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/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)
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, kinesiotape, etc.)
All disciplines
What are you most proud of in regards to your HomeCare agency
Open discussion
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
Patient has following medications ordered for pain. Is there anything that needs to be done differently with these medication orders?
Norco 5-325 MG TAKE 1 TABLET ORALLY EVERY 6 HOURS AS NEEDED FOR PAIN. Oral (Effective Date:01/02/2019 )
Open discussion
Include specific indications of when to take each medication - such as take for mild pain, take for moderate pain, take for severe pain
Include MAX doses of APAP in 24 hours for all meds containing APAP
All disciplines
Is it a Joint Commission Standard to test smoke detectors in a 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.
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
All disciplines
What is required when documenting coordination with others?
The person's or people's name involved in the communication, the way the communication occurred, and a brief review of what was coordinated.
Names must include, at a minimum, first initial, last name, and title.
(Source: User Guide)
What guidelines 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/LVN/PT/OT/ST
Patient has the following medication orders. Are these medication orders correct?
Bisacodyl 10 mg - 1 suppository as needed for constipation
Humulin N - inject 80U subcutaneously in the morning for blood sugar control
Stiolto Respimat - use 2 inhalations orally daily. Use at the same time each day
Bisacodyl 10 mg - 1 suppository as needed for constipation (MISSING FREQUENCY)
Humulin N - inject 80U subcutaneously in the morning for blood sugar control (MUST SPELL OUT UNITS - "U" IS A DO NOT USE ABBREVIATION)
Stiolto Respimat - use 2 inhalations orally daily. Use at the same time each day (MISSING INDICATION)
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
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/PT
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)
RN/LVN/PT/OT/ST
Medication Safety
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/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
All disciplines
How are patients/families/caregivers educated regarding Oxygen safety?
Open discussion
Include use of HC Guide to Oxygen
Document the education provided!!!
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/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 do you do if a surveyor asks you a question and you don't know the answer?
FREAK OUT!!!!!.....NOT!!!!!
Breathe. Believe in yourself! It is better to kindly let the surveyor know you will provide the answer shortly rather than guess. Use your Joint Commission Prep Guide as a resource. If additional assistance is needed, contact your supervisor.
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.
(Source Policy Addendum 3-001.A)
How is oxygen stored safely?
Portable tanks lying down or in a rack (3 or more - in a rack; 3 or less - lying down)
In a well ventilated area
Concentrator at least 6 inches away from wall/bedding/curtains/etc.
Tanks NOT under bed, in closet, etc.
At least 5 feet away from open flame (ex: wall heaters, hot water heaters, etc.)
Active Order of a patient currently on service, RN and PT involved in care, pt with dx of CHF - has been readmitted to hospital once since SOC
12/23/2018 01:30 PM : Weigh patient: DAILY AND RECORD FINDINGS. FAMILY TO WEIGH PATIENT
Question:
What assessment and instruction is needed for order to be implemented?
Discussion
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.