Policy and Procedure Manual

The

Policies and Procedures

of

Qualla Youth Health Center

 

Table of Contents

 

 

 

 

Health and Medical Division
Qualla Youth Health Center

SUBJECT: Administration of Allergy shots

PURPOSE: To define the policy and procedure for administration of allergy shots at the Qualla Youth Health Center.

STAFF GOVERNED BY THIS POLICY: Qualla Youth Health Center

EFFECTIVE DATE:

DATE REVIEWED OR REVISED: November 5, 2003

DISTRIBUTION: Qualla Youth Health Center (QYHC), Health and Medical Division

POLICY:

The QYHC is a medical clinic for children and adolescents and whereas, certain patients in our population are placed on allergy shots to help build immunity to certain allergens, the QYHC will administer allergy shots to patients who are under the care of an Allergist. These patients will bring in their medication along with their shot schedule. The QYHC will not be responsible for acquiring allergy medication for the patient or reordering the medication. The parent or guardian must bring in shot schedules, medications to be administered, and the name of the Doctor the patient is seeing.

PROCEDURE:

  1. The parent or guardian will contact the QYHC to inform the clinic that they wish to continue their child’s allergy shots at the QYHC.
  2. The parent or guardian will bring in a letter from the Allergist office confirming that the allergy shots may be administered at the QYHC.
  3. The parent or guardian will bring in the medications to be administered along with the shot schedule for the patient to follow.
  4. The QYHC will not administer allergy shots for the following bee stings due to the increased risk of anaphylatic reaction.
  5. Once all of the previous conditions have been met the patient will be set up for shot administration.
  6. The allergy shot will be administered to the patient after all vital signs have been taken.
  7. The nurse will follow the schedule developed by the Allergist.
  8. After the injection has been given the patient will wait approximately 20 minutes before leaving the clinic to ensure no reaction is taking place.
  9. The nurse will follow standard procedure of administration of subcutaneous injectables as described in Nursing Procedures 3rd edition by Springhouse p.239.
  10. Parents will be notified when the medication is near the end of the vial, so new vials can be obtained.
  11. The Allergist will be notified by the QYHC when the series of injections is complete.

 

 

 

 

Health and Medical Division
Qualla Youth Health Center

SUBJECT: After hours coverage for the QYHC

PURPOSE: To ensure that patients have access to medical providers after office hours.

STAFF GOVERNED BY THIS POLICY: Qualla Youth Health Center

EFFECTIVE DATE:

DATE REVIEWED OR REVISED: November 5, 2003

DISTRIBUTION: Qualla Youth Health Center

POLICY:

The QYHC operates on a daily basis and with posted hours of operations. To ensure that patients of the QYHC will have after hours coverage all patients will be instructed to seek care at the CIH facility Emergency Room.

PROCEDURE:

  1. If the patient arrives at the Clinic after the hours that are posted, a sign will be posted for the patient to go to the Emergency Room at the CIH facility to be seen by a Medical Provider.
  2. The answering machine will be turned on after hours and the message will state that if the patient needs to be seen before the clinic reopens, seek care at the CIH facility.

 

 

 

 

Health and Medical Division
Qualla Youth Health Center

SUBJECT: Bio-hazard Waste Removal

PURPOSE: To define the process for bio-hazard waste removal from the QYHC.

STAFF GOVERNED BY THIS POLICY: Qualla Youth Health Center

EFFECTIVE DATE:

DATE REVIEWED OR REVISED: November 5, 2003

DISTRIBUTION: Qualla Youth Health Center

POLICY:

The QYHC is a medical clinic and has a daily need for bio-hazard materials to be disposed of properly.

PROCEDURE:


All needles are to be disposed in the needle boxes.

Bio-hazard Red Waste Bags should be used for the following:

  1. Containers with 20 cc or more body fluids.
  2. Accumulated waste. More than one pelvic or procedure should go in the red bags.
  3. If fluid is compressed, runs or flakes.

Things that should not go into red bags for disposal:

  1. Urine specimen cups.
  2. Urine HCG tests.
  3. Ordinary waste, packing materials, or computer paper goes into regular waste.
  4. Gowns, paper covers, or paper towels.

When needles boxes are 2/3 full they will be closed and a new one will be started.
All red bio-hazard waste bags will be placed in the red waste container in the lab room.
When the bio-hazard waste container is 2/3 full the Safewaste company will be notified that the QYHC needs it to be picked up and disposed of properly. They will also pick up full needle boxes.

 

 

 

 

Health and Medical Division
Qualla Youth Health Center

SUBJECT: Bomb Threat

PURPOSE: To define the process if a Bomb Threat is received at the QYHC.

STAFF GOVERNED BY THIS POLICY: Qualla Youth Health Center

EFFECTIVE DATE:

DATE REVIEWED OR REVISED: November 5, 2003

DISTRIBUTION: Qualla Youth Health Center

POLICY:

The QYHC will follow the following procedure if a bomb threat is received at theClinic.

PROCEDURE:

  1. A bomb threat may be received by various means, but will usually be by telephone.
  2. The recipient of the call will attempt to obtain information from the caller using a checklist for such information. See attached form.
  3. The recipient of the call will immediately notify the director or designee.
  4. The Director will immediately call the Cherokee Police Department.
  5. No search of the premises will be made by the QYHC staff. However, unusual items should be noted and reported to the law enforcement search team.
  6. The Director or designee will inform all patients and staff of the bomb threat and begin evacuation proceedings. To avoid the risk that the bomb threat is real, the building will be evacuated in all cases.
  7. Staff will assist all patients from the building and then remove themselves.
  8. If time permits, staff should see that a few windows are opened and that doors are propped open when leaving the building.
  9. The Director or designee will see that everyone evacuates at least 500 feet from the building to a specified area.
  10. The Director or designee will inform the law enforcement officals of any missing persons.
  11. No staff shall conduct any search for missing persons.
  12. Patients and staff will not return to the building until it has been declared safe by the appropriate officials.

 

 


Health and Medical Division
Qualla Youth Health Center

SUBJECT: Child Abuse and Neglect Reporting

PURPOSE: Reporting of abuse

STAFF GOVERNED BY THIS POLICY: All Staff

EFFECTIVE DATE: November 5, 2003

DATE REVIEWED OR REVISED: July, 2004

DISTRIBUTION: Qualla Youth Health Center

POLICY:

According to state and federal law, a health care provider is bound to report any suspension of abuse.

PROCEDURE:

Any staff, which may suspect any form of abuse, may report that suspension.

 

 

 


Health and Medical Division
Qualla Youth Health Center

Clinical Photography Policy

 

 

 

 

Health and Medical Division
Qualla Youth Health Center

CODE OF CONDUCT
EASTERN BAND OF CHEROKEE INDIANS
HEALTH & MEDICAL DIVISION


POLICY

All Health and Medical Division programs (“the programs”) conduct their activities in accordance with the highest ethical medical and legal standards. Every individual in the programs must understand these standards and comply with them. Every individual must also learn and maintain current knowledge of the policies, rules and laws that cover his or her area of responsibility.

Behavior that violates these standards will result in disciplinary action. It is every individual’s responsibility to act ethically and to report any activity that could violate these standards.

These standards of conduct cannot, and do not, cover every situation you may face. If there is question or doubt regarding any situation, seek advice from your supervisor, other management staff, the Compliance Officer Teri Price, the Legal Division, or the compliance hotline (800-455-9014).


Standards of Conduct

  1. We provide high quality medical care.
  2. We keep patient information confidential.
  3. We are honest.
  4. We keep thorough and accurate records.
  5. We avoid even the appearance of a conflict of interest.
  6. We report behavior or requests that may be unethical or illegal. We do not retaliate against those who make such reports.
  7. We are good stewards of the property and resources entrusted to us.
  8. We maintain a safe working environment.
  9. We learn what we need to know to fully comply with these standards and the law.

    Guidelines and Explanations

1. We provide high quality medical care to the Cherokee people.

This standard includes:

  • Providing high quality health care services that meet the needs of our patients in a way that is consistent with the history and culture of the Cherokee people.
  • Provide all appropriate medically necessary services that patients need, in compliance with professional and legal standards.
  • Treating all patients with dignity and respect, consistent with our mission.

2. We keep patient information confidential.

This standard includes:

  • Respecting the privacy of all patients.
  • Not disclosing any information about a patient’s medical condition except as authorized by that patient, as needed for appropriate medical treatment, or as required by law.
  • Not retrieving or gathering information about a patient that is not required in the performance of ones duties.
  • Full compliance with other written confidentiality policies.

3. We are honest.

This standard includes:

  • Honest and accurate communication with patients and their families, as well as co-workers, supervisors, and outside agencies.
  • Billing only for the services we actually provide.
  • Avoiding “upcoding” or billing for a higher level of service than was actually provided, in order to obtain a higher reimbursement rate.
  • Avoiding “undercoding” or billing for a lower level of service than was actually provided, to obtain reimbursement for services that insurers may not cover.
  • Billing only for those medically necessary procedures (including not submitting a bill to Medicare, Medicaid or other insurance provider, for services that are above and beyond the funding source’s standards).
  • Seeking guidance from others before submitting a bill or taking any action that appears uncertain or questionable.
  • Accepting responsibility for mistakes and working quickly and cooperatively to resolve any problems created by those mistakes.

4. We keep thorough and accurate records.

This standard includes:

  • Thoroughly documenting all medical treatment and other patient information.
  • Ensuring that all books of account, financial statements, records and other documents are handled honestly and recorded accurately.
  • Maintaining all documentation necessary to support services billed to patients, the Federal government, or other third-party payers.
  • Ensuring that Tribal funds are well spent and accounted for.

5. We avoid even the appearance of a conflict of interest.

This standard includes:

  • Avoiding all personal interests (financial investments, family businesses, etc.) that could impact, or appear to impact, decisions made for the programs.
  • We will not solicit or accept personal gifts, favors, loans, cash, uncompensated services or other types of gratuities or hospitality from organizations doing business with the Health and Medical Division, competitors of HMD, co-workers, patients, families of patients or referral sources. However, the acceptance of an occasional gift or entertainment of nominal value, which does not create a corrupting influence, is acceptable. If an employee has doubt as to the appropriateness of a gift, he or she should seek guidance from Administration or Human Resources, the Compliance Officer or the HMD Hotline.
  • Fully disclosing any potential conflict of interest to supervisors and the Compliance Officer
  • (It does not violate this standard to accept culturally appropriate gifts from patients or their families which would be considered rude to reject, so long as the patient or family are not doing business with the programs.)

6. We report behavior or requests that may be unethical or illegal. We do not retaliate against those who make such reports.

This standard includes:

  • Reporting immediately any actions that are believed in good faith to be illegal or to violate these standards, including self-reporting.
  • Reporting immediately any request by another person to break the law or violate these standards.
  • Making the report to a supervisor, other management staff, the Tribal Internal Audit office, the Legal Division, or the compliance hotline (800-455-9014).
  • Never retaliating against any staff member who makes a good faith report under this standard.
  • Keeping as confidential as possible, all those who do report in good faith any actions believed to be illegal or to violate these standards.

7. We are good stewards of the property and resources entrusted to us.

This standard includes:

  • Treating program property with care and protecting it from damage, loss or theft.
  • Using financial resources wisely and frugally.
  • Avoiding frivolous or unnecessary expenditures of program funds.
  • Working to maximize program resources by generating accurate and careful documents needed to obtain reimbursement from appropriate sources.

8. We maintain a safe working environment.

This standard includes:

  • Reporting any conditions that may create a safety hazard for patients or staff.
  • Properly disposing of all hazardous materials and medical waste.
  • Reporting all accidents involving injury to a patient, employee or visitor.

9. We learn what we need to know to fully comply with these standards and the law.

This standard includes:

  • Devoting the time necessary to learn the complex medical and legal requirements that govern our work, and providing training opportunities for all staff.
  • Complying with all applicable Tribal and Federal regulations and guidance about documenting, coding, billing, and accounting for financial resources.
  • Complying with the Tribe’s Personnel Policy, applicable program policies and procedures, and all other applicable rules and regulations.

 


 

Health and Medical Division
Qualla Youth Health Center

Community Disaster Plan

 

 

 

 

Health and Medical Division
Qualla Youth Health Center

SUBJECT: Confidentiality of minor patients

PURPOSE: To define the policy and procedure concerning confidentiality at the Qualla Youth Health Center

STAFF GOVERNED BY THIS POLICY: Qualla Youth Health Center (QYHC)

EFFECTIVE DATE: July, 2000

DATE REVIEWED OR REVISED: November 5, 2003

DISTRIBUTION: QYHC, Health and Medical Division

POLICY:

In accordance with state statues and federal regulations the Qualla Youth Health Center will keep all facts relating to services (communicable diseases, pregnancy, substance abuse, or emotional disturbances) to minor individuals confidential unless it is determined by the Medical Provider that notification is essential to the life or health of the minor involved.

Federal regulation 42 C.F.R. 41a.6 states

All information as to personal facts and circumstances obtained by the staff about recipients of services shall be held confidential and shall not be disclosed without the individual’s consent, except as may be required by applicable law or as may be necessary to provide for medical audits by the Secretary of Health and Human services with appropriate safe guards for confidentiality of patient records. Otherwise, information may be disclosed only in summary, statistical, or other forms which does not identify particular individuals.

N.C. General Statue 90-21.5(b) states:

The physician providing 90-21.5 confidential services (communicable diseases, pregnancy, substance abuse, or emotional disturbances) to a minor shall not notify a parent, legal guardian, or custodian unless the situation, in the opinion of the attending physician, indicates that notification is essential to the life or health of a minor.

N.C. General Statute 7A-544 states:

When a report of abuse, neglect, or dependency, is received (by the department of social services)… the Director or the Director’s representative, may make a written demand for any information or reports, whether or not confidential, that may, in the Director’s opinion, be relevant to the protective services case. “and further” … any public or private agency or individual shall provide access to and copies of this confidential information and these records to the extent permitted by Federal law and regulations.

HIPAA 45 CFR 164.502(g)
Refer to HIPPA policy and procedues

PROCEDURE:

  1. All staff of the Qualla Youth Health Center shall keep all medical and personal information of all patients including minors confidential, as required by law, and shall adhere to the exceptions to confidentiality that are expressly laid out by law.
  2. All staff shall be trained in this policy when hired, and updated as necessary. All staff shall provide patients with a copy of this policy upon request. The Medical practitioner assigned to a patient whose confidentiality is an issue shall be the final decision maker for the Qualla Youth Health Center on questions of interpretation of this confidentiality policy.
  3. Any failure of staff members to observe the ethics of confidentiality will be regarded as cause for disciplinary action.

 

 

 

 

Health and Medical Division
Qualla Youth Health Center

SUBJECT: Diabetic Screening

PURPOSE: To define the policy and procedure for diabetic screening

STAFF GOVERNED BY THIS POLICY: Qualla Youth Health Center

EFFECTIVE DATE:

DATE REVIEWED OR REVISED: November 5, 2003

DISTRIBUTION: Qualla Youth Health Center

POLICY: The Qualla Youth Health Center serves the Native American population of the Eastern Band of Cherokee Indians. This population is at high risk for Diabetes. The QYHC will screen and glucose test all individuals who are 12 years and older on an annual basis and any patient who the Medical Provider deems is a high risk.

PROCEDURE:

Personnel conducting the screening will be adequately trained and demonstrate competency in the testing procedure.

If the patient is 12 years and older the screening will occur on an annual basis.

If the patient is under 12 years of age and accompanied by a parent or if parental permission is obtained then the patient will be checked.

See Nursing Procedures page 137-138, 3rd Edition, Springhouse for the procedure on how to do a fingerstick glucose check.

The following guidelines will be followed for referring patients for follow-up medical care and education:

A diagnostic fasting lab glucose will be ordered for participants identified with the following criteria:

  1. Screened non-fasting with a glucometer reading of greater than or equal to 120mg/dl.
  2. Screened fasting with a glucometer reading of greater than or equal to 95mg/dl.
  3. Screened non-fasting with a laboratory glucose of greater than or equal to 140 mg/dl (consider greater than or equal to 130 mg/dl if patient is at high risk for DM and/or it has been more than 2 hours since last meal.)
  4. Fasting is defined as no food or drink other than water for 8 hours.
  5. For individuals who have a positive screening test these patients will be scheduled with Cherokee Diabetes and Prevention Program.
  6. Parents will be informed of the patients condition (if they are not present in the clinic) and the referral appointment time.

Health and Medical Division
Qualla Youth Health Center

SUBJECT: Dispensing of Medications thru the QYHC

PURPOSE: To define the process for acquiring medications from the CIH facility.

STAFF GOVERNED BY THIS POLICY:

EFFECTIVE DATE:

DATE REVIEWED OR REVISED: November 5, 2003

DISTRIBUTION: Qualla Youth Health Center

POLICY:

The QYHC sees patients and at times medical treatment requires that medication be administered, these medications are called into the CIH pharmacy. The medications must be present on the CIH formulary.

PROCEDURE:

  1. The Medical provider will order the medication for the patient.
  2. The order will be called in to the CIH pharmacy.
  3. If the medication to be dispensed to the patient is in shot form, the medication will be picked up at the pharmacy by any QYHC staff member.
  4. The patient will be scheduled to return to the QYHC for administration of the injection.
  5. If the patient wishes to pick up the by mouth medications at the hospital, it is preferred.
  6. If the patient wishes to return to the QYHC for their medications, the medication will be ordered at the hospital and picked up at the end of the business day. The medication will be available for the patient, at the QYHC the following day. This is most useful for the patient requiring confidentiality.
  7. The QYHC will stock over the counter medications to be dispenced at the providers descrestion.

 


Health and Medical Division
Qualla Youth Health Center

SUBJECT: Eligible Patient Population

PURPOSE: Define the patients that are eligible for Qualla Youth Health Center Services

STAFF GOVERNED BY THIS POLICY: Qualla Youth Health Center

EFFECTIVE DATE:

DATE REVIEWED OR REVISED: November 5, 2003

DISTRIBUTION: Qualla Youth Health Center

POLICY:

The Qualla Youth Health Center provides medical services to all person who are eligible for services at the Cherokee Indian Hospital Service Facility. This includes enrolled members of the Eastern Band of Cherokee Indians, first descendents of enrolled members of the Eastern Band of Cherokee Indians, enrolled members of other federally recognized tribes and anyone else designated by the Cherokee Indian Hospital Health Service Facility.

PROCEDURE:

  1. When a patient calls for an appointment the person answering the phone will inquire if the patient has been seen previously in the clinic. If the patient has not been seen, the age of the patient will be established, along with their eligibility to be seen at the Clinic.
  2. In the event they do not have an open chart at the Cherokee Indian Hospital they will be required to do so prior to their initial appointment.

 

 

 


Health and Medical Division
Qualla Youth Health Center

Exposure Control Plan

 

 

 

 

Health and Medical Division
Qualla Youth Health Center

SUBJECT: Family Planning and Birth Control

PURPOSE: To define the policy and procedure for family planning and birth control as it is utilized at the Qualla Youth Health Center

STAFF GOVERNED BY THIS POLICY: Qualla Youth Health Center (QYHC)

EFFECTIVE DATE: July 2000

DATE REVIEWED OR REVISED: November 5, 2003

DISTRIBUTION: Health and Medical Division, QYHC

POLICY:

The QYHC serves the teen population of the Eastern Band of the Cherokee Nation. North Carolina Statute 90-21.5 allows a minor to consent to health services for the prevention, diagnosis, and treatment of pregnancy. This statute gives the minor direct ability to obtain contraceptives in the absence of parental consent. The QYHC will counsel and administer contraceptive to any patients who request such information and family planning.


PROCEDURE:

When a person presents to the QYHC for information on Family Planning/ Birth Control the nurse will counsel the patient of the methods of birth control: absteince, condoms, oral contraceptives, and Depo-Provera.

All patients will be given handouts with information on oral contraceptives and depo-provera and other forms of birth control. These handouts will contain information concerning side effects, contraindications for use, and how to use. (See attachment for copies of these handouts.)

Each patient will also be counseled on Sexually Transmitted Diseases and the diagnosis, prevention, and transmission of these diseases.

After each patient is informed of all methods of birth control and screened by the Nurse, the Mid-level provider will order any medicines which the patient and the provider in collaboration have determined is appropriate for the patient. (See attached screening questionaire)

The patient will be followed by the QYHC for any questions or problems which could arise after the start of the Family Planning.

See policy and Procedure for Depo-Provera administration

All medical records and conversations concerning patients will be kept confidential as defined in the policy and procedure confidentiality of minor patients.

 

 

 

 

Health and Medical Division
Qualla Youth Health Center

SUBJECT: Fire Plan

PURPOSE: To provide a plan of action in the event of a fire in the clinic.

STAFF GOVERNED BY THIS POLICY: Qualla Youth Health Center (QYHC)

EFFECTIVE DATE:

DATE REVIEWED OR REVISED: November 5, 2003

DISTRIBUTION: Qualla Youth Health Center (QYHC)

POLICY:

The QYHC is a medical clinic and houses staff, as well as patients. A fire plan is established for the safety of all occupants of this facility.

PROCEDURE:

  1. A copy of this plan along with a floor plan identifying exits, exit routes and location of fire extinguishers will be maintained in the clinic and with the Cherokee Fire Department.
  2. Each employee is required to read and understand the plan of action in the event of an actual or suspected fire in the facility.
  3. The Following anagram will be utilized in case of fire in the clinic:

    RACE
    R= RESCUE staff will safely remove and rescue all patients in the immediate area of the fire.
    A=ALARM sound the alarm, call 911.
    C=CONTAIN limit the spread of the fire, close the door, windows in the immediate
    area
    E=EXTINGUISH using the proper fire extinguisher, entinguish the fire

  4. The facility is a single story metal building housing the QYHC along with the Boys and Girls Club. There are 14 rooms located in the QYHC. The exterior walls are constructed of metal and the interior wall are constructed of wood and sheet rock.
  5. The fire alarm system consists of smoke alarms.
  6. The smoke alarms will be checked on a quarterly basis. Batteries in the units will be changes every January or sooner if they begin to signal “low battery.”

PLAN OF ACTION
In the event that a smoke detector signals without evidence of visible smoke or fire:

  1. The Nurse or Office Manager will evacuate all patients from the building
  2. The Medical Provider will call 911 and report that a smoke alarm is sounding
  3. All personnel will than search the building for any signs of fire and attempt to contain and extinguish the fire.
  4. If there is no visible signs of fire and the alarm continues to sound, the patients will not re-enter the building until the Fire Department has inspected the building and cleared the building of any possible fire.
  5. The Medical provider will notify Cherokee Health Delivery of the current condition.

In the event of an actual fire

  1. The staff member on duty will evacuate the patients from the building.
  2. A staff member will dial 911 from the nearest facility( Best Western, Cheveron, or Girls and Boys Club)
  3. If possible the staff will attempt to contain and extinguish the fire.
  4. The Medical provider will notify Cherokee Health Delivery of the outcome.

 

 

 

 

Health and Medical Division
Qualla Youth Health Center

SUBJECT: Flextime

PURPOSE: Define Flextime procedure

STAFF GOVERNED BY THIS POLICY: Qualla Youth Health Center

EFFECTIVE DATE:

DATE REVIEWED OR REVISED: November 5, 2003

DISTRIBUTION: Qualla Youth Health Center

POLICY:

In an effort to be receptive of the demands placed on personnel in the Qualla Youth Health Center at times it is necessary to work additional hours that are not part of the staff’s normal working hours. Examples are blood drives, health and safety days, patient contact later than the close of the day.

PROCEDURE:

  1. When work activities are necessary outside the normal office hours; notify the Qualla Youth Health Center director as early before the event as possible, so that you will be earning flextime. This applies for utilizing flextime also.
  2. Place a notation of the extra activity or use of earned flextime in the office appointment book.
  3. Place a notation of earned or used time in the log located in the computer room.

 

 

 


Health and Medical Division
Qualla Youth Health Center

SUBJECT: Hand Washing Procedure

PURPOSE: To protect employees and patients against contamination and cross infection.

STAFF GOVERNED BY THIS POLICY:

EFFECTIVE DATE:

DATE REVIEWED OR REVISED: November 5, 2003

DISTRIBUTION: Qualla Youth Health Center

POLICY:

The QYHC is a medical clinic and in the course of the office day will see patients one after another. To prevent spread of infectious diseases and cross contamination between patients the staff member will wash his/her hand after every patient contact.

PROCEDURE:

Hand washing is the most effective technique for preventing the spread of infection.
Cleanse hands after toileting, handling body secretions, after removing gloves, giving care to the patient and after any procedure.

  1. Turn on water to comfortable temperature.
  2. Moisten hands with water and apply heavy lather of soap.
  3. Scrub well for 10-15 seconds.
  4. Pay particular attention to areas between finger, around nail bed and under fingernails.
  5. Rinse well under running water.
  6. Dry hands with paper towels.
  7. Turn off facet off, using paper towel.
  8. Discard paper towel.
  9. Use of alcohol gel is permitted between patient visits.

 

 

 


Health and Medical Division
Qualla Youth Health Center

SUBJECT: Inquiries of laboratory results and radiology reports

PURPOSE: To define the policy and procedure for inquiring about results from labs and radiology exams.

STAFF GOVERNED BY THIS POLICY:

EFFECTIVE DATE:

DATE REVIEWED OR REVISED: November 5, 2003

DISTRIBUTION: CIH Laboratory and Radiology Departments

POLICY:

The Qualla Youth Health Center sees patients who require certain labs and radiology exams, these patients are sent to the CIH facility for these procedures.

PROCEDURE:

  1. After the Medical Provider establishes a need for initial/follow-up labs or radiology exams.
  2. The nursing staff will complete the necessary forms and instruct patient on how to proceed in acquiring these services.
  3. See attached forms.
  4. Upon receiving results the Medical Provider will review and make necessary patient contact for any follow-up.
  5. All results are duplicated and placed in the patients chart.


 

 

 

Health and Medical Division
Qualla Youth Health Center

SUBJECT: Lice Infestations

PURPOSE: To define the policy and procedure for dealing with patients who present with lice infestations.

STAFF GOVERNED BY THIS POLICY: Qualla Youth Health Center

EFFECTIVE DATE:

DATE REVIEWED OR REVISED: November 5, 2003

DISTRIBUTION: Cherokee Elementary School, Cherokee High School

POLICY:

Lice infestations cause a health, academic and social dilemma for school age students/children, the Qualla Youth Health Center has adopted a procedure for dealing with this problem.

PROCEDURE:

  1. The Qualla Youth Health Center will refer all head checks back to the appropriate school system.

 

 

 

 

Health and Medical Division
Qualla Youth Health Center

SUBJECT: Medical Records

PURPOSE: To define the policy and procedure for the protection of confidential medical records in the Qualla Youth Health Center

STAFF GOVERNED BY THIS POLICY: Qualla Youth Health Center (QYHC)

EFFECTIVE DATE:

DATE REVIEWED OR REVISED: November 5, 2003

DISTRIBUTION: Health and Medical Division, Qualla Youth Health Center


POLICY:

The QYHC keeps a copy of all ambulatory encounter forms that are generated at the clinic, these forms will be keep in the individual patients own record at the QYHC and the original will be sent to the Cherokee Indian Hospital.


PROCEDURE:

  1. A copy of each encounter will be made and kept in the patients own file.
  2. These files are kept in the filing room, divided according to gender and then alphabetized.
  3. The filing room is a locked, secure room and is only accessible to authorized personnel .
  4. Each new patient seen at the clinic is started a new chart, with a copy of the parental consent, a current health summary, and any other materials which would be related to the care of this patient.( immunization record, etc.)
  5. Any dated material in the patients chart will be shredded and disposed of properly.
  6. The original PCC will be taken to the Cherokee Indian Hospital to Medical Records at the close of each clinic day.
  7. A copy of each PCC and a billing form will be taken to RDO on the appropriate day for the Qualla Youth Health Center .

 

 

 


Health and Medical Division
Qualla Youth Health Center

SUBJECT: Nuclear Emergency

PURPOSE: In the event of a nuclear emergency, the Qualla Youth Health Center will do the following:

STAFF GOVERNED BY THIS POLICY:

EFFECTIVE DATE:

DATE REVIEWED OR REVISED: November 5, 2003

DISTRIBUTION: Qualla Youth Health Center

POLICY:

In the event of a nuclear emergency, the staff of the QYHC will have a destination and plan of action.

PROCEDURE:

  1. Upon notification of the threat of a nuclear emergency, the Director or designee will attempt to gain further information either by radio or by other means as may seem appropriate.
  2. The Director or designee will inform all patients and staff.
  3. If there is sufficient time for patients and staff to get home before the blast;
    1. Efforts should be made by the Director or designee to instruct patients and staff in the best ways to seek shelter.
    2. Patients and staff will go home.
  4. If there is not sufficient time for patients and staff to get home before the blast, the Director or designee will instruct patients and staff to:
    1. Move away from the windows and doorways and into hallways.
    2. Do not look at the blast.
    3. Lie prone on the floor.
    4. Take shelter under heavy pieces of furniture.
  5. If there is sufficient time for patients and staff to go home after the blast but before the fallout arrives:
    1. The Director or designee will give all patients and staff information on how to set up a home fall-out shelter.
    2. Patients and staff will go home.
  6. Fall-out shelter areas in the community include:
    1. Qualla Civic Center 300 spaces
    2. Cherokee Elementary School 5548 spaces
    3. Cherokee Baptist Church 476 spaces
    4. Yellow Hill Community Center 222 spaces

 

 

 

 

Health and Medical Division
Qualla Youth Health Center

SUBJECT: Nutrition Referrals

PURPOSE: To define the process for nutrition referrals from the Qualla Youth Health Center

STAFF GOVERNED BY THIS POLICY:

EFFECTIVE DATE:

DATE REVIEWED OR REVISED: November 5, 2003

DISTRIBUTION:

POLICY:

The QYHC is a medical clinic which encompasses all areas of care for children and adolescents. Nutrition plays a vital role in the development and growth of the patient. The QYHC will refer all patients, who the Medical Provider deems necessary, for Nutrition consults with the CIH Nutritionist.

PROCEDURE:

  1. Any patient who is evaluated by the Medical provider and has one or all of these presenting factors will be referred to the Nutritionist:
    1. Obesity
    2. Strong family history of diabetes
    3. Acanthosis Niagricans
    4. Any patient who wants a diet plan to lose weight
    5. Eating Disorders
  2. After the patient has been evaluated by the Medical Provider, and it is established the patient should be referred, a appointment is made with the Nutritionist.
  3. The CIH Nutritionist will have office hours that are at the QYHC for the convience of those patients who can not get to the CIH facility.
  4. These patients could also be referred to other providers and appointments will be made accordingly.

 

 

 


Health and Medical Division
Qualla Youth Health Center

SUBJECT: Office Closed During Normal Working Hours

PURPOSE: Define Procedure for Closing or Vacating the Office During Normal Hours

STAFF GOVERNED BY THIS POLICY: Qualla Youth Health Center

EFFECTIVE DATE:

DATE REVIEWED OR REVISED: November 5, 2003

DISTRIBUTION: Qualla Youth Health Center

POLICY:

In the course of normal working hours it will sometimes be necessary to close the office due to an emergency, training, or outside commitments. If this occurs refer to the following procedure.

PROCEDURE:

  1. Turn the Qualla Youth Health Center answering machine on.
  2. Leave a sign on the entrance door stating that the office is closed, why the closing is necessary, and that any emergencies should report to the Cherokee Indian Hospital.
  3. Notify Health Operations Director, or the Health Delivery Executive Secretary that the office is closed/vacant and where a staff member can be located.

 

 

 


Health and Medical Division
Qualla Youth Health Center

SUBJECT: Office Security

PURPOSE: Define Procedure for Securing Office

STAFF GOVERNED BY THIS POLICY: Qualla Youth Health Center (QYHC)

EFFECTIVE DATE:

DATE REVIEWED OR REVISED: November 5, 2003

DISTRIBUTION: Qualla Youth Health Center

POLICY:

All confidential material that is in the possession of the Qualla Youth Health Center will be kept secure and meet confidentiality/security standards as established by Tribal, Indian Health Service, and other licensing bodies.

PROCEDURE:

  1. The Qualla Youth Health Center appointment book, computer screen, or medical file will not be left unattended in an open office area.
  2. If the confidential material is to be left unattended for a few minutes is should be placed in a secure unobservable location; (i.e. in the desk drawer).
  3. If the confidential material is to be left unattended for more than a few minutes it should be placed in the file room and locked.

 

 

 


Health and Medical Division
Qualla Youth Health Center

SUBJECT: Office Working Hours

PURPOSE: Define Standard Office Hours

STAFF GOVERNED BY THIS POLICY: Qualla Youth Health Center (QYHC)

EFFECTIVE DATE:

DATE REVIEWED OR REVISED: November 5, 2003

DISTRIBUTION: Qualla Youth Health Center (QYHC)

POLICY:

The Cherokee Teen Center Staff observes working hours consistent with the Tribal Personnel and Policy Manuel, 7:45 A.M. through 4:30 P.M. The Qualla Youth Health Center Staff does not take breaks during the designated time, but rather takes one hour for lunch, 12:00 P.M. until 1:00 P.M. Depending on patient demand staff may work after 4:30 P.M. with Director approval.

PROCEDURE:

  1. Report to work at 7:45 A.M. and also at 1:00 P.M. unless other leave arrangements have been made.
  2. If longer patient hours are needed , present proposed new schedule to Director.
  3. Depending on office coverage this will be approved.
  4. Send new employee work schedule to Operations Director.

 

 

 

 


Health and Medical Division
Qualla Youth Health Center

SUBJECT: Pap Tracking

PURPOSE: To define the process for pap tracking and follow-up at the QYHC

STAFF GOVERNED BY THIS POLICY:

EFFECTIVE DATE:

DATE REVIEWED OR REVISED: November 5, 2003

DISTRIBUTION: Qualla Youth Health Center

POLICY:

The Qualla Youth Health Center is a medical clinic that provides family planning, pap and pelvic exams to adolescents who seek those services. Under the guidelines of N.C. General Statute 90-21.5(b) these services can be provided to minors without parental permission. To follow up on exams and lab results the patient will be contacted by phone or through the school nurse.

PROCEDURE:

The pap/pelvic exam is performed at the QYHC.

  1. The results from the pap test will be sent to the CIH facility.
  2. Once CIH has received the results, these are placed in the Provider’s lab box at the CIH facility.
  3. These results are brought to the QYHC a copy is made for the patients chart and the original is returned to the CIH facility.
  4. Once the results are reviewed by the Medical-Provider, the patient is contacted.
  5. All efforts to reach the patient will be done, but not at risk of breeching confidentiality.


Follow-up appointments or referrals will be made when the patient is contacted.

 

 

 


Health and Medical Division
Qualla Youth Health Center

SUBJECT: Parental consent for the treatment of minors

PURPOSE: To define the policy and procedure for which minors can be seen without the parent or guardian present at the time of evaluation

STAFF GOVERNED BY THIS POLICY: Qualla Youth Health Center (QYHC)

EFFECTIVE DATE:

DATE REVIEWED OR REVISED: November 5, 2003

DISTRIBUTION: QYHC, Health and Medical Division

POLICY:

Whereas the QYHC is a medical clinic for children and adolescents and whereas conditions arise when the parent is not available to accompany the minor to the clinic, written consent will be obtained on a yearly basis and placed in the medical record at the QYHC. If written consent in not obtainable at the time of the visit verbal consent may be taken from the parent or guardian for that particular visit.

PROCEDURE:

  1. Consent forms will be obtained for all patients under the age of 18 years. With exception of those patients who are over the age of 12 years and are seeking the following services: pregnancy testing, prenatal care, family planning, STD evaluation, substance abuse or emotional issues. See N.C. General Statute 90-21.5 concerning minor consent for confidential services.
  2. The consent forms will be made available to the Cherokee High School, Cherokee Middle School, Cherokee Elementary School, Swain High School, Swain Middle School, Swain Elementary Schools, Smokey Mountain High School, and Smokey Mountain Elementary School so that consent may be obtained from the parent at the beginning of the school year. These forms may be distributed by office staff, counselors, school nurses, or teachers to the students who are eligible to be seen at the QYHC.
  3. If a patient under the age of 18 years presents at the QYHC requesting medical services and does not have a consent form on file services may be provided on the basis of a telephone/verbal consent. This consent must be obtained and documented on the patient record. This documentation must include the date, time, name of the parent or guardian giving consent and signature of the provider who is taking the consent.
  4. Telephone/verbal consent is only applicable for that particular

 

 

 

 

Health and Medical Division
Qualla Youth Health Center

SUBJECT: Pregnancy Tests

PURPOSE: To define the policy and procedure for pregnancy tests.

STAFF GOVERNED BY THIS POLICY:

EFFECTIVE DATE:

DATE REVIEWED OR REVISED: November 5, 2003

DISTRIBUTION: Qualla Youth Health Center

POLICY:

The QYHC serves the adolescent population which are considered a high risk for teen pregnancy, testing is available at the Clinic.

PROCEDURE:

  1. If a patient presents at the QYHC and requests a pregnancy test, or if the Medical Provider or Nursing staff deems necessary one will be performed.
  2. Pending the results of the test the following options will be discussed.
    1. Negative Results
      1. If a negative result is obtained, the patient will be offered patient education on birth control. See attachment on Oral contraceptives and Depo-Provera.
      2. Patient will be asked if she has had a yearly pap/pelvic exam and if not one will be scheduled with consent.
    2. Positive Results
      1. If a positive result is obtained and with consent of the patient appointments will be made at appropriate facilities.
      2. Lab slips will be given to patient for all Prenatal labs to be done.
      3. If patient will be getting care at the CIH facility, an appointment for the first Prenatal check with the M.D.
      4. Referral to Maternal Child will be done with patients permission.
      5. Patient will be given information on Adolescent Parenting Program.
      6. The patient will be started on Prenatal vitamins.

Health and Medical Division
Qualla Youth Health Center

SUBJECT: Professional Attire

PURPOSE: Define acceptable clothing for professionals who come in direct contact
with patients and customers.

STAFF GOVERNED BY THIS POLICY: All HMD Staff

EFFECTIVE DATE: August 27, 2001

DATE REVIEWED OR REVISED: May 27, 2003

DISTRIBUTION: All HMD employees

TRIBAL POLICY:

4.16 Personal Appearance
Dress, grooming, and personal cleanliness standards contribute to the professional image presented to customers, visitors, and colleagues.
While conducting Tribal business, employees are expected to present a clean, neat, and professional business-like appearance. They should dress according to the requirements of their positions as determined by the appropriate supervisor or safety officer.

HMD POLICY:

  1. Employees involved in direct patient/client care are required to dress in professional attire and present a professional appearance, regardless of the circumstances*.
    1. Social activities are not exceptions if you are providing direct patient care during that day. You may, however, change clothes after patients are no longer in the facility if social or physical activities are planned.
  2. Some employees are required to wear uniforms. (EMS, Home Health, Clinics)
  3. Administration understands that inclement weather will allow variations in dress code policy.

*NOTE : Administration does not consider the following to be professional, business
like attire; jeans, shorts, sweat pants, overalls, short skirts,
T-shirts, cropped pants higher than mid-calf, and flip flops.

 

 

 


Health and Medical Division
Qualla Youth Health Center

SUBJECT: Public complaints to the Qualla Youth Health Center

PURPOSE: To document and resolve complaints.

STAFF GOVERNED BY THIS POLICY: Qualla Youth Health Center

EFFECTIVE DATE:

DATE REVIEWED OR REVISED: November 5, 2003

DISTRIBUTION: Qualla Youth Health Center

POLICY:

The Qualla Youth Health Center is a medical clinic and deals with the public on a daily basis. Complaints may occur in the day to day operation of the clinic.

PROCEDURE:

  1. All complaints made by the patients, their families or the public are to be referred to the Director of the QYHC.
  2. All staff should encourage the person making the complaint to put it in writing.
  3. Verbal complaints will be verified by the Director with the party making the complaint.
  4. Once the Director has verified the complaint, the information will be given to the Health Operations Director.
  5. The Director will follow-up with the complaintant if able/needed to verify that corrective action was acceptable.
  6. Written documentation of the problem and solutions are to be placed in the complaints folder.

 

 

 


Health and Medical Division
Qualla Youth Health Center

SUBJECT: Registration of Patients to Qualla Youth Health Center

PURPOSE: To define the process of registering patients to the Qualla Youth Health Center

STAFF GOVERNED BY THIS POLICY: Qualla Youth Health Center

EFFECTIVE DATE:

DATE REVIEWED OR REVISED: November 5, 2003

DISTRIBUTION: Qualla Youth Health Center

POLICY:

The Qualla Youth Health Center sees children/adolescents between the ages of 4-22 years, we begin the registration process when the patient arrives at the clinic.

PROCEDURE:

  1. The patient is greeted with a smile and a pleasant attitude.
  2. At the point when the patient enters the clinic it is ascertained the purpose of the visit.
  3. Appropriate forms are obtained due to varying circumstances of the visit.
    1. See attached forms.
    2. Copy of insurance card, Medicaid card, or any other avenue of payment.
    3. If the patient is not an established patient, a chart will be started for this visit.
    4. A consent will be obtained from the parent.
    5. A copy of the health summary will be obtained from the RPMS system.
    6. The patient will be ready for screening after this process.

     

 

Health and Medical Division
Qualla Youth Health Center

SUBJECT: Re-scheduling of Patients

PURPOSE: To define the process for re-scheduling patients at the QYHC

STAFF GOVERNED BY THIS POLICY: Qualla Youth Health Center

EFFECTIVE DATE:

DATE REVIEWED OR REVISED: November 5, 2003

DISTRIBUTION: Qualla Youth Health Center

POLICY:

The QYHC is staffed by a Mid-level provider, R.N., child psychologist and an Office Manager. Due to circumstances beyond control, the QYHC may have to close or reschedule due to one or more of the staff who are not at the clinic.

PROCEDURE:

  1. If the Mid-level provider is unavailable to be in the clinic and patients have been scheduled for that day, the patients will be notified as soon as possible and rescheduled.
  2. If the Nurse is unavailable to be in the clinic and patients requiring nursing interventions are scheduled, the Mid-level provider will assume these roles.
  3. If the Office Manager is unavailable to be in the clinic the Nurse or the High School Nurses Assistant will assume these roles.
  4. All patients scheduled will be rescheduled in the next available spaces.
  5. If the patients must be seen that day, they are referred to the walk-in clinic at the CIH facility for sign in at 12:00 p.m.

 

 

 

 

Health and Medical Division
Qualla Youth Health Center

SUBJECT: Scheduling of Appointments for the Clinic.

PURPOSE: To define the process for scheduling patients at the Clinic.

STAFF GOVERNED BY THIS POLICY: Qualla Youth Health Center

EFFECTIVE DATE:

DATE REVIEWED OR REVISED: November 5, 2003

DISTRIBUTION: Qualla Youth Health Center

POLICY:

The Qualla Youth Health Center schedules appointments as well as walkins. The following is the process of time allocation for medical encounters.

PROCEDURE:

  1. When a patient calls for an appointment to the clinic it will be ascertained at that time what will be the purpose of visit.
  2. The patient will be informed of what times are available and which would be suitable for the patient.
  3. Name, Date of Birth and current phone number will be obtained in case of need for rescheduling arises.
  4. All attempts will be made to accomidate the CHS students class schedule. The appointment will be made during the students elective class.

 

 

 

 

Health and Medical Division
Qualla Youth Health Center

SUBJECT: Screening Patients

PURPOSE: To define the process for screening patients

STAFF GOVERNED BY THIS POLICY:

EFFECTIVE DATE:

DATE REVIEWED OR REVISED: November 5,2003

DISTRIBUTION: Qualla Youth Health Center

POLICY:

The Qualla Youth Health Center is a Tribal Clinic but affiliated with the Cherokee Indian Hospital and Indian Health Service. We utilize the PCC format for all patient interactions. The office nurse, certified nurse assistant, or medical provider will screen the patient and fill in the form.


PROCEDURE:

  1. After registration the patient will be taken to the screening room.
  2. A chief complaint will be obtained.
  3. Basic vital signs will be obtained, such as temperature, pulse, respiration and blood pressure.
  4. Height and weight are established.
  5. Visual acuity.
  6. Then patient is escorted to appropriate exam room.

Health and Medical Division
Qualla Youth Health Center

SUBJECT: Severe Weather Conditions

PURPOSE: To define the policy and procedure for severe weather conditions, which could affect the ability of staff to get to clinic or the closing of the clinic,

STAFF GOVERNED BY THIS POLICY:

EFFECTIVE DATE:

DATE REVIEWED OR REVISED: November 5, 2003

DISTRIBUTION: Qualla Youth Health Center

POLICY:

Weather conditions are beyond human control and at times these prevent staff from arriving at the clinic. Weather could prevent the clinic from seeing patients. The following procedures will be followed in reference to weather events.

PROCEDURE:
Snow and Ice
Snow and ice conditions can usually be forecast in advance so that emergency action can be initiated before such conditions affect the medical practice. It is not anticipated that snow and ice conditions will affect the Health clinic building but transportation to the office may be affected. In such an event, proceed according to the following plan:

  1. The Director will receive notification by radio or some other means of hazardous road conditions due to snow and ice.
  2. The Director will talk with the Health Operations Director and a decision will be made as to the closing of the clinic. The staff will be informed.

Severe Thunderstorm
In the event of a severe thunderstorm proceed according to the following plan:

  1. The Director or designee will advise all patients and staff of severe weather conditions upon notification of the conditions’ existance.
  2. The Director will recommend that all patients and staff remain indoors and not venture out unless absolutely necessary.
  3. The Director will advise all patients and staff that the telephone is not to be used.
  4. Personnel will remain alert to the possibility of worsening weather conditions which may cause tornadoes and take appropriate action.

A Tornado Watch

  1. The Director will be notified by staff.
  2. The Director will continue to listen for weather advisory information.
  3. The Director will inform all staff and patients of the conditions.
  4. Regular activities will be continued.
  5. The Director will, if practical, designate persons to serve as lookouts.

A Tornado Warning

  1. The Director will receive notification of the WARNING immediately.
  2. The patients and staff will be alerted immediately.
  3. The Office Manager will make efforts to secure all medical records.
  4. If a tornado is sighted approaching the QYHC, staff themselves will direct patients to go to the interior hallway of the building.
  5. If time does not permit, get into the safest area of the room which you are in ( the inside wall farthest away from doors and windows.)
  6. Avoid windows and areas with wide roof spans.
  7. Get under any heavy furniture available.
  8. Assume a curled position and protect the head, eyes, and neck with the arms and hands.
  9. The Director will turn off all utilities if possible.

Flooding

  1. The Director will consult with the Health Operations Director as to whether or not to close the clinic.
  2. The Director will inform all staff if the clinic is to be closed.
  3. The office manager should make an effort to contact all patients scheduled for the estimated period of closure to inform them of the closing.
  4. If law enforcement officials advise the evacuation of the building, the Director will advise patients and staff to travel with care to another location.
  5. At all times, the Director will advise that the instructions and advise of local government be followed.
  6. Re-scheduling should be done as soon as possible.

 

 

 

 

Health and Medical Division
Qualla Youth Health Center

SUBJECT: Specimen collection

PURPOSE: To define the policy and procedure for collection, package, processing and review of results at the Qualla Youth Health Center.

STAFF GOVERNED BY THIS POLICY:

EFFECTIVE DATE:

DATE REVIEWED OR REVISED: November 5, 2003

DISTRIBUTION: Cherokee Indian Hospital and QYHC

POLICY:

The Qualla Youth Health Center is CLIA waived to perform certain and necessary labs to function as a medical clinic. In affiliation with the CIH, the Qualla Youth Health Center also obtains specimens to be processed at their facility.

PROCEDURE:
Lab Tests done at the Qualla Youth Health Center:

Gloves must be worn at all times during any of these procedures.

CLIA waived:

  1. Dipstick Urinalysis/Lab urinalysis
    1. Clean catch urine specimen is obtained from the patient.
    2. Test strip is placed in urine.
    3. Results are read according to urine time on each category.
    4. The test can be performed by any QYHC staff member.
    5. If a lab urinalysis is ordered a clean catch urine is obtained, placed in a specimen container, labeled and sent to CIH lab facility with the appropriate lab slip.
    6. Procedure for clean catch urine and dipstick urine see page 145-149 of the Nursing Procedure Book, 3rd Edition, SpringHouse.
  2. Rapid Strep/Throat Culture
    1. Using the appropriate cotton applicator the patients throat is swabbed.
    2. If 24 hour culture is to be done this swab is placed in a bio-hazard bag, labeled with the patients name, chart number, date and requesting physican. The lab requisition is placed in the outside slot of the bio-hazard bag.
    3. This is taken to the CIH facility at the end of the day.
    4. If a rapid strep is ordered this procedure is preformed at the Qualla Youth Health Center.
    5. Throat swabs can be performed by any QYHC staff member.
    6. Procedure for throat culture see page 160 of the Nursing Procedure Book, 3rd Edition, Springhouse.
  3. Urine Pregnancy Test
    1. A urine specimen is obtained from the patient.
    2. The lab is performed at the QYHC by any member of the QYHC staff.
    3. If a positive test is the result refer to the policy and procedure for Pregnancy.
  4. Capillary Blood Glucose
    1. A small drop of blood is obtained from the patient via finger stick.
    2. Results are read and if blood glucose is not within normal range, refer to policy and procedure for Diabetes.
    3. Medical-Provider will confer with M.D. and make appropriate referrals.
    4. Procedure for blood glucose see page 137-138 of the Nursing Procedure Book, 3rd Edition, Springhouse.
  5. Pap Slides, Chlamydia and Gonorrhea cultures
    1. Slides and cultures are obtained during a routine pap/pelvic exam.
    2. The specimens are labled and placed in the appropriate bio-hazard bags accompanied with a lab requisition.
    3. The specimens are escorted to the CIH lab facility.

QUALITY CONTROL

  1. The designated clinic personnel will perform and document quality controls for all required tests according to manufacturer’s recommendations.
  2. Trained clinic staff will perform and document preventive maintenance, cleaning and inspections on all equipment used for testing.
  3. Temperature checks will be performed and documented daily on refidgerators.

 

SUPPLIES

  1. Needed supplies for laboratory use will be ordered and maintained by the RN.
  2. Supplies will be maintained at an adequate level and will be checked monthly for expired or outdated materials.
  3. Laboratory supplies, reagents and materials will be maintained according to the manufacturers recommendations.

 


Health and Medical Division
Qualla Youth Health Center

SUBJECT: Staff Meetings

PURPOSE: Define the staff meeting schedule

STAFF GOVERNED BY THIS POLICY: QYHC, Cherokee Elementary School Nurse, Cherokee High School Nurse, Health Occupations Instructor.

EFFECTIVE DATE:

DATE REVIEWED OR REVISED: November 5, 2003

DISTRIBUTION: Qualla Youth Health Center

POLICY:

The QYHC works collaboratively with the elementary school and high school nurses, and with the health occupations instructor a monthly meeting will be held to discuss any issues or concerns that will arise.

PROCEDURE:

  1. The staff meeting will be held monthly.
  2. The staff meeting will be held at the QYHC and may rotate to the other facility sites.
  3. All personnel should attend so that everyone is kept up-to-date on new procedures and policies.
  4. The staff meeting will last approximately one hour.
  5. All personnel will be reminded of the staff meeting via memo.

 

 

 


Health and Medical Division
Qualla Youth Health Center

SUBJECT: Standing Orders for R.N.

PURPOSE: To define the standing orders for the R.N. at the QYHC

STAFF GOVERNED BY THIS POLICY:

EFFECTIVE DATE:

DATE REVIEWED OR REVISED: November 5, 2003

DISTRIBUTION: Qualla Youth Health Center

POLICY:

In accordance with the N.C. state board of nursing the staff R.N. may follow a set of standing orders that are written and signed by the Medical Doctor.

PROCEDURE:

  1. When the R.N. is left in the clinic, without a Medical Provider on site, a set of standing orders will be written for the nurse to follow.
  2. See attached copy of current standing orders.
  3. The R.N. may also receive verbal/telephone orders from the M.D., or Mid-level provider.
  4. The R.N. may only follow standing orders only when functioning in the clinic.

 

 

 

Health and Medical Division
Qualla Youth Health Center

SUBJECT: Throat Culture/Rapid Strep

PURPOSE: To define the process for performing a throat culture.

STAFF GOVERNED BY THIS POLICY:

EFFECTIVE DATE:

DATE REVIEWED OR REVISED: November 5, 2003

DISTRIBUTION: Qualla Youth Health Center

PROCEDURE:

  1. The patient that presents at the QYHC with a sore throat, temperature above 100.5 degrees and upper respiratory signs will be given a rapid strep throat culture.
  2. See Nursing Procedures Book page 160, 3rd Edition, Springhouse, for procedure on obtaining throat cultures.
  3. If the rapid strep is negative and the patient has visible pockets of pus or exudate on the tonsils a 24 hour throat culture will be obtained and sent to CIH lab facility to be run.
  4. The nurse will follow-up on the throat culture the next clinic day for results and notify the patient/parent.
  5. If a positive result is obtained the Mid-level provider will order the appropriate medications for the patient.
  6. If the nurse has obtained the results and no provider is in the clinic a verbal order will be obtained from a Medical provider. (Medical Director, Medical provider at CIH facility)

 


Health and Medical Division
Qualla Youth Health Center

SUBJECT: Workplace Exposure to Body Fluids

PURPOSE: Responsibility of Employees and Mangers of HMD in regards to body fluid exposure while on duty.

POLICY CATEGORY: Employee Health

STAFF GOVERNED BY THIS POLICY: Health and Medical Division

EFFECTIVE DATE: March 16, 2004

DATE REVIEWED OR REVISED:

DISTRIBUTION: Health and Medical Division

PROCEDURE:

HMD Employees: HMD employees will immediately report to their supervisor/managers any exposure that occurs while on duty. If the exposure occurs during Urgent Care clinics hours of operation, the employee will report to Urgent Care for evaluation. HMD employees can refuse any treatment, however the employee must, after the exposure site has been thoroughly washed, immediately present to for evaluation.
If the exposure occurs after Urgent Care hours of operation the employee will present to Cherokee Indian Hospital. The employee will notify their supervisor on the next business day. Employee Health will initiate follow up protocol.

HMD Managers/Supervisors: All managers/supervisors are responsible for knowing the Exposure to Body Fluids protocol as developed by Employee Health. Managers/Supervisors will allow employees who have been exposed time away from their worksite to present to Employee Health or CIHA for evaluation. The HMD supervisor/manager will be responsible for notifying Employee Health if an employee has had an exposure.


Refer to Workplan Exposure to Body Fluids Guide for Supervisors