Medication Management
How often should a med rec be done?
Every visit
When should you use a gait belt?
Any time you transfer or ambulate with a patient.
What must be completed on the emergency preparedness plan?
Everything!
How often must wounds be measured?
Weekly! This should include wound type, location, size (LxWxD) and type of drainage.
Wound supplies can not be ordered without this information.
When should a NOMNC be given to a patient?
A minimum of 48 hours prior to agency discharge.
What are the 6 steps for medication reconciliation?
1.) Compare all medication bottles to written medication list and EMR
2.) Document any discrepancies you find
3.) Contact the physician regarding the discrepancies (Must document the 2 way communication)
4.) Communicate the physicians instructions to the patient
5.) Document these steps
6.) Also, must report severe and moderate medication interactions to the physician
How should we communicate visits with patient and staff?
Fill in the patient calendar in the home and call the patient the night before to schedule the visit.
How do you communicate with the physician regarding your plan of care?
1.) If the physician is an EPIC doctor send case communication using the correct WEMI template. (We ONLY send case communication to the ATTENDING physician)
2.) If the physician is not an EPIC doctor, call the physician to give SOC report the same day the SOC is completed.
** You may call on Monday if the SOC is completed on the weekend unless it is an urgent matter
If you are unable to follow through with the plan of care (example: unable to obtain weight for a CHF patient, unable to drawn labs, unable to complete wound care) what should you do?
1.) Document why it was not completed
2.) Notify the physician that it was not completed and document this phone call
What is THAH's policy on supervisory visits for HHA's, LPNs and therapy assistants?
A supervisory visit must be completed every visit by every discipline.
What part of wound care orders must be included on the medication list?
1.) What we are using to cleanse the wound (not soap and water)
2.) Any prescription/over the counter topical
3.) Wound flushes if being used
What PPE is required to be in your bag at all times?
1.) Gloves
2.) Procedure mask
3.) N-95 mask
4.) Goggles/shield
5.) Gown
Where must all secondary disciplines list their frequency in the purple book?
Page 38-39 in the box that corresponds to your discipline
If you are recommending using ice or heat to your patient, what must you do?
1.) Obtain an order from the physician
2.) Add it to the pain care plan template. It must contain:
Type of modality, how many layers of protection, length of time to apply it, how often to use modality
Example: Apply ice over 2 protective layers for 15 minutes 3 times daily.
When you go to discharge your patient you look at the NOMNC and discover the discharge date was listed as yesterday. What do you do?
Have the patient sign a new electronic NOMNC with the correct discharge date.
What information must be included with a PRN medication order?
1.) Instructions regarding how and when to take the PRN medication
2.) If you have 2 medications for the same condition they must have different parameters for when to use them. Example: 2 pain medications, one if for moderate pain the other is for severe pain
What should you assess in the home if the patient is on oxygen?
1.) Patient has a no smoking sign up - If patient refuses sign document this refusal
2.) Oxygen tanks are stored securely
3.) Assess for open flame potential and smoking material
4.) Assess for smoke detectors
What must be left in the home on SOC?
1.) A completed admission book
2.) A completed calendar
3.) An accurate written medication list
What type of medications should have an end date?
1.) Antibiotics
2.) IV medications
3.) Opioids
4.) Steroids
Which disciplines need to complete heart sounds, lung sounds and bowel sounds at SOC?
All SOC Clinicians!!
Bonus: Therapists need to complete these at every visit for therapy only patients OR if there has been a change in one of these systems.
Who should do a med rec?
Every discipline except HHA and MSW
When must you sanitize your hands?
1.) Before direct contact with patients
2.) Before/after direct patient are
3.) If hands will be moving from a contaminated body site to a clean body site during patient care
4.) Before and after cleaning equipment
5.) Before and after each procedure
6.) Before and after collecting a specimen
7.) When hands are visibly soiled
8.) After any contact with contaminated materials
9.) Before entering a zipped compartment in bag
10.) After contact with inanimate objects - tablet, med bottles
Which pages must be filled out in the SOC book at the time of SOC?
1.) Page 4 - list manager with agency phone number and case manager (all secondary disciplines must make sure your name is listed on eval)
2.) Page 17 - Mark filing a complaint section
3.) Page 37 - Emergency preparedness plan
4.) Page 38-39 - Mark what applies to your patient
5.) Page 40-41 - Mark the boxes for all the ordered disciplines (secondary disciplines must add your frequency)
When you arrive at your patients home you find that they do not have all of their wound care supplies. What should you do?
Call the physician and request a change in orders for today's visit.
What needs to be included in your documentation for all interventions (therapeutic exercises, wound care, blood draws, ADL education)?