inpatient, ambulatory care, preventive and community health, and environmental health services for members of the Navajo Nation and the San Juan Southern Paiute Tribe.

1.2 Scope: The Contractor shall provide Respiratory Therapy services in accordance with section 5.0, performance based requirements.

1.2.1 The contracting Respiratory Therapist will perform competently a wide range of judgment and initiative in the application of cardiopulmonary procedures. Duties and responsibilities may encompass outpatient, inpatient and community health services to IHS patients.

1.2.2 Place of Performance: Contracting personnel will serve all areas of the hospital including but not limited to: Medical/Surgical, Outpatients, Emergency/Trauma Room, Pediatrics, Newborn Nursery, and Intensive Care Unit and Women’s Health Unit.

1.2.3 Period of Performance: Will be flexible to allow for short term (less than 1 week), long term (1-year to 3-year) and, where feasible, include intermittent support to meet unplanned needs that develop on a frequent basis.

1.3 Applicable Documents: Please see the web link listed unless document is listed as an attachment.

1.3.1 Joint Commission on Accreditation of Healthcare Organizations (TJC) http://www.jointcommission.org/

1.3.2 Centers for Medicare and Medicaid Services (CMS) Standards http://www.cms.hhs.gov

1.3.3 Accreditation Association for Ambulatory Health Care (AAAHC) http://www.aaahc.org

1.3.4 Section 231 of Public Law 101-647, the Crime Control Act of 1990.

http://www.policyalmanac.org/crime/archive/crs_federal_crime_policy.shtml

1.3.5 Section 4087 of Public Law 101-630, the Indian Child and Family Violence Act.

http://www.icctc.org/IHS-BIA%20CPT%20Handbook/PL%20101-630.pdf

1.3.6 Health Insurance Portability and Accountability Act (HIPAA) of 1996.

http://www.cms.gov/HIPAAGenInfo/

1.3.7 Privacy Act of 1974.

http://www.justice.gov/opcl/privacyact1974.htm

1.3.8 National Board of Respiratory Care, Inc. Code of Ethics and Standards of Practice and Care http://www.nbrc.org

1.3.9 IHS Service Unit and Health Center Policies, Procedures and Protocols.

(See section 11.0 for a list of attachments and exhibits)

1.3.10 Computer Security Act of 1980

http://security.ihs.gov/index.cfm

1.3.11 Federal Code of Conduct

http://www.ihs.gov

1.3.12 IHS General Directives

http://www.ihs.gov/index.cfm?module=AtoZ&option=index

1.3.13 IHS Computer Security Directives

http://www.jointcommission.org/ http://www.policyalmanac.org/crime/archive/crs_federal_crime_policy.shtml http://www.icctc.org/IHS-BIA%20CPT%20Handbook/PL%20101-630.pdf

2.0 Definitions

2.1 Acceptance: Constitutes acknowledgement that the supplies or services conform to the applicable contract quality and quantity requirements, except as provided in FAR subpart 46.5 and subject to other terms and conditions of the contract.

2.2 Approval: Acknowledgment by the designated Government official that submittals, deliverables, or administrative documents (e.g., insurance certificates, installation schedules, planned utility interruptions, etc.) conform to the contractual requirements. Government approval does not relieve the Contractor from responsibility for compliance with contract requirements.

2.3 Area: A defined geographical region for Indian Health Service administrative purposes.

Each Area Office may administer several Service Units.

2.4 Code of Ethics: The National Board of Respiratory Care, Inc. (NBRC) is a voluntary health certifying board which was created in 1960 to evaluate the professional competence of respiratory therapists.

2.5 Contracting Officer (CO): A Government employee with the authority to enter into, administer, and/or terminate contracts and make related determinations and findings.

2.6 Contractor: The individual awarded a legal binding contract to provide supplies and services.

2.7 Contracting Officer’s Representative (COR) or Project Officer (PO): A federal employee who assists the ordering/issuing activity contracting officer in the administration of task orders issued under this contract. The COR is primarily responsible for the technical assistance and day-to-day program management of the ordering activity’s task orders. Ordering activities may have different designators for this employee (e.g. GTR – Government Technical Representative, COTR–Contracting Officer’s Technical Representative, or PO - Project Officer).

2.8 Contractor Performance Assessment Report: A report that assesses a contractor’s performance and provides a record, both positive and negative, on a given contract for specific period of time.

2.9 Cooperative Attitude: Behavior that is positive and displays a willingness to perform assigned patient care tasks and to be a team player.

2.10 Cultural Awareness: Realization and respect for American Indian and Alaska Native practices.

2.11 Customer: Patients, staff and visitors of an IHS service unit and health center.

2.12 Customer Evaluation/Input: Written comments made to the Contracting Officer regarding the Contractors performance. This is one of the criteria used to evaluate the Contractor’s performance.

2.13 Dependability: Qualities of being trusted and being able to repeat the same task to yield the same result.

2.14 Federal Acquisition Regulation (FAR): The FAR is the primary regulation for use by all Federal Executive agencies in their acquisition of supplies and services with appropriated funds.

2.15 Government Vehicle: An IHS owned motor vehicle or a vehicle leased by IHS through agreements with the General Services Administration (GSA) or through commercial rental agreements.

2.16 Health Center: A facility physically separated from a hospital, with a full range of ambulatory services including at least primary care providers, nursing, laboratory, and x-ray which are available at least 40 hours a week for outpatient care.

2.17 Ordering Activity: An authorized user of IHS that may issue a task order to obtain required services under this contract.

2.18 Ordering Activity Contracting Officer: A Government employee of IHS authorized and warranted to issue task orders and to make subsequent task order modification(s) under this contract. The Ordering Activity CO has the authority to make initial determinations on all matters of dispute regarding task orders.

2.19 Orientation: An activity designed to provide basic familiarization of the facility and transition the respiratory therapist into the IHS Service Unit and/or Health Center and the Respiratory Department unit where the services will be provided.

2.20 Past Performance Information: Relevant information regarding a contractor’s actions under previously awarded contracts. This includes the contractor’s record of conformance to specifications and to standards of good workmanship; the contractor’s record of containing and forecasting costs on any previously performed cost reimbursable contracts; the contractor’s adherence to contract schedules, including the administrative aspects of performance; the contractor’s history for reasonable and cooperative behavior and commitment to customer satisfaction; and generally, the contractor’s business-like concern for the interest of the customer.

2.21 Patient Outcome: End result of respiratory therapy care.

2.22 Performance based Matrix: Lists the services to be monitored and the standards to be applied.

2.23 Personal Protective Equipment (PPE): The equipment used to protect medical personnel from exposure to biological, chemical, and radioactive hazards.

2.24 Personal Service Contracts: A contract that, by its express terms or as administered, makes the Contractor appear to be Government employee, as defined in FAR 37.

2.25 Service Unit: The local administrative unit of IHS.

2.26 Standards of Practice and Standards of Care: Authoritative statements by which the respiratory therapist profession describes the responsibilities for which its practitioners are accountable. The standards provide direction for professional nursing practice and a framework for the evaluation of practice. The standards of professional nursing practice may pertain to general or specialty practice.

2.27 Supervisor. Government employee authorized to provide verbal and written performance direction to the Contractor that the Contractor must follow without exception.

2.28 Task Order: An order issued in accordance with the terms of the contract that details an ordering activity’s specific requirements. An ordering activities written order to obtain services, at a minimum will include the following where applicable: description of services, skill categories, hours, price, period of performance, contract number, and the ordering activities task order number.

2.29 Tour of Duty: The time of day the respiratory therapist is scheduled to perform respiratory therapy duties; also considered the shift of the day. The time can vary according to the needs of each facility and/or clinic, e.g. 12 hour Tour of Duty, 8 hour Tour of Duty, 10 hour Tour of Duty. Includes weekends and holidays.

2.30 Valid Patient Complaint: Justifiable accusation made by a patient and supported by investigation.

2.31 Verifiable Emergency: An unexpected/unplanned absence by the contractor requiring valid documentation to confirm the occurrence.

3.0 Government Furnished Information, Property and Services

3.1 Information: Government unique information related to this requirement, which is necessary for Contractor performance, will be made available to the Contractor. The Contracting Officer or designee will be the point of contact for identification of any required information to be supplied by the Government.

3.2 Joint Use by the Government and the Contractor: Except for the property and service listed in 3.3 and 4.0, the Government will provide, for joint use by the Government and the Contractor, all necessary equipment, supplies, and clinic space to perform the services under this contract.

3.2.1 Government Vehicle: If required by the position, authorization shall be in accordance with IHS Chapter 12, Section 13 Motor Vehicle Management.

3.3 Contractor Exclusive Use:

3.3.1 Personal Protective Equipment (PPE). The Government will furnish the Contractor with appropriate PPE other than specified in paragraph 4 of the contract. The Government will be responsible for any repair, cleaning, and inventory required for the PPE. This does not include any type of uniform or laboratory coat.

3.3.2 The Government will provide facility specific contractor identification badges for each contractor. A minimum fee of $20.00 will be charged for lost or destroyed badges.

3.4 Training: Facility specific orientation/training necessary for the Contractor to perform the required duties, e.g., IHS information technology (IT) systems and operational procedures.

Training will be provided ONLY if the subject matter is necessary to improve or enhance the quality of respiratory therapy services or includes mandates made by the IHS Service Units/Health Centers while the respiratory therapist is working under this contract. Training will not be provided for the purpose of continuing education, career development or individual development.

4.0 Contractor Furnished Property

4.1 Except for the property specified in paragraph 3.0 as government furnished, the Contractor shall provide all uniforms and other personal medical instruments subject to the following:

4.1.1 Uniforms and Lab Coats: Uniforms and Lab Coats shall conform to the requirements of the Indian Health Service Manual, Part 3 Chapter 4 and meet the approval of the Respiratory Therapy Supervisor at each IHS facility.

4.1.2 Other personal medical instruments: “Other personal medical instruments” are defined as Contractor owned items may include but not limited to stethoscope, scissors, as appropriate to the work unit. The Contractor shall not use unsafe equipment or supplies at any time during performance of this contract. All Contractor furnished equipment and supplies shall be subject to inspection by the Government and must be approved by the COR prior to use by the Contractor. The Government reserves the right to prohibit the use of any materials, supplies, or equipment.

5.0 Performance-Based Requirements. The Contractor shall provide Respiratory Therapy services in the delivery of patient care to the Indian Health Service. Specific tasks include the following:

5.1 Respiratory Therapist Duties:

5.1.1 The Contractor shall perform respiratory therapy duties and manage patient’s needs as described in the (PD), identified by the Service Unit and as directed by Supervisor.

5.1.2 The Contractor shall perform in accordance with the competency standards listed in Exhibits, paragraph 11.

5.2 Work Schedule:

5.2.1 The Supervisor shall determine specific tour of duty. The contractor shall work 100% of the contracted hours.

5.2.2 Work Flexibility. As directed by the Supervisor, the Contractor shall rotate into other duty sections as needed to support patient care.

5.2.3 The Contractor shall obtain approval of the department Supervisor or designee prior to any absence from work. If the length of the absence exceeds eight (8) work hours the Contractor shall request approval at least fifteen (15) days, (the exception is verifiable emergencies) in advance of the desired absence.

5.2.4 Approval of leave is contingent upon availability of a qualified replacement.

5.2.5 The Contractor shall provide written documentation from a qualified health care provider for absences of three (3) or more consecutive days, due to illness, stating:

A. The cause of the current illness or incapacitation AND

B. Indicating the Contractor as contagious or non-contagious.

The Government reserves the right to examine and or re-examine any Contractor who meets the criteria.

5.3 Conduct: The Contractor shall meet standards as listed in the Federal Code of

Conduct.

5.4 Performance Evaluation:

5.4.1 The Contractor’s performance will be evaluated in accordance with the standards set forth in the contract and Performance-based Matrix of section 10.0.

5.4.2 Substantiated reports written by any customer dealing with patient safety, infection control, or other procedure that adversely affects patient outcome constitutes a breach of contract.

5.5 Identification of Contractor:

5.5.1 The Contractor shall wear a government issued contractor identification badge during performance of duty.

5.6 Management of Medical Information: The Contractor shall manage all patient information in accordance with HIPAA standards, Privacy Act, and IHS Service Unit and/or Health Center specific policies and protocols.

5.6.1 The Contractor shall ensure adherence to DHHS IT system security policies and procedures. The IT policies and procedures will be made available to the Contractor.

5.6.2 The Contractor shall immediately report to the Contracting Officer or COR any information or circumstances that may violate any statute, policy, or procedure.

5.7 IHS Information Technology Systems:

5.7.1 In performance of this contract, the Contractor shall adapt to and successfully utilize IHS information technology systems that are deemed by the Supervisor as necessary for acceptable contractor performance, including use of the Electronic Health Record (EHR).

5.7.2 The Contractor shall ensure that IHS information technology system security policies and procedures are adhered to. The IT policies and procedures will be made available to the Contractor at each IHS facility.

6.0 Contractor Qualification Requirements:

6.1 Experience. The Contractor must possess at least three (3) years of recent acute care experience. Have minimum of one year of experience in the following areas: Pediatrics, Adult ICU – Ventilator Management, Emergency/Trauma, Arterial blood gas punctures, analyzing and interpretation, Medical/Surgical care of young adults, adults and geriatric patients, General floor care, Floor to floor and ground transports, Performs Electrocardiograms and Competence in respiratory medications.

6.2 License/Registration. The Contractor must be Board Certified or Registered through the National Board of Respiratory Care.

6.2.1 Motor Vehicle Operator’s License. If required by the position, the Contractor shall possess a valid state driver’s license throughout the term of this contract.

6.3 Certifications. Current Advanced Cardiac Life Support (ACLS), Basic Life Support (BLS) and Registered Respiratory Therapist (RRT) is mandatory. Pediatric Advanced Life Support (PALS), Neonatal Resuscitation Provider (NRP), and Neonatal Advanced Life Support (NALS).

6.4 Health Requirements/Conditions of Employment:

6.4.1 Medical Evaluation. The Contractor shall provide a fitness for duty certificate issued by a licensed physician to perform the proposed job without significant risk to personal health or the health and safety of others.

6.4.2 Immunization. The Contractor shall also provide the following documentation:

Immunity to Rubella, Mumps, Measles Immunity to Hepatitis B series History of chicken pox (varicella) disease or positive titer Tetanus Diphtheria (Tdap) within the last 5 years Documentation of receiving a TB Mantoux skin test (PPD) within the past

12 months with documentation of follow-up for a positive test.

A signed declination of the Hepatitis B vaccination series will be accepted.

Current Influenza Vaccination

6.5 Language Requirements and Cultural Awareness. The Contractor shall read, understand, speak, and write English to effectively communicate with patients and other health care workers, and shall be respectful of the local, American Indian and Alaska Native culture.

6.6 Information Technology Skills. The Contractor shall possess basic knowledge, skills, and abilities to use a computer.

6.7 Orientation. All RTs providing service under this contract shall attend mandatory orientation and training specified by the government.

6.8 Background Checks: As directed by the Contracting Officer, the Contractor shall provide all requested information necessary to perform background checks. The Contractor shall comply with the requirement to obtain security investigations. The Contractor shall work with the IHS to ensure that the pre-employment screening process includes the appropriate investigation questionnaires and forms to be completed. All completed forms will be reviewed by the Contractor and forwarded to the Government Personnel. The Contractor will be immediately removed from the position if at any time the investigation receives unfavorable adjudication, or, if other unfavorable information that would affect the investigation becomes known.

7.0 Federal Tort Claims Act (28 USC 1346 (B), 1946): Federal Tort Claim Act coverage for medical related claim is extended to personal service contractors only when an incident of negligence is alleged to have occurred during the delivery of services by a contracted health care provider in a facility owned, operated, or constructed under the jurisdiction of the Indian Health Service. The services provided must have been within the scope of the personal services contract.

8.0 Challenges to Conflicts: For any inconsistency between supervisor directions, this Performance Work Statement, attachments and exhibits, the following order of precedence will apply:

(a) First Priority: Supervisor’s directions

(b) Second Priority: Position Description (attached)

(c) Third Priority: Performance Work Statement Exhibits

(d) Fourth Priority: Performance Work Statement Narrative

9.0 52.249-12 Termination (Personal Services) (Apr 1984): The Government may terminate this contract at any time upon at least 15 days’ written notice by the Contracting Officer to the Contractor. The Contractor, with the written consent of the Contracting Officer, may terminate this contract upon at least 15 days’ written notice to the Contracting Officer.

9.1 Any Contractor employee demonstrating impaired judgment shall not be allowed to continue working on the contract. The Government reserves the right to remove from the facility any Contractor employee who in the judgment of a licensed healthcare practitioner is impaired.

10.0 Performance – based Matrix

Performance-based Task Indicator Standard Quality Assurance Incentives

State the end results or outputs that you, the customer will formally accept or reject.

For the requirement, state the feature(s) of end result that will be surveilled.

For each “indicator,” state a performance level that, when met, means the task has been performed satisfactorily.

This Standard describes “What Success Looks Like.”

For each “Standard”, state the method used to check performance (i.e. random sampling, 100% inspection, periodic inspection, customer complaints).

List Positive and Negative Incentives. Address method of linking payment to quality of service.

Contractor shall provide Respiratory Therapy services in the delivery of patient care to the Navajo Area Indian Health Service.

Competency

Compliance

Patient Outcomes

Professionalism

Credentialing

Documentation

Service Quality

Perform 100% required tasks at 100% of the required competencies (refer to 11.0)

100% compliance with IHS Service Units and/or Health Centers published Policies;

Procedures; Standards of Care; and hospital and respiratory Therapy Protocols.

No reports of breached patient safety, infection control, and other procedures that might adversely affect patient outcome.

Performance characterized by continual cultural awareness and focus on customer service. 100 percent adherence to the Respiratory Therapy Code of Ethics and Federal Code of Conduct.

Uninterrupted credentialing as defined in

6.0 to 6.8 for period of contract.

100% percent of all documentation meets established IHS Medical Facility, t JC, and CMS standards to include, but are not limited to, timeliness, legibility, accuracy, content, date, time, signature and designated profession.

Satisfaction with quality of service is evidenced by valid customer inputs.

See QASP. Surveillance systems will include periodic inspections and customer complaints.

Payment of contract price for satisfactory service.

Contractor performance will be evaluated using the Contractor Performance Assessment Report. The evaluation will be considered when future IHS contract selections are made.

11.0 List of Attachments and Exhibits. To be provided by the Contracting Officer upon request.

11.1 Attachments

Position Description (Service Unit specific)

11.2 Exhibits

The Contractor shall provide care with competency in the field of Respiratory Therapy the services listed below but not limited to this list.

These services will be applied to patients of all age groups, from neonates to geriatric patients. These services will be performed in a timely manner, with respect and professionalism.

Oxygen administration using all the devices available, such as nasal cannula, simple masks, ventri-masks, partial rebreather, aerosol mask, oxyhoods, infant incubators etc.

Basic life support of all age specific patients.

Initial set-up of ventilators. Ventilator management of adult, pediatric, neonatal and geriatric patients. Ventilation of patients with known diseases such as COPD, asthma, pneumonia, adult respiratory distress syndrome etc.

Thorough documentation on the ventilator supported patients will be completed every 2 hours including the completion of the ventilator flow sheet.

Assisting with intubation of patients of all ages.

Proper care of endotracheal tubes and trach tubes. Including the use of a cuff monitor.

Weaning patients from ventilators and recording such measurements.

Extubation of patients of all age groups.

Knowledge of Respiratory pharmacology.

Nebulization treatments via small volume and large volume. Having knowledge of all Respiratory medications, their positive effects, adverse affects and proper doses.

Metered dose inhaler/spacer administration the effects of metered dosed medications, frequencies of administration and duration of medication’s effects.

BiPAP/CPAP administration and proper fit of nasal masks and full facemasks.

Proper suctioning technique of patients on ventilators and those patients who are not on ventilators who need nasopharyngeal/oral suctioning.

Comfort care to patients who are nearing their time of death.

Obtain sputum samples either naturally, by induction, or suction.

Performs arterial punctures being mindful to proper technique and transporting blood products properly. Analyzing arterial blood gases and interpretation.

Run venous blood gases.

Complete understanding, knowledge and application of chest physiotherapy involving postural drainage using percussion and vibration.

Peak flow monitoring of patients.

Proper use of oximeter and capnograph on all age groups.

Performs electrocardiograms on all age groups, documents patient information, pulls files and files those EKGs post-interpretation.

Maintains all respiratory equipment for future use by testing, cleaning and calibrating.

Adheres to JC and CLIA standards in care of patients, equipment, the blood gas laboratory and any other laboratories operating under GIMC.

Clearly educates and instructs patients/family followed by clear documentation of procedures.

The Respiratory Therapist must be knowledgeable and capable of performing in trauma situations, life and death situations, critically ill, high risk patients and disasters.

GIMC utilizes handwritten charting of documentation as its system. The Respiratory Therapist must abide to all JC standards for full assessments, monitoring affects of a patient’s response to care given and all pertinent information pertaining to the care of the patient.

Therapist is required to fulfill all physician’s documented orders for all patients who fall under the care of Respiratory Therapy, unless, the order could cause harm to the patient.

The Respiratory Therapist must be capable of performing Respiratory duties in an in-patient and out-patient setting.