Nursing Orientation - Power Point - Professional Pediatric Home Care

PROFESSIONAL
PEDIATRIC HOME CARE
General Nursing Orientation
Lourdes G. Wiley, MS, RN, NE-BC
Welcome!
• We are so glad you are here!! 
Our Services
• Private Duty Nursing
• Physical, Occupational, and Speech therapies
• Social work
• Patient advocate
• Over 800 patients served in the metro area
Mission and Vision
• To provide consistent comprehensive care to the
pediatric patients and their families who need
assistance in caring for special needs children in the
home setting. We believe in providing care with
compassion and respect for the inherent dignity,
worth, and uniqueness of each individual.
Every child and every family is unique as are their needs
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Ability to deliver holistic,
comprehensive, family-centered care.
One-on-one attention to one client
Focus is on WELLNESS and prevention
of hospitalization
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In-office training-basic prep/ P&P
Meet and greet
Case-specific orientation-with every new case
Review skills
 Research patient data/meds/diagnoses/procedures
 Competency list
 New skills require new competencies!
 Ask lots of questions!!!
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Clean scrubs or professional, comfortable
attire
Closed-toed shoes
Stethoscope
A positive, professional attitude and smile
Night nurses- laptop/tablet/things to read
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Your own pets or children- NEVER!
Fragrance
Sick germs
A negative attitude or frown
Inappropriate or revealing attire
Gifts or supplies
Be professional at all times!!
Our Nursing Team
 Lourdes
Wiley, MS, RN- Director of Nursing
 Nurse Case Supervisors:
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Emily Dold, RN
Joline Lowe, RN, CCM
Dori McDougal, RN
 In-home
Case Managers
 Home Care RNs
Therapy and Administrative
PPHC Staff
 Ann
Martin, BSN, RN- Administrator
 Jennifer Rahrer- Client Services Manager
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Patty Orlowski-Therapy Coordinator
Lauren Cino, RN- Intake Coordinator
Victoria Manley- Medical Records
Specialist
Krista Drew- Medical Office Assistant
Therapy and Administrative
PPHC Staff
 Chris
Wood- Business Development
 Chelsea
 Lisa
Preiss- HR/Benefits/Payroll
Ramsey, LCSW- social worker
Role of the Home Care
Nurse
O Comprehensive, holistic care of assigned
patient
O Participation in plan of care and
coordination of care
O Provide patients with excellent clinical care
in collaboration with interdisciplinary team
and family
O Monitor and report change in status
Professional Boundaries
O Define??
O Why is it a challenge?
O Why is the nurse primarily responsible for
maintaining boundaries?
O Legality
O Ethics
O Prevention of burnout
Scope of Practice
O Nurse Practice Act
O Training and competency
O Job Description
O Policies and Procedures
O Standard of Practice
Confidentiality/HIPAA
O Questions on Confidentiality Policy?
O Patient-sensitive/identifying data
O Social networking
O Mobile devices
O It’s a small world, be careful!!
O Keep yourself current and informed!
http://www.hhs.gov/ocr/privacy/hipaa/unders
tanding/
Conflict of Interest
O What is it?
O Why avoid it?
Fraud, Waste, and Abuse
O Questions on policy?
O Don’t falsify anything!
O Obligation to report witnessed cases
O Remember it is a crime!- most of our funds
come from state and federal sources
Reporting Suspected Abuse or Neglect
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What is abuse and neglect?
Who is vulnerable?
Mandated reporters- we are here to support you!
Reporting process
 Corresponding county CPS hotline
 Administrator/Director may report to state
 In an emergency, call 911!!
Emergencies
 For medical emergencies, perform BLS and call 911 !!
 Families have packets/plans for natural
disaster/emergency preparedness
 In-home emergencies, call 911
 Notify supervisors when patient is stable and EMS
has arrived
 Nurse must report off after hospital assumes care
Emergency Equipment
 Emergency To-go bag
 Emergency equipment check list
 Specific to patient needs and equipment
 Make sure ALL key essentials are functional when you
begin your shift- test equipment
 ABCs..
 Respiratory Equipment
 CPR mask/ambu bag/trach adapter- think and check list!
Adverse Event
 What is it?
 What do you do?
 Why do we track them?
 Injuries
 Medication Errors
 Incidents resulting in hospitalization
Infections
 Report to case manager/case supervisor
 Tracking and reporting
 Tracking form submitted by case manager
After Hours Accessibility
 Lourdes Wiley, DON- cell number 720-2264203
 On-call nurse- call 303-759-1342 and select
prompt for “on call nurse”
 Please limit after-hours calls to clinically
urgent matters-not appropriate for
scheduling issues
Overtime Approval Policy
 Overtime must be approved by DON before it is
worked
 Reserved for family needs/coverage
 Overtime is:
 Anything beyond 12 hours in a shift
 Anything beyond 40 hours in a work week, Sun-Sat
 Approval Form
Questions??
Stretch Break!!
Clinical Nursing Policies and
Procedures
Pediatric Nursing Assessment
 Head-to-toe assessment with vital signs at beginning
of shift and as needed or indicated by plan of
treatment
 Focused assessments and vital signs as needed and
ordered
 Check email for resources on pediatric assessment
review
Pointers for Assessment Success
 Approach child in a developmentally-appropriate
manner
 Go from least invasive to most invasive always
 Don’t offer choices where there are none
 Developing trusting, non-threatening environment
 Know baseline and normal for your patient!!
Pointers for Assessment Success
 Provide privacy as appropriate
 Incorporate fun, games, and play as appropriate
 Start with the easiest things first. Count respiratory
and heart rates while the child is quiet.
 Getting your temperature taken may be a
frightening thing for a child.
 Don’t forget pain is a vital sign!
Pointers for Assessment Success
 Getting your blood pressure taken may be a painful
thing for a child…that cuff may be awfully tight on a
little arm!
 Describe this to the child as a hug around their arm
or a ‘muscle-meter’ to see how strong they are!
Plan of Treatment and Orders
 You must have an order for every
intervention/treatment and medication, including
over the counter!
 Parents cannot relay or “give” orders
 Plan of treatment/485
 Intermittent orders
Procedure for Obtaining Orders
 May be written and signed at MD visit
 May be transcribed onto order sheet from dispensed
prescription if recent
 Telephone orders must be transcribed and signed by
nurse receiving the order
 Mail one copy to the office/keep one copy in the
chart
 Permanent changes/new orders become part of POT
Elements of Valid, Legal T.O.
 Refer to sample handout
 Include names of prescribing physician/RN taking
order
 Medication, Dose, Route, Schedule, indication for
administration if “as needed”
 Do NOT abbreviate!!
 Read back and document RBV x 1 (or more)
Medication Administration Policies
 You must read all policies and ask questions if
anything is unclear- return acknowledgment form
 Should be located in home chart at all times for
reference
 Follow 5 RIGHTS and you will RARELY go wrong!
5 RIGTHS
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Right patient
Right Drug
Right Dose
Right Route
Right time/reason
 Verify labels against MAR/orders every time!!
 Verify new handwritten/transcribed MARs to orders!
Medication Administration Policies
 Read, read, read policies
 Not all meds are appropriate for home care
 Know potential adverse reactions- you monitor
effects even if you don’t administer the med
 What to do when you do not administer the med
Medication Errors
 Some will happen- handle appropriately. Safety and
accountability are what we ask!
 Ensure safety and stability of patient- missed doses
are also errors
 Report to primary care or prescribing physician as
well as family
 Report to supervisor/Adverse Event Report to DON
Handwashing!!!
 Universal Standard Precautions Always!
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› What does this mean?
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Special Precautions
› Contact
› Respiratory/droplet
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Be aware of all policies!
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Unsure about appropriate precautions or
specific infections?
› Centers for Disease Control website
 www.cdc.gov
› Call DON/Supervisor
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Family practices and
education
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What it looks like- demonstration
All documents remain in the home always
Case manager submits paperwork biweekly
Payroll and billing sheets
EMR is coming!!
• Follow guidelines on handout- take with you your first few
shifts
• Entry every 2 hours minimum
• Who did you get report from/leave child in care of?
• Accurate time in/out-match billing
• Sign both sides
• Black ink only!
• We will provide feedback as needed
• Demonstrate need for skilled care and standards of practice
• Refer to sample nurses note
Stretch Break!!