Professional Pediatric Home Care

1. Professional Pediatric Home Care General Nursing Orientation Lourdes G. Wiley, MS, RN, NE-BC

2. Welcome! • We are so glad you are here!! 

3. Our Services • Private Duty Nursing • Physical, Occupational, and Speech therapies • Social work • Patient advocate • Over 800 patients served in the metro area

4. Mission and Vision • To provide consistent comprehensive care to the pediatric patients and their families who need assistance in caring for special needs children in the home setting. We believe in providing care with compassion and respect for the inherent dignity, worth, and uniqueness of each individual. Every child and every family is unique as are their needs

5. What makes home care unique? • Ability to deliver holistic, comprehensive, family-centered care. • One-on-one attention to one client • Focus is on WELLNESS and prevention of hospitalization

6. What to expect during orientation • In-office training-basic prep/ P&P • Meet and greet • Case-specific orientation-with every new case • Review skills • Research patient data/meds/diagnoses/procedures • Competency list • New skills require new competencies! • Ask lots of questions!!!

7. What to bring to work • Clean scrubs or professional, comfortable attire • Closed-toed shoes • Stethoscope • A positive, professional attitude and smile • Night nurses- laptop/tablet/things to read

8. What NOT to bring to work… • Your own pets or children- NEVER! • Fragrance • Sick germs • A negative attitude or frown • Inappropriate or revealing attire • Gifts or supplies Be professional at all times!!

9. Our Nursing Team • Lourdes Wiley, MS, RN- Director of Nursing • Nurse Case Supervisors: • Emily Dold, RN • Joline Lowe, RN, CCM • Dori McDougal, RN • In-home Case Managers • Home Care RNs

10. Therapy and Administrative PPHC Staff • Ann Martin, BSN, RN- Administrator • Jennifer Rahrer- Client Services Manager • Patty Orlowski-Therapy Coordinator • Lauren Cino, RN- Intake Coordinator • Victoria Manley- Medical Records Specialist • Krista Drew- Medical Office Assistant

11. Therapy and Administrative PPHC Staff • Chris Wood- Business Development • Chelsea Preiss- HR/Benefits/Payroll • Lisa Ramsey, LCSW- social worker

12. Role of the Home Care Nurse • Comprehensive, holistic care of assigned patient • Participation in plan of care and coordination of care • Provide patients with excellent clinical care in collaboration with interdisciplinary team and family • Monitor and report change in status

13. Professional Boundaries • Define?? • Why is it a challenge? • Why is the nurse primarily responsible for maintaining boundaries? • Legality • Ethics • Prevention of burnout

14. Scope of Practice • Nurse Practice Act • Training and competency • Job Description • Policies and Procedures • Standard of Practice

15. Confidentiality/HIPAA • Questions on Confidentiality Policy? • Patient-sensitive/identifying data • Social networking • Mobile devices • It’s a small world, be careful!! • Keep yourself current and informed! http://www.hhs.gov/ocr/privacy/hipaa/understanding/

16. Conflict of Interest • What is it? • Why avoid it?

17. Fraud, Waste, and Abuse • Questions on policy? • Don’t falsify anything! • Obligation to report witnessed cases • Remember it is a crime!- most of our funds come from state and federal sources

18. Reporting Suspected Abuse or Neglect • What is abuse and neglect? • Who is vulnerable? • Mandated reporters- we are here to support you! • Reporting process • Corresponding county CPS hotline • Administrator/Director may report to state • In an emergency, call 911!!

19. Emergencies For medical emergencies, perform BLS and call 911 !! Families have packets/plans for natural disaster/emergency preparedness In-home emergencies, call 911 Notify supervisors when patient is stable and EMS has arrived Nurse must report off after hospital assumes care

20. Emergency Equipment • Emergency To-go bag • Emergency equipment check list • Specific to patient needs and equipment • Make sure ALL key essentials are functional when you begin your shift- test equipment • ABCs.. • Respiratory Equipment • CPR mask/ambu bag/trach adapter- think and check list!

21. Adverse Event • What is it? • What do you do? • Why do we track them? • Injuries • Medication Errors • Incidents resulting in hospitalization

22. Infections Report to case manager/case supervisor Tracking and reporting Tracking form submitted by case manager

23. After Hours Accessibility Lourdes Wiley, DON- cell number 720-226-4203 On-call nurse- call 303-759-1342 and select prompt for “on call nurse” Please limit after-hours calls to clinically urgent matters-not appropriate for scheduling issues

24. Overtime Approval Policy • Overtime must be approved by DON before it is worked • Reserved for family needs/coverage • Overtime is: • Anything beyond 12 hours in a shift • Anything beyond 40 hours in a work week, Sun-Sat • Approval Form

25. Questions?? Stretch Break!!

26. Clinical Nursing Policies and Procedures

27. Pediatric Nursing Assessment Head-to-toe assessment with vital signs at beginning of shift and as needed or indicated by plan of treatment Focused assessments and vital signs as needed and ordered Check email for resources on pediatric assessment review

28. Pointers for Assessment Success Approach child in a developmentally-appropriate manner Go from least invasive to most invasive always Don’t offer choices where there are none Developing trusting, non-threatening environment Know baseline and normal for your patient!!

29. Pointers for Assessment Success Provide privacy as appropriate Incorporate fun, games, and play as appropriate Start with the easiest things first. Count respiratory and heart rates while the child is quiet. Getting your temperature taken may be a frightening thing for a child. Don’t forget pain is a vital sign!

30. Pointers for Assessment Success Getting your blood pressure taken may be a painful thing for a child…that cuff may be awfully tight on a little arm! Describe this to the child as a hug around their arm or a ‘muscle-meter’ to see how strong they are!

31. Plan of Treatment and Orders You must have an order for every intervention/treatment and medication, including over the counter! Parents cannot relay or “give” orders Plan of treatment/485 Intermittent orders

32. Procedure for Obtaining Orders May be written and signed at MD visit May be transcribed onto order sheet from dispensed prescription if recent Telephone orders must be transcribed and signed by nurse receiving the order Mail one copy to the office/keep one copy in the chart Permanent changes/new orders become part of POT

33. Elements of Valid, Legal T.O. Refer to sample handout Include names of prescribing physician/RN taking order Medication, Dose, Route, Schedule, indication for administration if “as needed” Do NOT abbreviate!! Read back and document RBV x 1 (or more)

34. Medication Administration Policies You must read all policies and ask questions if anything is unclear- return acknowledgment form Should be located in home chart at all times for reference Follow 5 RIGHTS and you will RARELY go wrong!

35. 5 RIGTHS Right patient Right Drug Right Dose Right Route Right time/reason Verify labels against MAR/orders every time!! Verify new handwritten/transcribed MARs to orders!

36. Medication Administration Policies Read, read, read policies Not all meds are appropriate for home care Know potential adverse reactions- you monitor effects even if you don’t administer the med What to do when you do not administer the med

37. Medication Errors Some will happen- handle appropriately. Safety and accountability are what we ask! Ensure safety and stability of patient- missed doses are also errors Report to primary care or prescribing physician as well as family Report to supervisor/Adverse Event Report to DON

38. Infection Control • Handwashing!!! • Universal Standard Precautions Always! • What does this mean? • Special Precautions • Contact • Respiratory/droplet • Be aware of all policies!

39. Infection Control • Unsure about appropriate precautions or specific infections? • Centers for Disease Control website • www.cdc.gov • Call DON/Supervisor • Family practices and education

40. The Home Chart • What it looks like- demonstration • All documents remain in the home always • Case manager submits paperwork biweekly • Payroll and billing sheets • EMR is coming!!

41. Documentation Guidelines • Follow guidelines on handout- take with you your first few shifts • Entry every 2 hours minimum • Who did you get report from/leave child in care of? • Accurate time in/out-match billing • Sign both sides

42. Documentation Guidelines • Black ink only! • We will provide feedback as needed • Demonstrate need for skilled care and standards of practice • Refer to sample nurses note

43. Questions?? Stretch Break!!