Policy and Procedure Manual

The

Policies and Procedures

of

Community Health Nursing

 

Table of Contents

 

 

Health and Medical Division
Community Health Nursing

TITLE: Abuse/Neglect of a disabled adult

EFFECTIVE DATE:

DATE REVIEWED OR REVISED:

POLICY:

Community Health will refer clients to proper resource if abuse or neglect is
suspected.

PURPOSE: To protect our clients.

PROCEDURE/PROCESS:

  • Any suspected abuse or neglect of a disabled adult must be reported to the county social services.
    Reports must be written on a referral form, signed by the program manager and a copy kept on the chart in the progress note section before sending the referral on to social services.
  • A disabled adult is 18 or older or lawfully emancipated and is physically or mentally incapacitated. A disabled adult is in need of protective services if he cannot perform or obtain essential services for himself and has no relative or friend who is willing and able to obtain or perform the services for him
  • A disabled adult is abused if he is unreasonably confined, if his caretaker willfully deprives him of necessary services, or if he is the victim of willfully inflicted physical pain, injury, or mental anguish.
  • A neglected disabled adult is one who (a) lives alone and cannot provide for himself the services that are necessary for his physical or mental health or (b) is not receiving services from his caretaker.

 

 

 

Health and Medical Division
Community Health Nursing

TITLE: Advanced Directives Policy

EFFECTIVE DATE: 11/03/03

REVIEWED: Annually

POLICY:

The EBCI Tribal Community Health Nurse (CHN) shall teach patients the need and benefits of Advanced Directives, when it seems appropriate.

The EBCI Tribal Community Health Nurse shall assist patients in the development of Advanced Directives for future care when such assistance is requested.

PURPOSE: To assist patients to participate in decisions about the intensity and scope of their future health care within the limits of the organization’s philosophy and mission and applicable laws and regulations.

PROCEDURE :

When a patient has decided to complete an Advanced Directives for health care the CHN will:

  1. Assist the patient to obtain the necessary forms.
  2. Teach the patient the differences between a Durable Power of Attorney for Health Care and a Living Will document.
  3. Read and explain the entire selected document to the patient.
  4. If the Durable Power of Attorney for Health Care document is selected, teach the patient the need to make a choice of a health care agent as someone who will be willing to carry out the patient’s wishes when the patient is no longer personally able to make those decisions.
  5. Teach the patient the need for two witnesses to sign the Advanced Directive Document—cannot be relatives of the patient or health care providers.
  6. Assist the patient to complete his/her part of the form. Have the patient wait to sign the document when the two witnesses will be present.
  7. Assist the patient when necessary to obtain photocopies of the Advanced Directives.
  8. Instruct the patient to inform his/her primary physician(s) that an Advanced Directive has been prepared and to give that physician a copy of the document. Encourage the patient to also provide a copy of the completed document to their health care agents and other health care providers.
  9. Any Advance Directive(s) given by the patient to the CHN shall be placed in the patient’s medical record.
  10. This document shall be reviewed with the patient or his/her health care agent annually or when there is a change in the patient’s health status.

 

 

 

Health and Medical Division
Community Health Nursing

TITLE: Annual Leave Requests

EFFECTIVE DATE: 7/12/02

REVIEWED: 11/01/03

POLICY: Community Health employees will submit annual leave requests in a timely manner.

PURPOSE: To maintain adequate patient coverage.

PROCEDURE/PROCESS:

  • Staff members are requested to make their annual leave requests at least three weeks in advance so that adequate coverage can be planned. During the Christmas and New Year holiday period, no more than one week’s vacation will be permitted per employee, to allow other staff members time to be with their families. Requests for vacation will be processed in the order submitted, with consideration give to previous vacations taken during the holiday period. A twenty-four to forty-eight hour notice is usually adequate if only one day off is needed and emergency leave requests will be reviewed by the Supervisor.

 

 


Health and Medical Division
Community Health Nursing

TITLE: Annual Patient Satisfaction Survey

EFFECTIVE DATE: 11/03/03

DATE REVIEWED OR REVISED: Annually

POLICY: The EBCI Community Health Nursing Department shall conduct (at minimum) an annual patient satisfaction survey, utilizing a standard form developed by the Community Health Nursing Department Staff and approved by the Health and Medical Division governing body.

PURPOSE: To provide an annual assessment of patient satisfaction with medical, nursing, or other care received from the Community Health Nursing Department.

To serve as a tool for the CHN Department quality assurance efforts and for planning.

PROCEDURE:

  1. CHN Department Staff shall develop and supply a standard patient satisfaction survey to be utilized.
    1. This survey shall be made available at the beginning of the fiscal year.
    2. Each department shall be supplied with a quantity of blank surveys to equal 10% of its users.
  2. During the period October through December of each year, the CHN department shall obtain completed surveys from 10% or more of its users.
  3. By December 1, each department shall forward the completed surveys to the Program Manager.
  4. The Program Manager shall process completed surveys and issue a summary report to the CHN Department Staff and include statistics in annual report.

 

 


Health and Medical Division
Community Health Nursing

TITLE: Automobile Insurance Coverage

EFFECTIVE DATE: 4/01/04

DATE REVIEWED OR REVISED:

POLICY: Community Health employees will provide proof of Automobile Liability Insurance.

PURPOSE: Coverage in case of a motor vehicle accident while on duty.

PROCEDURE/PROCESS:

  • All staff is required to have a current North Carolina driver’s license and properly maintained vehicle in good driving condition, including current liability insurance.
  • All staff will submit a copy of the first page of their auto insurance policy showing proof of liability coverage, upon hire and when any changes in insurance company or coverage occur.

 

 

 

Health and Medical Division
Community Health Nursing

TITLE: Bag Policy

EFFECTIVE DATE: 04/01/04

REVIEWED: Annually

POLICY: It is the policy of Cherokee Community Health that all RN’s and CNA’s carry a clean, adequately stocked bag of supplies to be used when providing care to all patients.

PURPOSE: Reduce cross-contamination from patient to patient. Have clean supplies available as needed.

PROCEDURE/PROCESS:

Nursing and CNA bags are the responsibility of each respective staff member. In addition to the required list of supplies (see Nursing bag or CNA bag supplies) the nurse should also carry in the vehicle a set of scales and a sharps container. Lock the vehicle if conditions indicate. Every month and as needed the bag will be washed inside and out with germicidal solution and allowed to air dry. Likewise, the blood pressure cuff should be cleaned with germicidal solution and let dry. This will be documented on the appropriate form and kept by the respective supervisor.

When bringing the nursing bag into the home, place the bag on a clean surface covered with a bag barrier such as paper towels, disposable wash cloths, bluepad or the bag barriers supplied to each staff member. This provides a barrier between the bag and patient’s environment to decrease the risk of contamination. This is also a good place to put small amounts of waste (alcohol pads, etc.). Sometimes it is preferable not to take the bag in and just carry into the home the supplies/equipment necessary. Nursing and CNA bags are never to be placed upon the floor.

The stethoscope bell/diaphragm should be cleaned with alcohol after each use, also scissor blades. Nail clippers should be washed with soap and water and wiped with alcohol after each use. Disposable thermometer shields should be used and the thermometer should be wiped with alcohol after each use.

 

 

 

Health and Medical Division
Community Health Nursing

TITLE: Basic Orientation

EFFECTIVE DATE:

DATE REVIEWED OR REVISED:

POLICY: Community Health will provide orientation to each new employee.

PURPOSE: To provide basic working knowledge of the agency, agency policy and procedures. To verify that all employees are oriented to the agency within a reasonable time frame.

PROCEDURE/PROCESS:

Orientation is conducted by all levels of staffing; verbally, visually, and in practice with a staff member. All staff including temporary personnel, must have basic orientation including but not limited to:

  1. Scope of practice for their licensure/certification.
  2. Job description – must be reviewed and signed by the employee.
  3. Supervision/Chain of command.
  4. Confidentiality/Client rights.
  5. Basic paperwork required as part of job duties.
  6. Office hours/how to contact nurse.
  7. Resource material.
  8. Skills validation, which must be done yearly.
  9. See orientation check-off list.

 

 

 

 

Health and Medical Division
Community Health Nursing

TITLE: Blood Glucose Monitoring Quality Control

EFFECTIVE DATE: 6/17/04

REVIEWED: Annually

POLICY: Program Blood glucose monitor(s) shall be calibrated each week on Monday prior to use. Patient glucometers will be calibrated every week or at every visit if visits scheduled less frequently then every week.

Each Calibration shall be recorded in a calibration log. (Copy of the calibration log sheet is attached).

PURPOSE: To assure accuracy of monitor performance and documentation for quality control.

PROCEDURE/PROCESS:

The calibration technique to be used will be that by the machine’s manufacturer.

Each staff shall be trained in proper technique upon being issued a machine for use in clinics and home visits.

Any machine not meeting calibration requirements shall not be used and shall be turned into the CHN supervisor for repair and replacement.

The individual calibration log shall be posted in the CHN department and labeled with provider names.

The calibration logs shall be submitted to the CHN supervisor for review.
The calibration logs shall be submitted with the monthly report. The CHN supervisor shall return the calibration logs to the appropriate staff.

When calibration logs are filled, they shall be placed in a central file notebook and kept for a period of one year.

Any questions or concerns with the calibration monitors and maintenance of the calibration logs shall be discussed with the individual and a plan of action for correction shall be established.

 

 

 

Health and Medical Division
Community Health Nursing

TITLE: Blood and Body Fluid Exposure

EFFECTIVE DATE: 11/03/03

REVIEWED: Annually

POLICY: It is the policy of HMD that programs and employees should take all necessary steps consistent with national infection control guidelines to prevent blood and body fluid exposures. In the event an exposure occurs, immediate steps should be taken to reduce the risk of disease transmission, ensure the employee receives the appropriate care and follow-up, and notify HMD and tribal authorities of the incident.

PURPOSE: To ensure that tribal clinical employees receive appropriate, timely care in the event of an exposure to blood or other body fluids.

PROCEDURE/PROCESS:

  1. As soon as blood or body fluid exposure occurs (e.g. contaminated needle or scalpel stick, splash into eyes or contact with mucous membranes, etc), hands or other affected skin should be thoroughly washed with soap and water and eyes or mucous membranes should be flushed copiously with saline or water.
  2. The employee’s supervisor should be informed immediately of the exposure and the supervisor will complete the standard tribal Incident Report form. The form must be filed with the tribe before the end of the next working day.
  3. The patient whose blood or other body fluid was the exposure source should be identified, if possible.
  4. The employee will then immediately go to the Cherokee Indian Hospital (CIH) Emergency Department (E.D.) with a copy of the Incident Report form. Upon arrival, the employee should notify the E.D. staff of the nature of the injury and that the visit will be covered by the Tribe’s Workman’s Compensation insurance.
  5. The E.D. physician will see the employee, offering counseling, testing and treatment consistent with current CDC guidelines, including testing of the source patient if he/she consents.
  6. The supervisor will assist the employee in obtaining any/all recommended follow-up tests and medical visits.
  7. Clinic and employee procedures will be examined to find ways to prevent future exposures.

 

 


Health and Medical Division
Community Health Nursing

TITLE: Blood Glucose Testing

EFFECTIVE DATE: 04/01/04

REVIEWED: Annually

POLICY: Community Health Nursing staff shall be trained in blood glucose monitoring procedure. CHN staff may perform blood glucose monitoring in the clinic or home setting.

PURPOSE: To assist patients in periodic monitoring of blood sugar levels for proper management of diabetes.

To provide periodic information for patient’s medical provider to aid in determining control between medical visits.

To provide screening of blood glucose in the clinic setting.

PROCEDURE/PROCESS:

STAFF TRAINING
All Community Health nurses shall demonstrate competency in blood glucose monitoring during the initial three month probationary period following hiring. Likewise, all CHR staff shall be trained and competency demonstrated during their three month probationary period. Training shall be done by the CHN Supervisor or designee.

All staff will be subject to annual review of skills and abilities to maintain quality delivery of services.

PERFORMING THE TEST

**The blood glucose monitor is to be calibrated prior to initial use and weekly thereafter. Calibration method shall be provided by the manufacturer. The results will be documented in the calibration log kept in the office of the Administrative Assistant.

  1. The blood glucose monitor and supplies shall be readied and placed on an aseptic area.
  2. The tester shall wash his/her hands and don a pair of gloves.
  3. The patient’s selected finger is cleansed with an alcohol pad and dried with a dry cotton ball or dry gauze pad (patients in the home setting can wash hands with soap and warm water instead of using alcohol).
  4. The finger is punctured using an approved lancet device in accordance with universal precautions.
  5. One drop of blood is placed on the test strip (the process for each individual machine shall be followed according to manufacturer’s instructions).
  6. The lancet shall be disposed of in the appropriate sharps container.
  7. The tester shall provide the patient with a dry gauze pad, cotton ball, or tissue to prevent any further bleeding from the punctured finger.
  8. The tester shall dispose of blood stained testing materials and gloves in an appropriate hazardous waste bag.
  9. Results shall be recorded on the patient’s PCC form and placed in the patient’s medical chart. **The patient’s physician shall be notified for a blood sugar above 300 or below 70, unless other parameters have been established by the MD.
  10. Results obtained during group screenings shall be documented on a IHS Group PCC and given to data entry personnel for entry into RPMS. Patients at group screenings will be given written results to present to their primary physician. For a blood sugar >300 the patient will be instructed to follow up with their primary physician as soon as possible. Those with a blood sugar of 400 or > will be advised to seek medical treatment immediately.

 

 


Health and Medical Division
Community Health Nursing

TITLE: Call Ins

EFFECTIVE DATE: 11/03/03

REVIEWED: Annually

PURPOSE: To provide supervisor adequate time to make changes to daily schedule and
provide coverage for deliveries, clinics, etc.

PROCEDURE/PROCESS:

Health employees will notify their immediate supervisor by 7:45 if
they are not going to be able to work that day due to illness or family emergency.

  • Employee will speak to the Community Health Nurse Supervisor if unable to come in,
    because e-mail and voice mail is not always reliable, it is best for the employee to talk
    directly to the supervisor if unable to come to work.
  • If employee is not physically able to talk with the supervisor, a family member may
    make the call.
  • If the supervisor is not available, you may ask to speak to the Program Manager, if
    available, or leave a message for the supervisor to return your call.
  • Leaving a voice mail on the Community Health voice is not acceptable, nor is sending
    an e-mail to the supervisor.
  • If employee needs to leave before their tour of duty is complete, the same procedure
    must be followed.

 

 


Health and Medical Division
Community Health Nursing

TITLE: Case Conference

EFFECTIVE DATE: 06/17/04

REVIEWED: Annually

POLICY: Conferencing of patient services

PURPOSE: Involve all staff in developing and updating plan of care for patients.

PROCEDURE/PROCESS:
A case conference meeting, led by the Community Health Supervisor or designee is held within 14 days of admission to active patient list. Documentation is accomplished by completing a case conference sheet for each patient (Attachment A). Multidisciplinary case conferences are to be done at least every two months.

 

 

 

Health and Medical Division
Community Health Nursing

SUBJECT: Community Health Nursing Criteria of Care/Practice Standards

EFFECTIVE: 8/12/02

REVIEWED: 11/03/03

POLICY: The Community Health Nursing department shall apply established Community Health Criteria of Care and Practice to program development, operation, and evaluation.

PURPOSE: To provide quality Community Health Nursing services according to nationally accepted standards.

PROCEDURE:

  1. Program Development
    The Community Health Nursing Department shall utilize the following resources as guides for program development, operation, and evaluation:
    1. I.H.S: Public Health Nursing Criteria of Care Vol. I and II
    2. ANA: Case Management by Nurses
    3. ANA: A statement of the Scope of Maternal and Child Health Nursing Practice.
    4. ANA: Community Based Nursing Services: Innovative Models
    5. ANA: A statement on the Scope of High-Risked Perinatal Nursing Practice.
  2. Practice Standards
    The Community Health Nursing Department shall utilize the following resources as guides to determine practice standards:
    1. I.H.S: Public Health Nursing Appraisal Guide.
    2. ANA: Standards of Community Health Nursing Practice
    3. ANA: Standards of Maternal-Child Health Nursing Practice
    4. ANA: Standards of Practice for the Perinatal Nurse Specialist
    5. ANA: The Scope of Nursing Practice
  3. Staff Development
    The Community Health Nursing Department shall utilize the following resources as guides for nursing staff development:
    1. ANA: Continuous Quality Improvement in Nursing
    2. ANA: Standards for Nursing Staff Development
    3. ANA: Standards for continuing education in Nursing

 

 


Health and Medical Division
Community Health Nursing

DRAFT
SUBJECT: Photoscreening Frequency

PURPOSE: Defines the frequency for Photoscreening children

STAFF GOVERNED BY THIS POLICY: Community Health Nursing

EFFECTIVE DATE: May 1, 2002

DATE REVIEWED OR REVISED:

DISTRIBUTION: Community Health Nursing staff, Child Service Coordinator, Child Care Centers, Cherokee Children’s Coalition,

POLICY:
All children 3 years of age will have their eyes screened with the MTI Photoscreener.

PROCEDURE:

  1. The CHN conducting the screening will contact the Child Care Centers to schedule a
    time for Photoscreening.
  2. All parents of children who are to be screened will be informed for consent by letter.
  3. Children whose parents do not return or sign the consent form will not be screened.



Health and Medical Division
Community Health Nursing

TITLE: Code of Ethics

EFFECTIVE DATE: 04/01/04

REVIEWED: Annually

PURPOSE: Guidance for decision-making concerning ethical matters

PROCEDURE:

Cherokee Community Health recognizes the need to incorporate concern for ethical aspects of care in their day-to-day practice. The program values health and well being for all persons, and strives to assist patients in achieving their optimal level of health. We respect and promote the rights of patients, and help them to express their health needs to obtain appropriate information and services. We involve patients and their families in health planning and health care decision-making, including choices concerning Advance Directives and the acceptance or refusal of Community Health services.

We are committed to providing quality care performed by employees who demonstrate a high level of competence, in a compassionate, supportive manner. We support staff efforts to increase their professional knowledge through continued education, training, and experience.

We value teamwork and cooperation, and strive for a work environment based on trust rather than control, on interdependence rather than individual greatness.

We acknowledge the importance of the spirit, and are sensitive to the cultural beliefs of patients, caregivers, and employees.

We safeguard the trust of patients by using confidential information in the context of a professional relationship, and share such information outside the health care team only with the patient’s permission.

We apply and promote principles of equity and fairness to assist clients in receiving unbiased treatment, health services and resources proportionate to their needs, regardless of ethnicity, religion, gender, or ability to pay for services.

We value honesty and integrity in serving our patients, and abide by all policies of the Eastern Band of Cherokee Indians.

 

 

 

Health and Medical Division
Community Health Nursing

TITLE: Communication needs of clients

EFFECTIVE DATE: 04/01/04

REVIEWED: Annually

PURPOSE: Appropriate services will be provided to patients with communication needs.

PROCEDURE:

All patients have the right to participate in their plan of care. Skilled staff are responsible for identifying patients with communication needs which could interfere in their quality of care. These needs could include language barriers, or barriers to vision or hearing. Assessment will be performed upon initial visit, and will be reevaluated with each visit. Staff members will be sensitive to these issues, incorporate them into the plans of care for the individual patient as needed, and provide appropriate information to all staff who care for this patient.

Patients with special communication needs will be assisted with obtaining the appropriate method to facilitate communication as necessary. The following guidelines are provided:

Interpreter for Cherokee language
Calvin Hill 497-7461
Stacy Rogers 497-6385
Carolyn West 479-4725
Margie Wachacha 479-4725

Phone devices Verizon Telephone Service
Communication boards and written materials will be provided as needed. Assistance will also be provided in obtaining devices to assist with impaired vision.

Skilled staff will make the appropriate referrals to obtain necessary equipment to assist patients with their communication needs.


Health and Medical Division
Community Health Nursing

SUBJECT: Community Health Nursing Forms

EFFECTIVE DATE: 11/30/03

REIVEWED: ANNUALLY

POLICY: The Community Health Nursing Program shall only use department or facility approved forms.

PURPOSE: To promote consistent record keeping and reporting.

PROCEDURE:

The following procedure shall be applied to the submission/distribution/orientation of staff for new forms.

  1. A draft form complete with a statement of purpose, intended use and instructions shall be submitted to the Community Health supervisor.
  2. The supervisor shall review and edit, as in dictated, and submit to the Program Manager for review and approval.
  3. Once the form has been approved it will be returned to the department head who will distribute and orient the appropriate staff.
  4. A list of approved forms shall be kept current and located in the Forms Manual.

 

 

 


Health and Medical Division
Community Health Nursing

TITLE: Complaints to Community Health

EFFECTIVE DATE: 07/12/02

DATE REVIEWED OR REVISED: 10/31/03

POLICY: Community Health will investigate all complaints.

PURPOSE: To provide documentation, follow-up and resolution to complaints when possible.

PROCEDURE/PROCESS:

  • All formal complaints made by patients, their families or the public at large are to be referred to the Program Manager of Community Health or designee. All staff should inform the person of the right to submit any complaint in writing to this agency. Staff shall route all formal complaints, either written or verbal, to the Program Manager, who will use her professional judgement in planning any investigation and the appropriate response. The investigation process may include routing the information to the Community Health supervisor, who will then investigate and provide a plan of correction, make corrective action as able, and provide a written report, along with the original documentation, to the Program Manager within 10 days of being assigned the problem. The Program Manager will follow-up with the complainant if able/needed to verify that corrective action was taken. If no solution is found, the Operations Director or Executive Director of the Health & Medical Division will be consulted. Written documentation of the problem and solutions/attempted solutions are to be filed in the complaint folder and kept for seven years, available to audit by appropriate persons when requested.
  • Complaints about one staff member from another staff member must be dealt with by chain of command. If solutions cannot be found, a written complaint will be submitted to the Program Manager, and all Tribal Personnel Policies must be followed.

 

 


 

Health and Medical Division
Community Health Nursing

TITLE: Conditions for Admission, Discharge, Continuation of Care

EFFECTIVE: 06/10/03

REVIEWED: Annually

POLICY: The EBCI Tribal CHN Program shall provide Health Nursing services for eligible patients in various setting, i.e. home, office, community, or clinics.

PURPOSE: To identify criteria and specific procedures for admission, continuation, and discharge
to the Community Health Nurse’s active caseload.

PROCEDURE: CRITERIA:

A client shall be admitted to the Community Health Nursing (CHN) active caseload if:

  1. The client’s health care needs are within the CHN scope of services, based on:
    1. Professional nursing assessment, observation, and evaluation.
    2. Teaching and training for the client and/or family.
    3. Guidance and counseling.
    4. Direct care requiring skilled nursing care when there is a reasonable expectation that the client’s medical, nursing, and social needs can be met safely in his/her residence.
    5. Information and referral.
  2. Service needs that can be met during the hours of the CHN Department’s hours of operation.
  3. The CHN Department will not provide services when:
    1. A change in the client’s condition or home situation which would
      require care or services other than those which can be adequately
      and safely provided by the CHN Department.
    2. Another person (such as a family member) is capable of providing the
      required services and has been prepared to assume this responsibility.
    3. The client no longer needs therapeutic services.
    4. Efforts to manage CHN staff safety have failed.
    5. The client is deceased.
    6. After three unsuccessful attempts to find the client at home.

PROCESS STEPS:

A. ADMISSION

  1. All referrals made to the CHN Program shall be evaluated
    within two (2) working days of receiving the referral.
  2. When a client will be seen for only one visit (and not
    admitted to the active caseload) a limited physical
    assessment will be completed, and a record of the visit
    shall be documented.
  3. When a client will be seen for more than one visit
    (admitted to the active caseload) a medical record shall be
    established; a care plan shall be cooperatively prepared with
    the client; and written documentation of the visit shall
    be recorded.

B. CONTINUATION OF CARE

  1. The Community Health Nurse shall make visits as required to
    meet the client’s health care needs.
  2. When appropriate, based on assessed Priority Level of Care,
    the client shall be assigned to CHR for continuation of care.
  3. The client shall be informed of the approximate time of the
    next service/visit.
  4. Any change in condition shall be reported to the attending physician.
  5. A written report shall be made for each home visit.
  6. The nursing care plan on clients in the active caseload shall be revised when the
    client:
    1. Has a new nursing diagnosis,
    2. The client did not meet the outcome criteria within the time frame
      specified on the nursing care plan.
    3. Outcome criteria were met for the priority problems and new
      interventions and outcomes are written for subsequent problems.

C. DISCHARGE/INACTIVATION OF SERVICES:

  1. When a client is discharged or inactivated from services of the CHN Program, the client shall be informed of the discharge and the reason
  2. The attending physician shall be notified in writing.
  3. Documentation of the reason for discharge or inactivation shall be made in client’s health record.
  4. CHN services may be reactivated at any time the client meets admitting criteria or a new referral is received.

 

 


Health and Medical Division
Community Health Nursing

TITLE: Confidentiality of personnel files

EFFECTIVE DATE: 04/01/04

REVIEWED: Annually

PURPOSE: Assure the confidentiality of all employee personnel files

POLICY:

Each employee will have a personnel file maintained in a secure area in the Supervisor’s office. Copies are kept in secure areas of the office of the Executive Director of the Health and Medical Division, and in the Tribal Human Resources Department. The employee may request a copy of any information in this file by contacting the Human Resources Department (see Tribal Policy).

Information concerning the application, dated and signed withholding statements, and verification of citizenship will be kept in the Personnel files at the Human Resources Department of the EBCI.


Results of criminal background checks will be kept in a secure area of the program manager’s office.

 

 

 


Health and Medical Division
Community Health Nursing

SUBJECT: Respect for cultural beliefs

EFFECTIVE DATE: 04/01/04

REVIEWED: Annually

PURPOSE: Appropriate services will be provided to patients from a variety of cultural backgrounds, beliefs, and languages.

POLICY:

All patients, families, and caregivers have the right to their own beliefs and customs. This agency realizes that beliefs may affect the patient’s lifestyle, dietary habits, health views, methods of healing, family roles and role of the caregiver. Staff members will be sensitive to these issues and be able to effectively incorporate these views into appropriate care of the individual patient as needed. A cultural needs assessment will be completed on initial assessment of each patient admitted for home nursing/CHR visits (attachment A).

Staff will be offered inservices at least annually to address the relationship of beliefs to health and healing.

 

 

 

 

Health and Medical Division
Community Health Nursing

TITLE: Daily Activity Scheduling

EFFECTIVE DATE: 6/10/03

REVIEWED: Annually

POLICY: All staff shall create and provide to the CHN Supervisor a weekly calendar of planned activities.

PURPOSE: To provide guidelines for daily scheduling of activities/assignments.

To assure accountability of all staff during the work day.

To facilitate assurance of staff safety during the work day.

PROCEDURE/PROCESS:

All staff shall possess and post a weekly calendar of activities. This is to include patient visits, meetings, and administrative time.

The CHN Supervisor, or designee, shall create and post a weekly calendar of patient visits.

All staff shall begin work at the time determined by the agency (7:45). Staff beginning work from a location other than the CHN office shall do so only with prior approval by the CHN Supervisor.

All staff shall return to the office thirty (30) minutes prior to the end of the business day. Any exception should be considered out-of-the-ordinary and should be rare in occurrence.

All staff who experience a situation making it necessary to remain in the field and not return to the office at least 30 minutes prior to close of business, must notify the Supervisor immediately upon realization of the situation. Staff are at no time to assume a right to flextime and must have prior approval from the CHN Supervisor for any such determination.

All staff who are in the field conducting community clinics, community education sessions, or home visits, must call the office twice a day (i.e., mid-morning and early afternoon) to check for messages or additional instructions and/or assignments.

 

 


Health and Medical Division
Community Health Nursing

TITLE: Dress Code

EFFECTIVE DATE: 6/17/04

REVIEWED: Annually

POLICY: All staff will report for work dressed appropriately for the performance of their assigned duties.

PURPOSE: To ensure professional appearance and safety of staff

PROCEDURE/PROCESS: All staff shall adhere to the following:

  1. Hair must be clean and neat, and of a style which will not interfere with work.
  2. Fingernails must be clean and must not be of a length which interferes with duties or could inflict injury to the patient.
  3. Clothing must be clean and in good repair. Skirts should be at least to the knee to allow for bending and stooping.
  4. No shorts, jeans, or denim of any color is allowed.
  5. No crop tops or low necklines.
  6. Shoes should be clean and protect the foot.

In addition, field staff must also adhere to the following requirements:

  1. No sandals, or high heeled pumps.
  2. Jewelry should be kept at a minimum and safe for patient care.
  3. Rings that do not tear gloves may be worn.
  4. Uniforms or scrubs are required.
  5. Uniform type skirts or split skirts may be worn, if the length is at least to the knee to allow for bending and stooping.
  6. No sleeveless tops or blouses.
  7. Uniform type pedal pushers or shorts that go to the top of the knee may be worn.
  8. Sweatshirts and sweatpants in good taste may be worn in periods of severe cold, as determined by the supervisor.

The program will furnish uniforms to employees who provide direct patient care as follows:

  1. After completing the 90 day probationary period, each field staff employee will be issued 3 sets of scrubs.
  2. Uniforms are considered the property of Community Health; if an employee leaves the program for any reason prior to the completion of 12 months of service, the uniforms must be returned. Upon completion of 12 months of continuous service with the program, the uniforms will become the property of the employee.
  3. Each year following the initial hire date, the employee will receive two additional sets of scrubs. Upon completion of an additional 12 months of continuous service with the agency, these uniforms will become the property of the employee.

 

 

 

 

Health and Medical Division
Community Health Nursing

TITLE: Emergency Response Plan for Immunization Reactions in a Community Health Setting

EFFECTIVE DATE: 08/13/02

REVIEWED: 11/03/03

POLICY: All EBCI Community Health Nursing Staff who administer immunizations, in community settings, shall respond effectively and efficiently to emergency situations involving immunization reactions.

PURPOSE: To provide direction for responding to immunization reaction emergencies, by the Community Health Nursing Staff.

PROCEDURE/PROCESS:

REQUIREMENTS: Nurses shall:

  1. Be proficient in the general application of first aid. Be prepared to take the leadership role in caring for any patient in a medical emergency.
  2. Maintain current certification in cardio-pulmonary resuscitation for health care providers in accordance with standards of the American Red Cross or the American Heart Association. Renewal requirements are determined by these credentialing agencies.
  3. Assure emergency equipment is adequately stored and easily accessible. 1. Disposable pocket resuscitation masks with one-way valve FOR ALL EMERGENCY SITUATIONS.
  4. The Community Health nurse shall remain with the patient throughout the entire incident and follow steps listed in this policy under the specific situation.
  5. THE NURSE SHALL MAKE A RAPID CARDIOPULMONARY ASSESSMENT WITH ATTENTION TO: A-AIRWAY B-BREATHING C-CIRCULATION
  6. The nurse (or designee) shall call 911, or the local emergency response team, if the condition warrants. If a physician is on site, he/she shall be notified immediately. A staff member (if available) shall be designated to record the patient’s vital signs.
  7. All patients who require emergency care related to an immunization reaction will be referred to a physician for follow-up care.
  8. The CHN/or designee will obtain and record the name, address, and phone number of the patient and the name and phone number of the physician or hospital to which the patient has been referred.
  9. The Community Health Nurse Supervisor and appropriate physician will be notified, and a Community Health Incident Report form shall be completed immediately upon stabilization of the emergency situation.

 

COMMON EMERGENCY SITUATIONS FOLLOWING ADMINISTRATION OF MEDICATIONS/IMMUNIZATIONS:

  1. Fainting – Probably the most common reaction, usually due to anxiety.

    IF THE PATIENT COMPLAINS OF FEELING FAINT:
    a. Place the patient in a chair with his/her head between their legs.

Health and Medical Division
Community Health Nursing

TITLE: Employee Incident Report

EFFECTIVE DATE: 06/17/04

REVIEWED: Annually

POLICY: All employees experiencing work-injuries, regardless of the severity,
shall complete an incident form.

PURPOSE: Documentation of employee incidents in order to analyze contributing
factors, ensure employee safety, reduce liability exposure, and meet the requirements of the EBCI Personnel Policy Manual.

PROCEDURE/PROCESS:

  1. An employee incident is any event taking place while the employee is at
    work that results in injury to the employee.
  2. When an incident occurs, the employee shall notify their supervisor immediately. If the supervisor is not available, the program manager shall be notified of the incident.
  3. The Employee Incident Report shall be filled out completely and given
    to the employee’s supervisor within one working day.
  4. The original shall be forwarded to Human Resources, a copy retained
    by the program manager, and a copy will be given to the employee.
  5. The Employee Incident Report shall be reviewed by Human Resources,
    as indicated in the EBCI Personnel Policy Manual, and Worker’s
    Compensation reporting shall be done as needed.
  6. Employee shall be instructed to be evaluated at closest ER/clinic for
    possible problems/complications.
  7. Recommendation for follow-up care, review of incident, including
    what (if anything) could have been done to prevent it will be carried
    out before the Employee Incident Report is filed in employee personnel
    record.

 

 

 

Health and Medical Division
Community Health Nursing

TITLE: Employee Skills Check List

EFFECTIVE DATE: 06/17/04

REVIEWED: Annually

POLICY: Employee skills check list to completed annually

PURPOSE: To assure that competency of skills are consistently monitored.

PROCEDURE/PROCESS:
The yearly skills checklist will now be done each year during the month of July by the Community Health Nursing Supervisor or designee for the field staff (RN’s, CHR’s, and CNA’s). This is to provide for more consistency. For staff that are working prn, the yearly skills checklist will be done at a set time agreed upon by the employee and the CHN Supervisor.
Attachment A – RN Skills Check List
Attachment B – CHR/CNA Competency Review Checklist

 

 

 

Health and Medical Division
Community Health Nursing

TITLE: Flextime

EFFECTIVE DATE: 11/03/03

REVIEWED: Annually

POLICY: Community Health employees will accumulate, and use flextime at the discretion
of their supervisor.

PURPOSE: To provide adequate coverage, and to compensate the employee for working
off tour.

PROCEDURE/PROCESS:

  • Flextime can only be earned at the approval of the Community Health Nurse Supervisor.
  • It is the responsibility of the employee to notify the supervisor in advance of the event
    that will keep the employee past their tour of duty.
  • The amount of flextime earned, must be reported to the supervisor as soon as possible.
  • Flextime can only be taken with the supervisor’s permission and must be arranged in advance.
    Employees are encouraged to use their flextime within the same week.
  • Timesheets must reflect actual time worked, in order to accurately record flextime used.

 

 

Health and Medical Division
Community Health Nursing

TITLE: Group Services Record

EFFECTIVE DATE: 06/17/04

REVIEWED: Annually

POLICY: Records shall be maintained for all group services provided by the Cherokee Community Health Program.

PURPOSE: To document public health group preventative efforts.

PROCEDURE/PROCESS:

  1. The following information shall be recorded and kept on file for group services:
    1. Title of group service
    2. Purpose of group service
    3. Date and location of group service
    4. Responsible staff
    5. Presenter, if appropriate
    6. Number of participants
    7. Evaluation of group services
  2. If the group service involves a screening program (i.e., BP, CBG, TB screening) the IHS PCC Group Preventative Services Record will be completed according to its prescribed instructions. (Attachment A – 3 pages).
  3. If the group service involves a screening program (i.e., BP, CBG, TB screening) the registered individual’s data shall be entered into their respective health record.


 

 

Health and Medical Division
Community Health Nursing

TITLE: Handwashing procedure

EFFECTIVE DATE: 6/17/04

REVIEWED: Annually

POLICY: Employees are to adhere to strict handwashing when providing patient services
Note* Hand washing is vital to infection control.

Hands are to be washed prior to any patient contact. (When first entering the patients home.)

Wash hands after toileting (self or patient), handling body secretions, patient care, or handling equipment.

Wash hands prior to putting on gloves, between glove changes and when gloves are removed.

Hands are to be washed at the conclusion of the visit, prior to leaving the patient’s home.

PURPOSE: To protect staff and patients from contamination and cross infection

EQUIPMENT:
SINK WITH RUNNING WATER
LIQUID SOAP
PAPER TOWELS
HAND WASH KIT (hand wash kits contain liquid soap and a paper towel.) These kits are to be used where there is running water but no liquid soap or paper towels available.

PROCEDURE/PROCESS:

  1. Water should be adjusted to a comfortable temperature. Warm water is best
  2. Moisten hands well. Apply a generous amount of liquid soap. Scrub all surfaces for 10-15 seconds.
  3. Rinse by holding hands lower than your elbows. Be sure to rinse off soap completely.
  4. Dry hands with a paper towel.
  5. Turn faucet off, using a paper towel.
  6. Discard the paper towel in a proper receptacle.

NOTE: IN HOMES WITH NO RUNNING WATER, ALCOHOL GEL MAY BE USED IN THE VERY SAME MANNER HAND WASHING IS PERFORMED. WASH YOUR HANDS AT THE VERY NEXT STOP.

 

 

 

Health and Medical Division
Community Health Nursing

TITLE: Participation in Health Fairs

EFFECTIVE DATE: 11/03/03

DATE REVIEWED OR REVISED: Annually

POLICY: Community Health Nursing and the Community Health Representative will participate in local/community health fairs.

PURPOSE: To promote awareness and prevention of Diabetes and Hypertension.

PROCEDURE/PROCESS:

Equipment needed: BP cuff, stethoscope, hand cleanser, alcohol pads, AccuChek machine and supplies, scale for random weights, Group PCC forms and program brochures.

Arrive 30 minutes early to set up display, always wear name tag.

When patient arrives at booth, verify that patient has a Notice of Privacy Practice Act on file with department, obtain the patient’s date of birth or chart number if eligible for services at CIHA. Perform B/P check per P&P Manual, record BP on sign-in sheet and write down for patient on health screen card. If BP is less than 90/60 or elevated/greater than 150/90, assess patient for symptoms (headache, weakness, vision changes) and instruct in follow-up care, then document encounter on pcc. If patient reading greater 200/100, the patient will be advised to seek medical treatment immediately.

If patient would also like a random CBG done, perform procedure according to P&P Manual, then record results on sign-in sheet and health screen card. If CBG <70 and patient symptomatic of hypoglycemia (hunger, cold sweat, weakness and nervousness), instruct/assist patient in measures to increase blood sugar levels, assess response to measures and instruct on follow-up care, then document on PCC.. If CBG >300, assess patient hx for Diabetes, diet, activity and instruct on follow-up care, then document on PCC. For CBG’s of 400 or greater, the patient will be advised to seek medical treatment immediately.

 

 

 

Health and Medical Division
Community Health Nursing

TITLE: Home Assessment

EFFECTIVE DATE: 6/17/04

REVIEWED: Annually

POLICY: The PHN or designee (specifically CHR’s, Community Health CNA’s, etc.) shall assess all home environments at a level that is deemed appropriate for each individual client upon admission and on a continuing basis.

PURPOSE: To identify environmental conditions that may affect the health status, health behavior, and safety of the client.

To educate clients in areas of safety concern and assist them in determining remedies.

PROCEDURE/PROCESS:

  1. Caseload clients
    1. On the initial admission visit, and subsequently, the first visit of each calendar year, a home safety survey shall be completed. (See attachment A-4 pages)
    2. A copy of the completed survey shall be given to the client, the CHN Supervisor, and as appropriate, the client’s medical care provider.
    3. The PHN or staff member shall review the survey with the client and enlist the client’s participation in the survey. The PHN or staff member shall review the results with the client and mutually develop an action plan for resolution of concerns.
  2. Non-caseload clients
    1. If a PHN or staff member is called upon to make a home visit to an individual’s home and the individual is not on a regular caseload, an informal home safety assessment shall be conducted.
    2. An informal home safety assessment is defined as identifying hazards that can be observed in the area where the visit takes place, or in the area surrounding the home while entering or leaving the residence.
    3. If the individual desires a complete home safety assessment, it shall be conducted at the time of the visit. If time does not allow during the first visit, a time will be set for a safety assessment visit.

 

 

Health and Medical Division
Community Health Nursing

TITLE: Intramuscular and Subcutaneous Injections to Adults

EFFECTIVE DATE: 11/03/03

REVIEWED: Annually

POLICY: All Cherokee Community Health Nurses shall administer intramuscular and subcutaneous injections to adults according to the fundamental standards of nursing practice.

PURPOSE: To administer recommended immunizations or prescribed medication by injection with maximum consideration for safety, efficacy, and comfort.

PROCEDURE: General Information

  1. When giving multiple injections select a different site for each.
  2. Disposable needles and syringes should be utilized.
  3. Attempt to minimize anxiety through conversation.
  4. Two drugs (if compatible) may be mixed together in one syringe and given as one injection.

Equipment

  1. Disposable syringe with needle
  2. For intramuscular injection: 20-23 gauge, 1-1/2 inch long.
  3. For subcutaneous injection: 5/8 inch for 45 degree angle, ½ inch for 90 degree angle.*Nursing – judgment should always be used in needle selection. Consider the weight and amount of muscle mass.
  4. Individually packaged alcohol wipes or cotton balls & alcohol.
  5. Medication or Vaccine

Recommended Sites for Injection

  1. Intramuscular
    1. Deltoid
      The deltoid muscle, while convenient, can accommodate only small volumes of fluid, usually 1 ml or less, never more than 2 ml.
      The injection is given in the lateral posterior portion of the muscle, which should be grasped between the thumb and fingers so that the thickness of the muscle can be assessed.
      The tip of the needle should be angled slightly upward to avoid the major arteries and nerves of the axilla and upper arm. (See Attachment A)
    2. Gluteal
      The dorsogluteal site is composed of the thick gluteal muscles of the buttocks. The injection site must be chosen carefully to avoid striking the sciatic nerve, major blood vessels, or bone. The nurse should palpate the posterior superior iliac spine, and then draw an imaginary line to the greater trochanter of the femur. This line is lateral to and parallel to the sciatic nerve. The injection site is then lateral and superior to this line.
      The ventrogluteal site contains no large nerves or blood vessels. The nurse places the heel of the hand on the client’s greater trochanter, with the fingers pointing toward the client’s head. The right hand is used for the left hip, and the left hand for the right hip. With the index finger on the client’s anterior superior iliac spine, the nurse stretches the middle finger dorsally, palpating the crest of the ilium and pressing below it. The triangle formed by the index finger, the third finger, and the crest of the ilium is the injection site. (See Attachment B)
    3. Vastus Lateralis
      This muscle contains no major blood vessels or nerves. It is situated on the anterior lateral aspect of the thigh. The third middle of the muscle is suggested as the injection site. It is established by dividing the area between the greater trochanter of the femur and the lateral femoral condyle into thirds and selecting the middle third. (See Attachment C)
    4. Rectus Femoris
      This muscle belongs to the quadriceps muscle group. It is situated on the anterior aspect of the thigh. This site may cause considerable discomfort for some people. (See Attachment C)
  2. Subcutaneous
    Common sites for subcutaneous injections are the outer aspect of the upper arms and the anterior aspect of the thighs. Other areas that may be used are the abdomen, the scapular areas of the upper back, and the upper ventro/dorso gluteal areas.
    Injection sites need to be rotated to minimize tissue damage, aid absorption, and avoid discomfort.
    The needle may be inserted at 45 degree angle or 90 degree angle, depending on the amount of subcutaneous tissue.

Preparation and Administration

  1. Wash hands
  2. Select equipment as necessary
  3. Mentally check the “five rights”
    1. Right patient
    2. Right medication
    3. Right dose
    4. Right route
    5. Right time
  4. Draw up the medication as ordered. If the needle is to be inserted at a 90 degree angle, draw up a 0.2 cc air bubble into the syringe. Invert so that the air is near the plunger.
  5. Change the needle on syringe as indicated for certain drugs, to prevent irritation from the needle insertion.
  6. Explain the procedure.
  7. Position the patient in the appropriate position and select the injection site.
  8. Cleanse the site(s) with antiseptic.
  9. Stabilize the muscle or subcutaneous tissue with the thumb and finger.
  10. Use a dart-like motion to insert the needle at the recommended angle.
  11. Aspirate for blood and inject medication slowly if no blood is aspirated. If blood is aspirated, withdraw needle and move to alternate site.
  12. Withdraw the needle in the same direction as injected.
  13. Apply pressure and massage the area unless contraindicated.
  14. Dispose of the equipment according to blood borne pathogen guidelines. (Remember: do not recap needles under any circumstances).

Note: The Z-Track injection is a variation of intramuscular injection used to administer an intramuscular medication that is highly irritating subcutaneous and skin tissue:

A clean sterile needle should be attached to the syringe before injecting medication. Pull the skin and subcutaneous tissue about 2.5 – 3.5 cm (1 – 1&1/4 in.) to one side at the injection site. Inject medication and maintain the traction while removing the needle, then permit the skin to return to its normal position.

 

 

 

Health and Medical Division
Community Health Nursing

TITLE: Immunization Administration

EFFECTIVE DATE: 6/17/04

REVIEWED: Annually

POLICY: All nursing personnel (RN’s) shall administer immunizations according to current CDC and State of North Carolina regulations.

PURPOSE: To provide current immunizations for individuals seeking medical care through Community Health Nursing.

PROCEDURE/PROCESS:

Administration

  1. The nursing personnel shall follow current guidelines found in the DHHS/CDC manuals, “Epidemiology and Prevention of Vaccine-Preventable Disease”, and “Advisory Committee on Immunization Practice”(ACIP).
  2. Copies of the manuals shall be readily available in the CHN office.

Technique

The nursing personnel shall follow “The Cherokee Community Health Department Vaccine Routes and Sites Charts and Illustrations”, and “Immunization Reaction Protocol”.

 

Health and Medical Division
Community Health Nursing

TITLE: Incidents, Accidents, Variance Reports

EFFECTIVE DATE: 04/01/04

REVIEWED: Annually

POLICY: The incident form is used as part of the Cherokee Community Health Nursing QA Program. This form must be completed for all unusual occurrences involving a patient, employee or family member which is not consistent with regular routine, regardless of whether or not there was an apparent injury or other damage. Also, all occurrences of significant patient complaint or criticism, including complaints from a patient’s relative or friend, should be the subject of and incident report. Employee accidents or injuries are among the instances requiring an incident report.

PURPOSE: To insure that Cherokee Community Health Program has a system for reporting and documenting all incidents, accidents, variances, and unusual occurrences.

PROCEDURE/PROCESS:

  1. All employees are responsible for submitting Incident Reports as appropriate. Appropriate follow-up will be initiated by the Community Health Program Manager.
  2. When an event occurs, an Incident Report is completed by personnel aware of the occurrence.
    1. The form is completed in its entirety and submitted to the immediate supervisor within forty eight (48) hours.
    2. The narrative portion of the Incident Report should NOT contain opinions or conclusions, but rather, consist of facts, direct observations and witnessed statements.
    3. A copy of the Incident Report form will be forwarded to the Operations Director of Health and Medical Division for informational/tracking purposes only. NO OTHER COPIES OF THIS REPORT WILL BE MADE.
    4. If the occurrence involves a patient, chart precisely the necessary information on the Visit Note. Conclusionary or opinion notations such as “ERROR” or “MISTAKE,” will not be made, nor that an incident report was completed.
    5. If the occurrence involves a patient, the patient’s primary physician will be notified of the incident within forty-eight (48) hours.
  3. The employee completing the report form will immediately forward the report to his/her immediate supervisor, within forty-eight (48) hours for review and countersignature. Thereafter, the form is to be forwarded to the Community Health Program Manager for review and follow-up. The Program Manager will notify the family within forty-eight (48) hours of receipt of the Incident Report and to communicate with them and inform them of any corrective action. The information obtained from the reports will be entered in the “Unusual Occurrence Log” and used for future QA reports for the purpose of:
    1. Improving the management of patient care and treatment by assuring that appropriate and immediate intervention occurs for the patient’s safety and to assure the prevention of occurrences.
    2. Providing a datebase for Cherokee Community Health so that the care being given can be analyzed, evaluated and acted upon.
  4. All Incident Reports will be filed by month. The file will contain the original Incident Report, follow-up report and the interventions taken to prevent a recurrence.

 

 


Health and Medical Division
Community Health Nursing

TITLE: Infectious Waste

EFFECTIVE DATE: 04/01/04

REVIEWED: Annually

POLICY: All waste resulting from patient visits will be disposed of in trash receptacles in the patient’s home. All sharps will be disposed of in appropriate containers in the patients home if available or in a puncture resistant sharps container carried by the staff member.

PURPOSE: To identify the process for disposing of waste resulting from patient visits.

PROCEDURE/PROCESS:

  1. All waste resulting from patient visits by Cherokee Community Health Nursing staff will be disposed of in trash receptacles in patients home. Waste from dressing changes, etc. shall be placed in trash receptacles with a plastic liner in the p;atient’s home for disposal by the patient or caretaker.
  2. All sharps (used needles, syringes, disposable instruments, etc.) will be disposed of in a puncture resistant container (hard plastic container with lid) located in the patients home. If an appropriate sharps container is unavailable in the home, then the sharps shall be placed in a puncture resistant sharps container carried by the staff member in their field bag.
  3. When the sharps container in the field bag is 2/3 full, the sharps container will be securely closed and taken by the staff member to the Cherokee Indian Hospital and placed in the receptacle for sharps disposal located in the Laboratory.

 

 

 

Health and Medical Division
Community Health Nursing

TITLE: Medication List Policy

EFFECTIVE DATE: 04/01/04

REVIEWED: Annually

POLICY: Each patient of Cherokee Community Health will have a list of current medications included as part of the clinical record. An RN will perform assessments on an ongoing basis to determine the patient’s knowledge of his/her medications, additional teaching needed, or patient’s inability to retain such teaching.

PURPOSE: To provide a procedure for monitoring, teaching, and updating a list of medication for each Community Health patient, consistent with the plan of care.

PROCEDURE/PROCESS:

  1. The admitting RN will obtain from the patient a list of all medications, either prescribed or over the counter, including herbal remedies.
  2. This Medication Profile will include an assessment by the RN to determine the patient’s knowledge, need for teaching, or inability to retain teaching. The nurse and the patient/caregiver will sign his/her name and date the form, verifying that the medication regimen is correct. A copy of this will be kept in the patient’s home, updated as needed.
  3. The nurse will contact the patient’s physician to confirm that these are the current medications, and they will be included in the POC that is sent to the physician for signature.
  4. During each nursing visit, the nurse will ask the patient, or caregiver if present, if there have been any changes in the medications, including the patient’s decision to discontinue any medications without the physician’s knowledge.
  5. The RN case manager will review the Medication Profile at least every 60 days or when any changes are made. If there have been no modifications to the medication regimen, the nurse can sign and date at the bottom of the page with the statement “reviewed”, no changes.” If any new medications are ordered, an assessment of the patient’s knowledge or need for teaching will be performed.

 

 

 

Health and Medical Division
Community Health Nursing

TITLE: Nursing Licensure

EFFECTIVE DATE: 6/17/04

REVIEWED: Annually

POLICY: All nurses (RN, LPN) shall have a current and valid nursing license on file at all times to maintain employment.

It is the responsibililty of each individual nurse to assure his/her license is current, valid, and on file.

Failure to maintain a current and valid license shall result in immediate suspension, and pending further investigation, may result in termination of employment.

Failure to notify the supervisor and program manager of any lapses or other problem with a license shall result in immediate termination of employment as soon as the lapse or problem becomes known to the supervisor and/or program manager.

PURPOSE: To assure only duly licensed personnel are providing nursing services.

PROCEDURE/PROCESS:

  1. Upon employment, the nurse shall provide a copy of his/her unrestricted license to the employing supervisor.
  2. Immediately upon receipt of a renewed license, the nurse shall provide the supervisor with a copy in the same manner as identified above.
  3. The nurse shall abide by all rules and regulations as set by the State of North Carolina Board of Nursing in order to maintain a current, valid, and unrestricted license during his/her tenure of employment with the Cherokee Community Health Program.

 

 

 

Health and Medical Division
Community Health Nursing

TITLE: Patient Rights and Responsibilities

EFFECTIVE DATE: 6/17/04

REVIEWED: Annually

POLICY: It is the policy of Cherokee Community Health to ensure that patients will receive appropriate information and instruction concerning their rights and responsibilities, and that a procedure will be in place to review these rights on a regular basis.

PURPOSE: Each patient on the active home visit list of this program has the right to be informed of his/her rights. The RN case manager is responsible for the protection and promotion of those rights.

PROCEDURE/PROCESS:

  1. The admitting RN will review Patient Rights and Responsibilities during the initial visit, documenting the patient’s response to this teaching. A copy of Patient Rights and Responsibilities will be left in the patient’s Community Health information folder that is to remain in the home for future reference.
  2. Upon admission, each patient will receive a list of names and phone numbers to be used in case of emergency, or to register a complaint. This list will be kept in a location designated by the patient, such as in the Community Health information folder, on the refrigerator, or next to the telephone.
  3. The RN case manager will provide follow-up instructions concerning rights and responsibilities at least every 60 days, documenting the patient’s response to this teaching, and ensuring that the patient knows the location of the emergency contact list.
  4. If at any time it is determined that the patient is unable to understand this information, the patient’s caregiver will be given the information described above.

 

 

 

Health and Medical Division
Community Health Nursing

TITLE: Priority, Timeliness and Frequency of PHN Visits

EFFECTIVE DATE: 06/10/03

REVIEWED: Annually

POLICY: Community Health Nursing staff will prioritize visits, provide visits in a manner and
determine frequency/intensity of visits based on the parameters outlined
under “Procedure” section below.

PURPOSE: To identify and prioritize target population groups requiring Public Health
Nursing Services.

To provide guidelines for timeliness of visits.

To identify realistic spacing of public health nursing contacts according to
identified large population groups.

To utilize levels of disease prevention and health promotion in planning
nursing service to a community.

PROCEDURE:

A. Prioritization of Referral (Please see attachment A for detailed listing)

Upon receipt of referral, PHN will prioritize referral based on the following
Priority categories:

1. Priority 1- Intensive visits (visits spaced every 4 -10 days until client meets
criteria for discharge from PHN services).

    1. Active communicable/infectious disease.
    2. Acute or chronically ill patient requiring prompt skilled nursing intervention and/or family instruction.
    3. High risk maternity patients (Prenatal, Post Partum, Women’s Health)
    4. High risk neo-nate, infant, child.
    5. Neglected or abused individuals.
    6. Psycho-social emergency situations.
    7. Emergency situations involving safety hazards (Poisoning, accidents, etc.).
    8. Self neglect including, non compliance with medical regime Emergency or potentially life threatening.
    9. Acute illness/crisis of individual living in a vulnerable family
    10. Vulnerable families – need for PHN to periodically monitor/evaluate or reassess health/psychosocial and provide family/individuals with support and assist in developing coping/problem solving skills.

Timeliness for PHN Response to Referrals

After PHN receives referral, PHN will respond to referral in a timely manner within 2 working days after receipt of referral. PHN is to make contact with patient within the timeframe specified in order to evaluate immediate situation. If initial evaluation cannot be scheduled within the 2 working days, a note of contact, with reason for delayed evaluation shall be documented on the initial referral and returned to source of referral.

Frequency/Intensity of PHN Visits

When PHN has completed initial evaluation, PHN will prioritize referral and determine intensity/frequency of PHN visits based on the following guidelines:

  1. Priority I – Intensive Visiting ( visits spaced every 4 -10 days) until client meets Criteria for discharge – refer to PHN Policy on Admission, Continuation or Discharge Criteria.
  2. Priority II – Periodic Visiting (visits spaced every 2 – 8 weeks) until client meets criteria for discharge.

ATTACHMENT A

PRIORITY, INTENSITY, AND TIME LINES FOR PUBLIC HEALTH NURSING


PRIORITY I/ TIME LINES FOR INITIAL CONTACT:
Requiring visits/initial contact within 2 working days after receipt of referral.

INTENSITY OF VISITS:
Visits every 4 – 10 days until client changes to another level of intensity or meets criteria
for discharge.

  1. ACTIVE COMMUNICABLE/INFECTIOUS DISEASE:
    Needing treatment, case contact investigation and/or client education (includes STD).
  2. ENVIRONMENTAL DISASTER.
  3. NEWLY DIAGNOSED ACUTE OR CHRONICALLY ILL:
    Clients/family requiring prompt, skilled nursing intervention and/or instruction, acute post surgical. Examples: Monitoring/evaluation of S/S of infection: administration of medications: dressing changes; use of special equipment; diet teaching.
  4. HIGH RISK MATERNITY PATIENTS:
    *Multiple gestation with complications.
    *Single parent or client without family support.
    *Third trimester prenatal without prenatal care.
    *Current medical complication.
    *Current alcohol/substance abuse.
    *Current domestic violence.
    *Poor nutritional status.
    *Socio-economically stressed home environment.
    *Primiparas and multipara with five or more pregnancies.
    *Prenatals under 19 or over 35 years of age.
    *History of previous medical complications.
    *History of previous alcohol/substance abuse.
    *Multiple gestation without complications.
    *History of previous domestic violence.
  5. HIGH RISK POST PARTUM CLIENTS:
    *Premature or multiple birth delivery
    *Complications of labor, delivery or puerperium.
    *Clients with history of prenatal medical problems.
    *Breast feeding problems/complications.
    *Delivery resulting in infant death or severe congenital anomalies with need for
    emotional/psychological support.
    *Client from socio-economically stressed home environmental.
    *Clients needing additional teaching (parenting, child care).
    *Primiparas
    *Clients under 19 or over 35 years of age.
    *Single parent with family support.
    *Clients with history of substance abuse or domestic violence.
  6. HIGH RISK NEONATE/INFANT/CHILD
    *Infants transferred to other facilities.
    *Clients with medical problems and/or congenital anomalies.
    *Neonates with complications of labor/delivery.
    *Premature infants or low birth weight (2500 grams at birth).
    *Infant(s) of multiple birth delivery.
    *Failure to thrive or lack of other normal physiological/mental development.
    *Evidence of poor maternal/infant bonding.
    *Infants born to mothers with a history of alcohol/substance abuse.
    *Infant/child in socio-economic stressed homes needing PHN services.
    *Infant/child in dysfunctional or vulnerable families needing PHN service.
    *Clients in families with history of domestic violence.
    *Infant/child of teen parent (s) in need of PHN services.
    *Clients whose parents have cognitive or learning deficits.
    *Client with single parent in need of PHN services.
  7. NON-COMPLIANCE WITH MEDICAL TREATMENT:
    With potentially life threatening or adverse consequences.
  8. NEGLECTED OR ABUSED INDIVIDUALS:
  9. PSYCHO-SOCIAL EMERGENCY SITUATIONS when Mental Health Staff not available:
    EXAMPLE: Suicide threat (attempt/gesture), ETOH withdrawal or other life threatening emotional disturbance.
  10. HOUSEHOLD ACCIDENTS:
    Situations involving poisoning, falls, suffocation, drowning, burns, major cuts, etc.
  11. ACUTE ILLNESS OR CRISIS OF AN INDIVIDUAL LIVING IN A VULNERABLE FAMILY:
    *Multi-problem crisis prone family.
    *Socio-economically stressed family with inadequate resources.
    *Dysfunctional families in need of referral, teaching, monitoring, or case management.
    *Single parent families.
  12. TERMINALLY ILL CLIENTS AT END STAGE:
    Needing PHN services.


PRIORITY II:

INTENSITY OF VISITS:
Visits every 2 – 8 weeks until client changes to another level of intensity/meets criteria for discharge.

  1. ACTIVE COMMUNICABLE DISEASE UNDER TREATMENT:
    Clients in need of education of how to arrest/prevent transmission to others in a household/community.
  2. NEWLY DIAGNOSED CHRONIC OR TERMINAL DISEASE:
    Under treatment but without adequate family support in need of PHN intervention/support for follow through of medical treatment plan, teaching of appropriate interventions, prevention of complications and knowledge of resources.
  3. PRENATAL/POST PARTUM/NEWBORN:
    Without complications but in need of basic MCH supervision and patient education.
  4. NON-COMPLIANCE WITH MEDICAL TREATMENT non-emergency:
    Presenting hazards to health.
  5. NON-EMERGENCY PSYCHO-SOCIAL SITUATIONS:
    Needing PHN support to cope, seek appropriate intervention, and identify resources.
    EXAMPLE: unresolved grief, dysfunctional family situation.
  6. INFANTS/CHILDREN/ADULTS WITH SPECIAL NEEDS:
    Needing PHN support to cope and/or access resources.
    EXAMPLE: Mental or physical developmental deficits.
  7. DELINQUENT IMMUNIZATION STATUS:
  8. CLIENTS WITH HISTORY OF RECURRENT EPISODES OF ILLNESS OR HOSPITALIZATION:
  9. ENVIRONMENTAL HAZARDS:
    Issues that need PHN assistance to identify SAFETY HAZARDS and resources for correction.
  10. HEALTH PROMOTION/DISEASE PREVENTION:
    Individual, family and community education. Clients with knowledge deficit needing teaching regarding disease, treatment, medication, and understanding principle needed to carry out treatment.
  11. CHRONIC OR DEBILITATING ILLNESS OR INFECTION/COMMUNICABLE DISEASE UNDER TREATMENT WITH FAMILY SUPPORT:
    Needing occasional PHN monitoring, intervention, assessment, evaluation or education.
  12. INDIVIDUALS, FAMILIES OR GROUPS WITH HEALTH PROMOTION DISEASE PREVENTION ISSUES:
    Including screening for such as seniors, diabetes, schools, etc.
  13. INDIVIDUALS/FAMILIES WHO HAVE REACHED HIGHEST LEVEL OF FUNCTION:
    Needing PHN intervention to prevent regression.


 

 

 

Health and Medical Division
Community Health Nursing

TITLE: Processing PCC Forms

EFFECTIVE DATE: 6/17/04

REVIEWED: Annually

POLICY: All Health and Medical PCC forms will be processed in an efficient, accurate and timely manner.

PURPOSE: Establish the procedure for processing PCC forms.

PROCEDURE/PROCESS:

  1. PCC forms should be processed on a daily or weekly basis.
  2. A PCC Processor should be identified at each clinical site. This person will be responsible for checking errors correcting them before they are processed.
  3. Before the PCC form is processed, the clinic processor should make sure:
    1. The form contains the name of the provider
    2. The patient’s name is legible
    3. The purpose of the visit is listed
    4. The date of birth is listed
    5. The chart number listed.
    6. The clinic location is documented at the top of the form*
      (*Cherokee Diabetes Program outside the IHS facility, Snowbird, Cherokee, etc.)
  4. After the processor has checked the form they should:
    1. Tear the PCC form apart and
    2. Batch by month and day
  5. PCC forms will be processed in the following manner:
    A PCC consists of 4 copies, the white copy and two yellow copies
    1. The original WHITE COPY will be filed in the patient’s medical record in the Community Health Nurse’s office, after review for completion by the CHN Supervisor or designee. A photocopy may be sent to CIHA for the patient’s medical record there, per medical provider request, or if it contains pertinent information relating to recent changes in patient’s status.
    2. The PINK COPY should be sent to Third Party Billing at Health and Medical Division.
    3. One YELLOW COPY should be filed in the patient’s medical record on completion, until the original copy can be placed in the file.
    4. The other YELLOW COPY, which may be illegible, may be shredded.
  6. Third Party Billing office hours are from 7:45-4:30.

 

 

Health and Medical Division
Community Health Nursing

TITLE: Referrals To/From CHN Department

EFFECTIVE: 11/03/03

REVIEW: Annually

POLICY: The Community Health Nursing Department will accept referrals from EBCI medical providers, EBCI nursing providers, social services, local public health agencies, other Tribal programs, and community members. Referrals from medical providers will be followed by written orders when appropriate.

The Community Health Nursing Department will make referrals to other providers through oral and written form.

Confidentiality standards are to be adhered to at all times, and compliant with applicable HIPAA regulations.

PURPOSE: To provide access to Community Health Nursing services within the EBCI Tribal community.

To assist patients in obtaining an acceptable level of self-care after illness, injury, or hospitalization.

To provide appropriate sharing of information to assure proper care is provided to the patient and/or family.

PROCEDURE:

Incoming Referrals

Incoming referrals shall be accepted by the Community Health Nursing supervisor or designee. All referrals must be documented on an Intake Referral Sheet, and submitted to the CHN supervisor, who then assigns an RN for follow-up.