NPSGs
All disciplines
What are the 2022 Homecare National Patient Safety Goals?
Identify patients correctly
Medication safety
Prevent infection
Prevent patients from falling
Identify patient safety risks for patients who are using oxygen
RN/PT/ST
What are High Alert Medications?
Policy Addendum 3-001.A: HAMP Policy (High Alert Medication Policy)
High Alert Medication Policies Apply in the Following Situations in Home Care:
All opiate/narcotic infusions including patient controlled analgesia (PCA)
All pediatric (age < 14 years) intravenous medications and infusions
All insulin injections using concentrations greater than 100 units/mL
Hand Hygiene: At the end of the 20 second required friction time, your hands are still wet...what do you do?
Continue friction/rubbing until your hands are completely dry
What are the characteristics of a SMART goal?
Which characteristic of the SMART should be reviewed and updated at every visit?
SMART goals are pt specific, measurable, achievable, realistic and time bound (needs to be a specific date).
(Time bound) The goal dates should be reviewed at every visit and updated as needed. Goal dates that are outdated shows surveyors that the care plan is not being reviewed and updated regularly.
All disciplines
Language assistance is a Joint Commission standard and CA Senate Bill 853: What is the difference between an interpreter and a translator? What type of _______ services are available per Kaiser Permanente policy?
Interpreter - interprets spoken or signed language
Translator - translates written language
Interpreter services available are as follows:
QBP - Qualified Bilingual Providers (may speak to patient in patient's own language but may NOT act as an interpreter for another staff member)
QBS - Qualified Bilingual Staff, level 1 or level 2
Language Line
Certified Sign Language Interpreter
(Source: Orientation Manual and User Guide)
All disciplines
NPSG: Identify patients correctly: What two patient identifiers may be used in a single family home?
What two patient identifiers may be used in a multiple patient setting?
The two primary identifiers are:
1. Patient name
2. Patient address
In any situation of continuing one-on-one care where the staff knows the patient, one of the identifiers can be direct facial recognition.
In the case where patient is located in multiple patient setting (Board and Care, ALF) staff will use the identifier of date of birth (DOB) instead of place of address.
RN/LVN/PT/OT/ST
What are the required elements of a complete medication order?
Patient name
Medication name (generic or brand)
Dose
Route
Frequency
Indication for use
Stop date, if appropriate/applicable
(Source: Policy Addendum 2-020.A)
True or False
A lab specimen bag, containing a patient's blood specimen, can be place in the clean side of the trunk?
False
A lab specimen bag that contains a patient's blood specimen needs to be placed in the biohazard bag in a designated area on the dirty side of the trunk.
RN/PT/OT/ST
Patient lives with another person in the home environment who uses oxygen. Patient does not use oxygen. Is an oxygen assessment necessary?
Yes, oxygen safety assessment is required if oxygen is present in the home, even if the patient is not using the oxygen.
Conduct a home oxygen safety risk assessment that addresses at least the following:
Whether there are smoking materials in the home
Whether there are other fire safety risks in the home, such as the potential for open flames
Whether or not the home has functioning smoke detectors
Then, inform the patient and family/caregiver of the findings of the safety risk assessment and educate the patient and family/caregiver about the causes of fire, precautions that can prevent fire-related injuries, and recommendations to address the specific identified risk.
(Specify education using the HH/HO guide to oxygen safety and pt/caregiver response to instruction. Include specific instruction provided, not page numbers used. Guides/pages numbers can be updated/changed.)
(Source: Policy 2-041 and User Guide)
All disciplines
What must be documented when using interpreter services?
Language Line: Interpreter ID# and the company name
Certified Interpreter: NUID for Qualified Bilingual Staff (QBS) and the QBS level.
(Source: User Guide)
All disciplines
NPSG: Prevent infection: What guidelines does Kaiser Permanente follow in regards to hand hygiene and what are the "5 moments of hand hygiene?"
The WHO (World Health Organization)
a) Before touching a patient (to initiate patient care)
b) Before clean/aseptic procedures
c) After body fluid exposure/risk
d) After touching a patient (completing patient care)
e) After touching patient surroundings
RN/LVN/PT/OT/ST
Is this medication order correct?
Acetaminophen 325mg
Take 2 - 3 tablets by mouth every 8 hours as needed
What's missing?
Indication
When to take 2 tablets vs 3 tablets
Max dose of all sources of Tylenol in 24 hour period
(Source: Policy 3-002)
Acetaminophen 325 mg
Take 2 tablets by mouth every 8 hours as needed for mild headache.
Take 3 tablets by mouth every 8 hours as needed for moderate to severe headache.
Do not exceed more than 3000 mg of Acetaminophen in 24 hours from all sources
Describe the sequence of 'donning' (or putting on) PPE when visit a patient
Gown, mask or respirator, eye protection, and then gloves
All disciplines
Whose responsibility is it to monitor oxygen safety compliance?
Every discipline has a responsibility to observe for oxygen safety non-adherence (ie: missing oxygen placard, smoking with oxygen on, unsafe storage of oxygen, using gas stove with oxygen on, candles in the home, etc.)
All disciplines: communicate concerns with team
MSW/HHA/RD: Report to Clinical Supervisor and Case Manager
SN and Rehab: Re-assess and re-educate as appropriate; involve physician/Clinical Supervisor/DME provider as appropriate; complete eRRF as appropriate
All disciplines
May family members act as interpreters for patients? If yes, what is the process?
-Kaiser policy discourages the use of family and friends as an interpreter.
-Document that interpreter services were offered at no charge.
-If, due to a language barrier, the patient is not able to communicate to you his/her preference to use a relative or friend to interpret, use an interpreter service to determine the patient's preference. This ensures that the preference is being made by the patient and not by the relative/friend.
-If the patient chooses to use a family member or friend as an interpreter, issues of competency of interpretation, confidentiality, privacy, and conflict of interest will be considered.
-Ensure the family member or friend identified agrees to be present for home visits.
-Document the full name and relationship of the family member or friend interpreting.
-Minors (under 18) will not be used to interpret, in order to ensure confidentiality of information and accurate communication.
(Source: Policy 1-013 and User Guide)
All disciplines
What is best practice for medication reconciliation to be done?
At SOC, Recertification and at least weekly as best practice
If a patient has a more than 1 medication with the same indication, what is required in the sig?
The sig needs to include in which order each medication be taken.
for example: Norco 3/325mg Take 1 tab by mouth every 6 hours as needed for moderate pain.
Morphine 15mg Take 1 tablet by mouth every 6 hours as needed for moderate -severe pain if not relieved by Norco.
In addition to the 5 moments for hand hygiene, what patient care activity would also require hand hygiene?
Hand hygiene is also required in between glove changes (before putting gloves on and after taking gloves off).
All disciplines
What is required when documenting coordination with others?
The person's or people's name involved in the communication (including family/caregivers), the way the communication occurred, and a brief review of what was coordinated (significant clinical findings, changes in the patient's condition, new orders, etc.)
Names must include, at a minimum, 1st initial, last name, and title.
(Source: User Guide)
RN/LVN/PT/PTA/OT/ST
How often is pain assessed and what is included in the pain assessment?
At EVERY visit: pain when worst AND Current medication/doses in the last 24 hours
Complete full pain assessment for each pain site if patient has had any pain or required an intervention/pain medication "in past 24 hours."
Full pain assessment includes:
intensity best/worst (and identify scale used)
location
other pain factors (radiation, quality, onset, frequency, duration, precipitating/aggravating/alleviating factors)
(Source: Policy 2-012 and User Guide)
All disciplines
What type of falls does Joint Commission consider a Sentinel Event?
A witnessed falls with Major Injury
a. What is a considered a major injury?
Falls resulting in any fracture, surgery, casting or traction, subdural or intracranial hemorrhage or injury (rib fx, small liver laceration), a pt on coagulopathy needed blood products or death
b. What is considered a 'witnessed fall'?
A witnessed fall when there is a HH/HO field clinician is in the home at the time of the fall.
RN
In regards to High Alert medications, what is the difference between verbal read-back and double-check?
A Verbal Read-Back of medication orders occurs between the nurse and a pharmacist and must be performed for every new or changed order for a High Alert Medication prior to medication administration. (This includes at SOC or the first time HH or HO sees the patient with a high alert med.)
Double check is a procedure in which the nurse and an appropriate patient, family member, or caregiver confirm that a medication is being administered in accordance with the medication order. This must be performed immediately prior to every administration of a High Alert medication, including cassette and infusion bag changes.
(Source Policy Addendum 3-001.A)
What should be done with the re-usable equipment immediately after patient care?
What should be done with re-usable equipment after it's been cleaned/disinfected?
Immediately after patient care, the re-usable equipment must to go onto a dirty barrier.
After cleaning/disinfecting re-usable equipment, it must be placed onto a clean barrier to allow for the wet time per manufacturer guidelines prior to putting the equipment back into the clinical bag.
All disciplines
How is the plan of care and visit plan communicated with the patient/caregiver(s)? Whose responsibility is it to inform the patient/caregiver? And, how is this documented?
Patients/caregivers are informed of the plan of care when each discipline initiates care, using the My Care Plan Form. This can be updated as needed throughout the plan of care.
Patient/caregivers are informed of the visit plan in several ways. At SOC/Eval, the POC is discussed with patient/caregiver, including frequency and duration.
The calendar left in the patient's home is updated by each clinician throughout the POC to reflect the visit plan; this includes involving the patient/caregiver(s).
In addition, at each visit, the next visit plan, including day or day range, is discussed with patient/caregiver(s) and documented in the care plan under the "next visit plan."
MSW/RD/HHA
If the patient/caregiver identifies new pain or pain above pain goal, what is your responsibility?
Notify patient's case manager directly or RN in the office by the end of the visit
(Source: User Guide)