NPSGs
What two patient identifiers may be used in a single-family home and facility?
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 in multiple patient setting (Board and Care, ALF) staff will use the identifier of date of birth (DOB) instead of place of address.
Name at least 2 time frames when drug reconcilliation is completed?
A complete drug regimen must be completed at
SOC
Recert
When updates to the comprehensive assessment are made
Name at least 3 elements of an oxygen assessment:
Assess for potential fire risks such as potential open flames
Assess for smoking materials in the home
Assess for smoke detectors
Assess for carbon monoxide detectors
Assess for adequate oxygen tank storage
Impact of fire risk to neighboring building
OPEN DISCUSSION
What is the process when the HHA has a missed visit?
The home health aide should contact the case manager if a visit is missed. The case manager should then notify the physician of the missed visit. Physician notification may vary slightly by agency.
What are the time points of a bereavement risk assessment? (4 time points)
Time points
SOC
Recertification
Death
Changes in risk factors in the bereaved
DAILY DOUBLE!!!
All disciplines
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
What are High Alert Medications?
High Alert Medication Policies Apply in the Following Situations in Home Care:
PCA - All opiate/narcotic infusions including patient-controlled analgesia
Pediatric (age < 14 years) intravenous medications and infusions
High Concentration Insulin - All insulin injections using concentrations greater than 100 units/mL
Whose responsibility is it to monitor oxygen safety compliance?
EVERY DISCIPLINE!!! has a responsibility to observe for oxygen safety
Look for non-adherence each visit (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/SPC/Volunteer: Report to Clinical Supervisor and Case Manager
SN: Re-assess and Re-educate as appropriate; involve physician/Clinical Supervisor/DME as appropriate; complete eRRF as appropriate
A staff message has been sent to a physician requesting orders. When can these orders be acted upon?
Orders cannot be acted upon until an order is received by a provider.
Open discussion
What are the elements of a bereavement assessment? (3 elements)
Elements
Assess and identify all who are determined to be bereaved
Identify level of risk related to bereavement
Care plan bereavement risk to everyone as appropriate
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 detectors is not required by Joint Commission standards.
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
A 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?
It is not recommended to store oxygen in a garage
Summer temp fluctuation - max temp is 140 degrees F
Ventilation issues – oxygen tanks must have proper storage ventilation
Clearance – There must be clearance around oxygen
think about what else is in the garage...ie hot water heater with flame, other furniture, auto etc
What is the process for receiving verbal orders from a provider?
All verbal orders will be “read back” and confirmed by the physician (or other authorized licensed independent practitioner) or designee to ensure accuracy of the order.
Verbal order verification is required for all medication orders and orders for therapeutic agents before action is taken on the order. Verbal order verification will be obtained by recording the verbal order and reading the order back to the ordering physician. The read-back portion of this process must be performed in a direct, live communication with the physician
How often are volunteer services documented in the care plan and who is responsible for these updates?
Volunteer services are documented in the care plan at least every 15 days. This is completed by the social worker and documented in the IDG update note.
What "guideline" does Kaiser Permanente follow regarding 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
Regarding 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.
What is the max dose of a high flow oxygen concentrator?
Are there any special considerations 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)
DAILY DOUBLE!!!
For patients with a Port, if you are a nurse, regardless of treatment, what is your responsibility? (5 elements)
Port site must be observed/assessed and documented at SOC.
Determine needs for Port.
Obtain orders if appropriate.
If orders to flush, include in medication orders
Include in Plan of care
When should you assess for a language interpreter assistance
When a patient speak a language other than English
What are 5 key elements of medication reconciliation?
Obtain information on what medications the patient is currently taking
Assure proper documentation (name, dose, route, frequency, purpose)
Compare what the patient is taking to what is ordered
Med list - provide written information on medications to patient (including name, dose, route, frequency, purpose)
Educate – explain the importance of managing meds to the patient
RN
What's missing in this medication order?
Acetaminophen 325mg
Take 2 - 3 tablets by mouth every 8 hours as needed
Indication
As needed order (When to take 2 tablets vs 3 tablets)
Max dose of all sources of Tylenol in 24-hour period
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
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.
You have received a referral to see a patient for a Hospice evaluation.
After you have completed your evaluation, you determine the patient is appropriate for Hospice services and the patient/caregiver(s) agree.
What are your next steps? (4 elements)
What are your next steps? (3 elements)
Obtain consents and completed Benefit Election.
Communicate with physician, report findings, and obtain physician orders to create a plan of care and reconcile medications
In addition, communicate/coordinate with rest of HO team regarding your findings and your plan of care.
DOCUMENT all the coordination completed
At least 3 questions you should ask related to emergency planning?
1) What is your relocation plan?
2) What is your plan to get there?
3) Do you have an emergency contact outside your area
4) Do you have supplies for at least 3 days?