Open Arms Free Clinic provides free medical care to those in need in the community. It operates on Mondays, Wednesdays, and Fridays from 8AM to 5PM and can see up to 25 patients daily on a first-come, first-served basis. Staffed entirely by volunteers, the clinic aims to deliver quality healthcare services for free while also promoting health education and raising awareness of health issues facing the community.

1. Open Arms Free Clinic13 hands wayblessings, NC 24681 Providing Free Medical Care to our Community Hours: Monday, Wednesday and Friday – 8AM – 5PM

2. Our Mission: Open Arms Free Clinic is a faith-based non-profit organization that provides free quality health care in our community for those who lack appropriate alternatives (Advocacy: The Free Medical Clinic of Greater Cleveland, 2009). It is our intention to develop programs that address the community health needs through collaborative efforts with area hospitals and health care agencies (National Association of Free Clinics, 2009). We will provide care as an expression of God’s love for all people.

3. Our vision is to: Deliver quality health care services for free to those who qualify. Promote health and wellness in our community through health care education (Ashe County Free Medical Clinic, n.d.) Provide care in a compassionate environment that will improve the health of our community. Raise awareness of the need for support from educational, business, medical and faith based communities to help protect the health of our community (Carefree Medical & Dental Clinics, 2007).

4. Open Arms Free Clinic Services Primary Family Medicine Affordable or free prescription services Referral to Medical Specialists when necessary Access to free laboratory and X-ray services Durable medical equipment Well child examinations and immunizations Sports, school and employment physicals

5. Delivery of Services Services are provided by an all-volunteer staff of physicians, nurse practitioners, physician assistants, nurses, nursing assistants, pharmacists and various unlicensed personnel (Guidelines for Starting Free Medical Clinics, n.d.) Hours of operation are: Monday, Wednesday, Friday 8Am – 5PM 25 patients can be seen daily and patients are seen on a first-come first-serve basis This is a free clinic…there is no charge for medical exams

6. Delivery of Services Prescription medications are provided free or for a nominal fee No narcotic prescriptions are available on site Lab work and X-Ray services provided in partnership with area hospitals at no cost to patients

7. Eligibility Requirements No private health insurance Do not qualify for Medicaid, Medicare, NC Health Choice or Veterans Benefits (Ashe County Free Medical Clinic, n.d.). Total household income must not exceed 200% of Federal Poverty Level based on size of your immediate family (Harmony Health Clinic, n.d.). You must set up an appointment for a one-time interview to apply for and determine eligibility

8. Resources (2009, May 06). Retrieved May 24, 2010, from Advocacy: The Free Clinic of Greater Cleveland: http://thefreeclinic.org/advocacy.htm About ACFMC. (n.d.). Retrieved May 23, 2010, from Ashe County Free Medical Clinic: http://www.acfmc.org/about.php Care Free Medical Clinic, Inc - Free Medical Clinics in Mason and Lansing, Michigan. (2007). Retrieved May 23, 2010, from Carefree Medical & Dental Clinics: http://www.carefreemedical.com/board.htm Guidelines for Starting Free Medical Clinics. (n.d.). Retrieved May 24, 2010, from http://members.cox.net/billsisson/Guidelines,htm Harmony Health Clinic. (n.d.). Retrieved May 24, 2010, from Harmony health Clinic: http://www.harmonyclinicar.lorg/en/services National Association of Free Clinics-Advocacy and Support for America's Free Clinics. (2009). Retrieved May 27, 2010, from The National Association of Free Clinics(NAFC): http://www.freeclinics.us/membersbenefits.php

9. Performance Improvement and Patient Satisfaction Open Arms Free Clinic

10. Goals for Clinic Improvement Provide safe care – Avoiding injuries to patients from care that intended to help . Provide effective care – Services based on evidence and scientific knowledge that avoids underuse and overuse. Provide patient-centered care – Respectful and responsive to patient preferences, needs and values. Providing timely care – Reducing waits and harmful delays for those who give and receive care

11. Methods for Improvement Organize a Process Improvement Team that includes Medical, Pharmacy, Nursing and Support Staff as well as members from the church sponsor and participating hospitals. Establish improvement goals –What are we trying to accomplish? Identify changes that will result in patient and employee/volunteer satisfaction improvement. Implement changes using the PDSA model (Plan-Do-Study-Act). Use benchmarking tools to compare/contrast survey results and evaluate changes in care with other clinics (CAHPS Surveys & Tools). Resource How to Improve. (n.d.). IHI.org: A resource from the Institute for Healthcare Improvement. http://www.ihi.org/IHI/Topics/Improvement/Improvement Methods/HowToImprove/. Downloaded 6/2/1010/

12. Evaluation Monitor safety and patient satisfaction with point-of-care surveys. Evaluate any cost saving programs implemented after a 3 month period and investigate additional partnerships that may result in reduced operating costs. Monitor and evaluate improvements with employee volunteers, medical partners and participating hospitals and seek additional measures to ensure quality of care delivered to our patient population.

13. Organizational Structure Open Arms Free Clinic

14. Organizational Structure

15. Patient AcuityPatient Acuity Mix Open Arms Free Clinic

17. Acuity levels will be based on the medical needs and services provided to the patient. The higher the need, the higher the acuity level.

19. Budget Open Arms Free Clinic Fiscal Year Ending 12/31/2009

20. Budget

21. Budget Resources Ada Jenkins Free Clinic of Our Towns Financial Summary, (2008). downloaded from http://www.adajenkins.org/services/health/medical Clinic.cfm June 21, 2010. The Free Medical Clinic of Greater Cleveland Financial Statements, (2009). Downloaded from http://www.thefreeclinic.org.advocacy.htm May 24, 2010.

22. JobDescriptions Open Arms Free Clinic

23. Job Descriptions Executive Directors – Church Deacons and Pastor, Pharmacist, Physician and Nurse Practitioner/Physician Assistant making up a governmental body that is faith based. Medical Directors - On-site rotating physicians. Physicians – Here at Open Arms Free Clinic, we have the highest quality, qualified and caring physicians in the region. They are licensed, Board Certified, ACLS certified, and have local hospital privileges.

24. Job Descriptions Physicians will direct patient cre, treatments and medical direction to the interdisciplinary team ensuring standard of care is upheld. Nurse Practitioner/Physician Assistant – On site at Open arms Free Clinic we have a Nurse Practitioner/Physician Assistant who is licensed and Board Certified. They work directly with the Physician, who co-directs the interdisciplinary team with Physician based assessments, uses standards of care appropriate for our level of acuity, redirects, and refers to appropriate centers those who need a higher level of care than our team can deliver.

25. Job Descriptions Pharmacists – Licensed and Board Certified, able to direct the interdisciplinary team when appropriate. They will report directly to the physician or NP/PA to reduce medical errors. Pharmacy Technician – Person who works directly under the Pharmacist. They are trained to have a basic knowledge of medications, recognize high-risk medications and disperse medications to the nursing staff as directed.

26. Job Descriptions Registered Nurse – At Open Arms Clinic we have the finest Nursing Staff who will carry out appropriate assessments and monitoring of labs and vital signs. They are always aware of appreciating the seriousness of the patient’s condition. All Nursing care is highly qualified with BCLS, ACLS, and PALS. CNA’s – Our CNA’s are highly qualified and caring individuals who are well versed in BCLS and vital signs. They report directly to the physician, nurse practitioner, or nursing staff. All Patient Care will be kind and courteous.

27. Job Descriptions Office Personnel – Secretary, Bookkeeper, and Receptionist. Our office staff is trained to be the receptionist, accountant, and the person in charge of ordering supplies simultaneously. If for any reason we cannot treat you appropriately, we re well capable of stabilizing methods of life support until Emergency Medical Services arrive for transport to an appropriate facility.

28. Competencies for Open Arms Free Clinic Staff by Profession All Staff, Physicians, Nurse Practitioners', RN’s, Pharmacists, All Licensed Staff, & Unlicensed staff

29. Competencies by Profession All Staff: Must maintain current BCLS Physicians & NP’s: Must maintain current BCLS, ACLS, & PALS as well as mandated yearly job specific competencies including blood borne pathogens, reading x-rays, and environmental safety procedures. Also other competencies as deemed necessary to maintain a safe practice & patient care. RN’s: Must maintain current BCLS,ACLS, & PALS as well as mandated yearly job specific competencies for registered nurses including blood borne pathogens, glucose testing, performing EKG’s, environment of care, & others as deemed necessary to perform job specific tasks.

30. Competencies by Profession Pharmacists: Must maintain current BCLS, ACLS, & PALS. All yearly job specific competencies must be completed as designated by the state of North Carolina. All Licensed Staff: Must maintain the required continuing education as set forth by the state licensing board and all governing bodies. All Unlicensed Staff: Must complete all mandated yearly competencies as determined by the facility & any others as seen needed.

31. Performance Appraisals 30 Days, 90 Days, 6 Months, & Yearly

32. Schedule of Performance Appraisals With every new hire, the employee will receive a 30 day, 90 day, and yearly evaluation from the time of their hire date. Every employee will have a shortened 6 month review to evaluate any needs or concerns with job specific and organizational specific tasks. Peer review evaluations were be used as additional appraisal tools at the yearly evaluation of the employee.

33. 6 Month Review Appraisal This is done to assist the employee in achievement of personal & professional goals/objectives for the yearly appraisal Goals/objectives from the previous year will be reviewed for areas of improvement. Review with employee on how they view their work performance in achieving these goals & improvements. Discuss any issues, needs, concerns, or challenges so the employee may reach their goals.

34. Yearly Evaluation & Appraisal Peer reviewed surveys will be obtained and reviewed from 7-8 employees who work in close relation. Surveys will remain anonymous and used only for performance improvement purposes. Survey questions will be job specific only and not used for any purpose other than those specified. Employees will also do self evaluations

35. Magnet Forces Open Arms Free Clinic is not eligible to apply for Magnet Status because it is not a hospital and we do not have a Chief Nursing Officer to oversee nursing activities. We will strive to implement the 14 Forces of Magnet to promote quality in an environment that supports and identifies excellence in professional practice and nursing care delivery.

36. The 14 Forces of Magnetism Force 1 – Quality of Nursing Leadership – We will strive to be knowledgeable, strong risk-taking leaders who advocate for staff and patients. Force 2 – Organizational Structure – We shall share decision making and strive to work as a cohesive group for the betterment of the patients and staff. Force 3 – Management Style – The staff will provide leadership and take the responsibility of providing constructive criticism and support for each other

37. Magnet Forces (con't) Force 4 – Personnel Policies and Programs - We are an all volunteer clinic. We provide creative and flexible staffing that supports a safe and healthy work environment. Personnel policies are developed with direct care nurse input. Force 5 – Professional Models of Care – Our nurses are capable of treating the patient mix and acuity with knowledgeable and competent nursing care using the primary nursing model.

38. Magnet Forces (con’t) Force 6 – Quality of Care – Quality patient care is the Mission of our clinic. The entire organization strives to ensure that each patient contact is a positive experience. Force 7 – Quality improvement – Our process for Quality Improvement will ensure that we provide safe, effective, patient centered care in a timely manner. Force 8 – Consultation and Resources – We will provide adequate resources, support and opportunity for our staff and patients to utilize the expert opinion of specialists and advanced practice professionals when their assistance is needed.

39. Magnet Forces (con’t) Force 9 – Autonomy – Our nursing staff functions autonomously while working with various other professionals to care for our patient population . This self-directed nursing care is consistent with professional standards. Force 10 – Community and the Healthcare Organization – Our clinic developed out of the partnership with churches, local hospitals, and healthcare providers to provide care to patients in need and in that way improve patient outcomes.

40. Magnet Forces (con’t) Force 11 – Nurses as Teachers – The nursing staff will provide education to patients using literature, handouts, and other resources available. We will partner with local educational institutions to provide mentoring opportunities for students. Force 12 – The Image of Nursing – The nursing staff is essential to the team that provides care to patients and respected for the quality of the care they provide.

41. Magnet Forces – (con’t) Force 13 – Interdisciplinary Relationships – Our staff will have mutual respect for one another regardless of their title. Force 14 – Professional Development – The clinic values and supports the personal and professional growth and development of its nursing staff. Because of the volunteer nature of the staff and the limited resources of the clinic we are not in a position to provide monetary incentive for certification and/or advanced degree education.

42. Magnet Forces (con’t) Resources Trofino, Joan, (May, June, July 2007), Magnet recognition: The nobel prize for nursing practice. Nevada Rnformation, 23-25 downloaded from http://www.nvnurses.org on July 18, 2010.