NPSGs
What are the Homecare NPSGs? (5 goals)
Identify patients correctly
Use medicines safely
Prevent infection
Prevent patients from falling
Identify patient safety risks for patients who are using oxygen
(Source: The Joint Commission)
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)
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.
(Source: Policy 2-041 and User Guide)
PT/OT
What modalities of care may be provided without a physician's order?
Simple answer - NONE
All modalities require a physician's order (ie u/s, cpm, e-stim, ice/heat therapy, ther ex, tens, kinesiotaping, etc.)
All DISCIPLINES
What are you most proud of in your agency?
Open Discussion
Daily Double
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.
(Source: Policy Addendum 2-007.A)
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
All disciplines
Whose responsibility is it to monitor oxygen safety compliance?
Every discipline has a responsibility to observe for oxygen safety non-adherence (ie smoking with oxygen on, unsafe storage of oxygen, using gas stove with oxygen on, open flames 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 as appropriate; complete eRRF as appropriate
All disciplines
What is the policy for documenting missed visits? What is the process when the HHA has a missed visit?
Policy 2-018: The physician must be notified if a scheduled visit is not completed. The reason for the missed visit and notification of the physician must be documented in the medical record.
HHA missed visit - HHA must coordinate to Case Manager and/or HomeCare Team. Physician notification may vary slightly by agency.
RN
For patients receiving infusion therapy, how often are IV assessments completed
IV site must be observed/assessed and documented at each nursing visit. Document assessment in Infusion Assessment
Is it a Joint Commission standard to test smoke detectors in the home?
Home care staff may ask the patient and family whether smoke detectors are functioning or may test the smoke detectors if they are accessible. However, testing smoke detector5s is not required by Joint Commission standards.
RN/PT/OT/ST
When must a complete drug regimen review be completed?
A complete drug regimen must be completed at
SOC
Recert
ROC
When updates to the comprehensive assessment are made
(Source: Policy 3-002)
Oxygen order is for 2 liters via nasal cannula as needed for shortness of breath.
During home visit, clinician notes patient is using 3 liters via nasal cannula continuously.
What would be your next steps?
Assessment - why is patient using different dose and continuously
Contact physician for reconciliation of oxygen orders
Education patient regarding physician orders for oxygen therapy. Use teach-back to confirm understanding.
Document assessment findings, coordination with physician, education provided, and patient's level of understanding.
DAILY DOUBLE!!!
RN/PT/OT/ST/MSW/RD
You have received a referral to see a patient for an eval.
After you have completed your evaluation, you determine you need to see the patient for further visits, and the patient/caregiver(s) agree.
What are your next steps?
Communicate with physician, report findings, and obtain physician orders for plan of care.
In addition, communicate/coordinate with rest of HH team regarding your findings and your plan of care.
DOCUMENT all the coordination completed
RN/LVN
What is the policy for when wounds are to be measured, ie at what time points and what frequency?
Wounds are to be measured at the following time points:
SOC
Recert
ROC
New wound
Change in wound
Weekly
(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
(Source: The WHO)
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
Patient lives in a small home and does not want to store the extra portable oxygen tanks inside the home. Patient wants all extra portable oxygen tanks to be stored in the garage. What instruction would you provide to the patient?
Open Discussion
max temp is 140 degrees F
must have ventilation
clearance around oxygen
think about what else is in the garage...ie hot water heater with flame, etc.
RN/LVN/PT/OT/ST/RD/MSW
A staff message has been sent to a physician requesting orders. When can these orders be acted upon?
open discussion
RN/LVN
How is wound care completed documented in the careplan?
What if there are options in the active order (ex: use NS or Wound Cleanser)?
SN PERFORMED WOUND (ENTER NUMBER) DRESSING CHANGE PER ACTIVE MD ORDER DATED (ENTER DATE OF MD ORDER).
IF there are options - must specify which option was used
Also document how patient tolerated dressing change, any education provided, etc.
All disciplines
What do you do if a surveyor asks you a question and you don't know the answer?
FREAK OUT!!!!!.....NOT!!!!!
Breathe. It is better to kindly let the surveyor know you will provide the answer shortly rather than guess. Use your Joint Commission Prep Guide (coming soon) as a resource. If additional assistance is needed, contact your supervisor.
RN
In regard 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 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 is the max dose of a high flow oxygen concentrator?
What three special considerations are there for a high flow concentrator?
High flow oxygen concentrators can deliver up to 10 liters/minute of oxygen
Special considerations for high flow concentrator: Proper oxygen delivery such as face mask. Documentation of oxygen concentrator should specify high flow concentrator AND patient should have an M tank in the home in case of emergency (ie power outage)
RN/LVN/PT/PTA/OT/ST
Unless the physician has ordered specific parameters, what are the Kaiser Permanente parameters for reporting the following to the physician?
BP, HR, O2 sat, Glucometer blood sugar, Temp
SBP less than 95 or over 140
DBP over 90
HR less than 60 or over 100 or newly irregular from SOC baseline
O2 sat less than 95%
Glucometer blood sugar less than 70 or over 250
Oral temp over 100
Temporal temp over 101.8
(Source: User Guide: Physician Notification Parameters)
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?
May family members act as _______ for patients? If yes, what is the process?
Interpreter - interprets spoken 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 level2
Language Line
Certified Sign Language Interpreter
(Source: Orientation manual and User Guide)
Policy 1-013: Family members or friends of the patient will not be used as interpreters unless specifically requested by the individual and after the patient has understood that an offer of an interpreter at no charge has been made. Such an offer and response will be documented in the patient’s record. 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. If the family member or friend is not competent or appropriate for any of these reasons, competent interpreter services will be provided to the patient.
Ensure the family member or friend identified agrees to be present for home visits.
Minors will not be used to interpret, in order to ensure confidentiality of information and accurate communication.