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August 31, 2012

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DIDD Team,

Below, are various items I would like to share:

  • Commissioner’s Loaned Executive Program: As a department, we will face crucial decisions in the coming months. How we reach these decisions largely depends on input outside of our organization. Currently, we are in the planning stages of developing a shadowing project where willing provider CEOs would volunteer their time and spend three consecutive days in our downtown Central Office. This will entail participating in discussions with me and other executive staff on issues concerning policy, budget, the HCBS Waiver, DIDD initiatives, and other key areas as voiced by participating CEOs. Further details and dates will be forthcoming. If any provider executive is interested, please contact Missy Marshall at Missy.Marshall@tn.gov to submit your name for consideration.


  • Medication Safety and Electronic Prescriptions:  Dr. Cheetham has provided me with the following clarification about the requirement for providers to have written prescriptions.

    An important element to ensure people we support receive medications safely is verifying the Medication Administration Record (MAR), the medication label and the prescriber’s order all are the same.  Rapid introduction of electronic prescriptions (escripts) that have replaced a written prescription, has created challenges for providers to have a copy of the written prescription as specified in the Medication Administration for Unlicensed Personnel curriculum, ‘the green book’.  This issue will be addressed with the new curriculum and rules.  However, in the interim any of the following are acceptable documentation:

    • A signed copy of the written prescription.
    • An agency’s document of a visit which includes the medication ordered (drug name, dose, route, times and duration) and signed by the physician/prescriber.
    • A copy of the prescriber’s office copy of the faxed or electronic prescription.
    • A copy of the pharmacy faxed or electronic script (a copy of the escript could be requested from the pharmacy).

    Physician/prescriber orders should be questioned if not clear or legible to ensure people receive their medications safely.  Also, if the medication has an unusual appearance or is different from usual, it should be questioned.

  • Sunscreen:  As you know, medications/drugs require a physician or other prescriber’s order, and must be administered by a nurse or someone who has Medication Administration for Unlicensed Personnel certification.  Dr. Cheetham advised me that according to the Federal Drug Administration (FDA) definition, sunscreen should no longer be considered a drug.
    Therefore, in concurrence with Dr. Dreyzehner, Commissioner of Health, effective immediately DIDD will allow application of sunscreen without a physician’s order, and application of sunscreen in accordance with the directions on the label no longer requires certification in Medication Administration for Unlicensed Personnel.  As with any treatment, there must be consent.  Also, if the purpose of the product is more than sunscreen (for example, if insect repellent is combined with the sunscreen), it would be considered a drug and the usual requirements would apply.  This change is consistent with DIDD’s focus on health promotion.

  • Learning About CQLs Personal Outcome Measures (POM):  DIDD’s first step in the accreditation process involves learning about the people we support.  The tool used to learn about people and their lives is called Personal Outcome Measures.  We need to understand the outcomes and learn how to support people with having these present in their lives.  For the Personal Outcome, People Are Treated Freely, we should:

    • Provide people with access to a fair and impartial hearing of grievances and an independent review of limitations to personal freedoms.
    • Provide people with training and support so that limitations are reversed and removed.
    • Review and change policy and practices that limit or restrict people.

    Each week, we will endeavor to provide more education about accreditation to the entire DIDD team.

  • Regional Accreditation Teams:  I am pleased to introduce the following members:

East: Kelly Bradley-Owens, Amber Perry, Dana Scott
Middle: Jennifer Aldrich, Derrell Lankford, Tony Pena
West: Allison Adkison, Kimerly Brown, Tina Taylor

  • Updated Crisis Information Sheet:  The Crisis Information Sheet was distributed in last week’s edition.  A revised Crisis Information Sheet is now available.  Please discard the previous copy and replace with the newer version (see attached).  The revisions include some changes to the template to allow for easier use when entering information.  The Crisis Information Sheet is a resource intended to assist agencies in providing critical information to first responders when they arrive to the scene for situations involving a person served by DIDD.  It contains critical information that law enforcement noted was especially important to receive upon their arrival.  The Crisis Information Sheet is being offered to agencies to use voluntarily and is not required.  Please contact Dr. Rebekah A. Thomas, Director of Protection from Harm, at Rebekah.A.Thomas@tn.gov  if you have any questions.


  • Requirement for Independent Audit Program:  Agencies having provider agreements with DIDD and receiving $500,000 or more in aggregate state and federal funds under the agreement are required by the terms of the agreement to have an annual independent audit of their financial statements.  The audit is to be conducted “in accordance with the requirements of the Tennessee Comptroller of the Treasury.”  The Comptroller has prescribed a uniform audit contract for DIDD agencies that are required to have an audit.  The Comptroller’s office reminds us that agencies are required to use the web-based application known as the Contract and Report System (CARS) for executing the contract to audit accounts.
    An agency must engage a CPA to audit financial statements by the end of each agency fiscal period so as to have an annual audit completed in a timely manner (six months after the close of the fiscal period).
    Your Fiscal Accountability Review (FAR) team reminds you that a current audit is one that has a fiscal year ending during the period covered by the FAR review.  Also of note: the audit is to be conducted in accordance with Government Auditing Standards (also known as the YELLOW BOOK).  If there are questions about the Comptroller’s requirements, your email contact at the Comptroller’s Office is Iris Haby at Iris.Haby@cot.tn.gov.

  • An Ounce of Prevention:  For this issue, we are shifting focus from a provider community responsibility to one which applies to DIDD employees.  All DIDD staff who access the State’s information network are required to follow the State’s Acceptable Use Policy regarding Network Access Rights and Obligations.  This policy covers several arenas including state-owned hardware, software, internet, and email usage.

    The State of Tennessee actively monitors network services and resources and users have no expectation of privacy.  Users who have internet access are specifically prohibited from using the internet to access non-State provided web email services (for example, using state equipment or resources to access a private Yahoo or Gmail account).  One of the reasons for this prohibition is that computer viruses often use this type of activity to gain access to the state network.

  • Ovarian Cancer Walk:  MillarRich is sponsoring a one-mile walk on September 26 in honor of Elaine, who recently passed away from the disease.  Elaine received services from MillarRich and was very special to their entire team.  This event is open to everyone.  Please see attached flyer for additional details.


  • Developmental Disabilities Planning and Policy Council (DDPPC):  DIDD is pleased to announce the recent appointment of Ms. Tonya Bowman to the Developmental Disabilities Planning and Policy Council as an advocate for children with an intellectual and/or developmental disability.  Ms. Bowman is currently working in the field of intellectual and developmental disabilities, serving as a Family Resource Specialist for Family Voices of Tennessee.  In this capacity, she assists families who have a loved one with a disability.  She is also the mother of a daughter with multiple disabilities.  Ms. Bowman has an undergraduate degree from Murray State University of Kentucky and a joint graduate degree from TSU/MTSU.

    The DDPPC welcomes Tonya as a valuable member and we are all looking forward to working with her.

  • Commissioner’s Luncheon:  This month’s luncheon was held with persons served and staff from Emory Valley Center.  Each person received a signed photograph of Governor Haslam and a DIDD pin.  Jennifer Enderson, President of Emory Valley Center, noted that everyone had a great time and enjoyed meeting DIDD staff.  Ms. Enderson expressed, “I kept asking if everyone was having a good time and they always responded with a huge smile and ‘yes’.”  We really enjoyed Emory Valley’s visit and special thanks to them for taking time out of their day to spend with us.

  • Nashville Focus Group:  A reminder that the dance sponsored by the Nashville Focus Group will be held at One Cannon Way at Clover Bottom Developmental Center on Friday, September 7th from 11 a.m-2 p.m.  All are welcome.  There is no admission charge and snacks will be provided.