Home Care Nursing Education

Drain Care

100

• What securement devices will you use to secure any drain tubes?

• Multipore Dry Surgical Tape
• Grip-Lok
• Stat Lock

200

 How often does a Nephrostomy tube need to be changed?

•  Usually a Radiology follow-up appointment is schedule every 4-6 weeks to change the catheter.

300

When do you need to alert a physician or Nurse Practitioner about concerns with a nephrostomy tube?

• ongoing leakage from insertion site
• ongoing bleeding/clots
• increased urine sediment (gravel or stones)
• decreased urine output
• elevated temperature greater than 37.8°C or aches, chills
• nephrostomy tube has been accidentally dislodged

400

 Will you irrigate Biliary Drainage Catheters with the tip located in the liver?

A: No.  Because liver is a solid organ and there is a risk of liver trauma. Consult with CRN regarding irrigation biliary drainage catheters with tip location not in the liver.

500

 You receive a doctor’s order to remove an abscess drain in the community. What will you do?

A: Contact with physician and let physician know according to HH policy: Physician will insert and remove abscess drains. HCNs don’t remove drains for abscesses in the community

DOT

100

True or False

Delegation of Task is the last resource.

A: True. Always explore alternates before doing a DOT.

200

Why can we not delegate PRN medication? What will we do if client has PRN medication?

• CHWs can’t make any assessment or judgements regarding if client requires a PRN medication
• Request GP to switch PRN medication to regular medication or let client/family/caregiver to manage PRN medication

300

How often do you need to do the DOT review?

• Non-medication DOTs: initially more frequently to ensure stability, then every 6 months. For example: compression stocking DOT
• Medication with IMMP: Q 6 month. For example: a blisterpacked med DOT with medication that haven’t changed can be evaluated every 6 months
• Medications without IMMP: Q 3 month or more often. For example: a medicated cream for rash should be evaluated within 2 weeks to ensure the effectiveness of the treatment.

400

 What document do you need for a non-IMMP DOT?

• Decision to Delegate: Assessment Tool
• DOT procedure- (copy to HS educator)
• DOT monitoring/evaluation Tool

500

 When you initiate, update or discontinue DOT, what do you update in Paris?

 You need to revise HSSP, under DOT section, insert a row and put below information

• Type of DOT
• Schedule
• Client’s specific instruction
• Backup plan

Documentation

100

 When you visit client today, client’s daughter told you that she is no longer the client’s emergency contact. Client’s son will be the emergency contact in the future. What will you do with this information?

• Update in Paris under Central Index,
• Notify the other team member who involve in client’s care
•  Print out the new Facesheet.

200

 When will the “Site of Service Tool” be used?

• At the point of referral to HH services by HHSL, HHL and QRP
• Used by HHPs if HHSL are unable to determine best site of initial visit
• At initial visit and on subsequent visit to evaluate changes in status of site of service

300

 Who is accountable to process doctor’s order?

RNs to ensure that orders are to be within the scope of HCN practice prior to acceptance and implementation of the directive. RNs to transcribe doctor’s order to green sheet.

LPN to consult with clinicians or RNs before accept and implement doctor's order.

400

What tool do you use to communicate with other health professionals?

SBAR communication tool to support successful communication.

500

When can a verbal/telephone order be accepted?

• Verbal/telephone orders are only permitted when clients’ care will be compromised without the order and when prescriber is not available through any other means within the time frame needed.
• Verbal/telephone orders must be documented on authorized health professional order forms, and signature from the prescribing health professional is obtained by fax or mail

HSSP

100

True or False: There must be an active HH referral (internal/external) and HS referral (must pass to HS team) before you initiate HSSP

True

200

What information do you need to put in the "Additional Details" in Schedule of HSSP?

Additional details is a mandatory field that we put a breakdown of hours (ie. 1 hour am and 30 mins HS)

300

How do you end the HS service?

In the HSSP revise mode; insert a service start date and end date (start date and end date need to be the same day), enter an approval of hours; then accept change and save. Notify HS intake. HSSP status will change from “ACTIVE” to “COMPLETE” at midnight on that day.

You can discharge the client next day.

400

What does each order status (draft, submit and active) mean in HSSP?

• Draft: order details are saved after the initial creation of the form without fully completing the mandatory fields, can be edited freely, client will not receive service.
• Submitted: Bottom of HSSP click “Finalize and submit order” and save. HSSP needs to be in revision mode in order to edit
• Active: Confirm HSSP and passed to HS by click “Notify HS intake”. Client will receive services as authorized.

500

What information can be importing from a previous HSSP into the new HSSP?

"Task" and "Delegation of Task" details can be imported. All HSSPs have a unique HSSP IN Number-you must note this number prior to importing the tasks into the new HSSP to ensure you are importing the correct details.

Education Resources

100

What is CLWK?

 Connecting Learners with Knowledge (CLWK) website of providing wound educational resources to nurses across the province of British Columbia.

200

What resources can I find on the CLWK site?

• Product information sheets
• Skin health and Pressure Injury prevention Resources
• Wound and Ostomy resources
• Continence resources
• Modules and Videos

300

Where can I find the skill describing how to apply an abdominal binder to support the muscles underlying large abdominal incisions?

under clinical Skills

400

What can I find in Patient education catalogue?

In this online catalogue, you can find health education information in many languages and links to reliable health information on external websites.

500

What are Home health Decision support tools and where can we find them ?

Clinical Decision Support tools are reference resources designed to support clinical decision-making. Health care professionals utilize these tools to quickly lookup information concerning diagnostic and treatment guidance at the point-of-care with a patient such as policies, care plans, care standards, and related resources to support evidence based care to patients/residents/clients.

Give an example of a DST ? -  Skin and Wound - Wound Bed Preparation for Healable and Non-Healable Wounds in Adults and Children - Guideline

Specialized Community Service Programs for the complex medically Frail

HH policies

100

Client is 64 years old with a disability receiving Daily wound care 

What Supply policy can we use for supply coverage?

Ministry of Social Development and social Innovation (MOH process)

Client has to be eligible and known to  the MOH prior sending in the requests for supply coverage.

200

• Client is admitted to Home health receiving wound care, when do you review the Supply Policy with the client? 
• What do you review with client in regard to the Supply policy?

On admission.

• Review the pamphlet : Working Together for Health
• Supplies are provided for the first 2 weeks of treatment after establish the treatment plan
• You need to purchase your supplies after the 14 days
• We provide a list of medical supply stores
• Review the contract : Important information for clients receiving care in BHH (sign )

300

Who is responsible to follow up with the Supply policy?

Any HCNs on the next client scheduled visit and document the plan in Pixalere and on worksheet

400

 What is PLAN P and what supplies are covered under plan P ?

PLAN P ; clients on the BC Palliative Benefit program 

 Clients exempted from this policy are clients on the BC Palliative Benefits Program (PBP). They will receive all required medical and dressing supplies as entitled to them by the PBP at no cost. Home Care Nurses (HCN) will supply these items from Home Health supplies as available. The provision of specialized items required by clients eligible for Palliative Benefits Program, which are not routinely available from home care nursing supplies, requires consultation with the Hospice/Palliative Care CRN or the WCC.

500

• What is the Braden scale and skin assessment schedule in the community ?

• On Admission Braden Risk & Skin Assessment Schedule For all clients
• Ongoing Assessments Braden Risk & Skin Assessment Schedule For adults with Braden score 18 or less (at risk to very high risk) at every visit within the first 3 weeks, then transition to quarterly (every 3 months)
• Ongoing Skin Assessment Schedule For adults with a Braden score 19 or greater: quarterly(every 3 months) 
•  When client condition has deteriorated/changed, and client has been hospitalized, complete Braden risk and skin assessment.

Pixalere 1

100

PIXALERE Wound HISTORY –what do we document in the wound history?

the Cause of the wound and when the wound occurred and what was done for the wound

200

• PIXALERE Health Care Providers – What do we document in this field?
•  

• First and last name of health care providers such as GP, vascular surgeon, Phone  and Fax number

300

• Where do we document recent Blood sugar levels and /or any other diagnostic tests?

400

• Where do we document Monofilament test results and when and why should we complete the monofilament test on our clients?

• In the Advanced lower limb assessment  
• To be completed for all clients with diabetes ,PVD and/or impaired blood flow
• A monofilament test is done to test for nerve damage (peripheral neuropathy), which may be caused by conditions such as diabetes. Risk is loss of protective sensation

500

"A GENERATED System referral IS ACTIVATED Based On the information you have entered in Pixalere in regards to the wound measurements"

Q : What does this mean and what action is required from you?

• This is an alert to let you know that the client care needs to be reviewed
• Actions: Respond to this alert by adding a detailed progress note on why the wound is not progressing /healing and review the client, wound profile to ensure the underlying cause is addressed and goal of care is achievable

Pixalere 2

100

• What are the WCC referral criteria? 

1. All referrals to the WCC should have a clinical question or concern identified within the referral.

2. The WCC should be called for any issues requiring a response within the 3 working days for a Level 1 referral

3. FYI is an update for the WCC and does not require a response. 

4. All Clients with complex wounds will be referred upon admission to the HH program for the following issues: Complex wound care such as compression therapy, open cavity surgical wounds, and diabetic foot ulcers. Clients with questionable circulation.  

5. Client with a Braden scale below 15

6. Wound deterioration, percentage of healing is reversing or measures of the wound are increasing.

7. Client with 2 or more pressure injuries located 2 or more bony prominences.

8. Referral request for VAC therapy , CSWD, Toe/Brachial Pressures

9. Client who is admitted to program with a wound older than 3 months or is expected to be on care for longer that one month. 

10. Client whose wound has failed to progress towards healing. (< 30% closure in 21 days)

11. Nursing care plans which have changed twice without improvements in percentage of healing time

200

When do we update the start and Review date on the treatment plan?

 Each time you change the treatment plan /products (Review date is Q 2 weeks)

• Wound Treatment Plan
  DATE STARTED: April 26, 2023
  REVIEW DATE: May 10, 2023
  PERI-WOUND:
  DRESSING APPLICATION:

300

Where do we need to document Antibiotics (po/iv) in Pixalere?

400

Where do you document the plan and follow up plan in regard to the supply policy?

:   Pixalere (nursing care plan) and Worksheet in chart

HH SUPPLY POLICY DISCUSSED: (DATE)
HH WILL PROVIDE: (DATE)
CLIENT WILL PROVIDE: (DATE)
SBAR: (DATE)
THIRD PARTY FUNDING: (DATE)

500

Post your wound care client visit, you discuss with WCC to change the antimicrobial dressing to Acticoat to be apply on the next visit. Where are you going to document this information?

A. Wound care treatment plan

B. Progress Note

Answer: B

Wound care treatment Plan needs to reflect what you did on your visit.