The
Policies and Procedures
of
Woman's Wellness
MISSION STATEMENT
The mission of the CWWC it to provide quality health care
services to eligible women through health promotion and disease
prevention, emphasizing breast and cervical cancer screening and
early detection.
The CWWC Policy and Procedure Manual is designed to supplement
the Eastern Band of Cherokee Indians Personnel Policy Manual. The
purpose of this manual is to help ensure that the utmost in professional
quality health care is delivered at the CWWC. It provides guidance
and instruction for the daily operation of the clinic and may not
include specific patient care protocols for certain illness and
or conditions, which are the responsibility of the primary care
provider.
The CWWC serves the women of the Eastern Band of Cherokee and or
those women who are determined eligible for care at the Cherokee
Indian Hospital.
The CWWC is one of twenty-one programs within the Health and Medical
Division for the Eastern Band of Cherokee. A description of the
services provided by each department can be located in the EBCI
Resource Manual.
The Health and Medical Division is one of nine divisions within
the EBCI. Refer to the EBCI and Health and Medical Division Organizational
Charts. The Health and Medical Division Administration includes:
Deputy Director Health & Medical - Ms. Susan Leading Fox
Health Operations Director:- Ms. Jody Adams
Fiscal-Grants Coordinator:- Mrs. Trina Owle
Executive Secretary: - Mrs.Janice Jones
Administrative Assistant: - Ms. Martha George
Medical Director: - Dr. Ann Bullock
Accounting Director: - Ms. Karen Kennedy
Personnel
The Cherokee Women’s Wellness Center is currently staffed
with the following personnel:
Center Manager (1/2 time)
Two (2) Nurse Practitioners
(1) Family Nurse Practitioner (1/2time)
(1) OB-GYN Nurse Practitioner
One (1) RN-Data/Case Manager
One (1) LPN
One (1) CNA/Receptionist
One (1) CNA/Outreach Worker
One (1) RN Public Health Nurse (1/2 time)
One (1) Supervising Physician (on site prn for consultation and
management of
Referrals)
SCOPE OF SERVICES
The CWWC provides outpatient services to all eligible females.
Services include:
- HOLISTIC PATIENT HISTORY AND LIFESTYLE ASSESSMENT
- SCREENING FOR DIABETES; ANEMIA; DYSLIPIDEMIAS; THYROID DISORDERS;
HYPERTENSION; AND OTHER AS NEEDED
- TREATMENT OF UNCOMPLICATED COMMON ILLNESSES
- COMPLETE PHYSICAL EXAMINATIONS
- BREAST AND CERVICAL CANCER SCREENING
- FOLLOW UP OF ABNORMAL CERVICAL CANCER SCREENING INCLUDING COLPOSCOPY
- CONTRACEPTION
- HORMONE REPLACEMENT THERAPY
- SEXUALLY TRANSMITTED DISEASE SCREENING AND TREATMENT
- MENSTRUAL IRREGULARITY EVALUATION
- PREGNANCY TESTING
- PRECONCEPTION COUNSELING
- BASELINE INFERTILITY ASSESSMENT
- BASELINE INCONTINENCE EVALUATION
- MANAGEMENT OF UNCOMPLICATED COMMON GENITO-URINARY TRACT CONDITIONS
- PROMOTION OF SELF AND FAMILY CARE
- HEALTH EDUCATION AND COUNSELING FOR PATIENTS AND FAMILIES
- HEALTH EDUCATION FOR COMMUNITIES AND GROUPS
AS REQUESTED
- BASIC UNCOMPLICATED URGENT CARE
- REFERRAL TO QUALIFIED MEDICAL SPECIALISTS; PUBLIC AND PRIVATE
HEALTH; AND SOCIAL SERVICE AGENCIES AS NEEDED
- TRANSPORTATION FOR BREAST AND CERVICAL CANCER SCREENING SERVICES
OR TREATMENT
SERVICES FURNISHED THROUGH AGREEMENT OR
ARRANGEMENT
The Cherokee Indian Hospital is utilized for external laboratory
services. A CWWC staff member transports lab specimens to the CIH
laboratory daily. Lab results are returned within 7 to 10 days.
A laboratory employee or an outpatient staff member calls abnormally
positive values directly to the clinic as soon as possible. Original
lab results are placed in the CWWC lab box located in the Outpatient
area. A CWWC staff member picks these up on a regular schedule and
provides them to the ordering provider for review.
Through a Memorandum of agreement with area hospitals and providers,
referrals for other services not provided at the CIH are accepted.
PATIENTS BILL OF RIGHTS
- The Patient has a right to considerate and respectful care.
- The Patient has the right to obtain from his/her physician
complete and current information concerning his/her diagnosis,
treatment, and prognosis in terms the patient and reasonably expect
to understand. When id is not medically advisable to give such
information to the patient, the information should be made available
to an appropriate person in his/her behalf. He/she has the right
to know, by name, the physician responsible for coordinating his/her
care.
- The patient has the right to receive from his /her physician
information necessary to give informed consent before the start
of any procedure and or treatment. Except in emergencies, such
information for informed consent should include, but not necessarily
be limited to the specific procedure and or treatment, the medically
significant risk involved, and the probable duration of incapacitation.
When medically significant alternatives for care or treatment
exist, or when the patient requests information concerning medical
alternatives, the patient has the right to such information. The
patient also has the right to know the names of the person responsible
for the procedures and or treatment.
- The patient ha the right to refuse treatment to the extent
permitted by law and be informed of the medical consequences for
this action
- The patient has the right to every consideration of his privacy
concerning his own medical care program. Case discussions, consultations,
examination, and treatment are confidential and should be conducted
discreetly. Those not directly involved in his care must have
the permission of the patient to be present.
- The patient has the right for expect that all communication
and records pertaining to his/her care should be treated as confidential.
- The patient has the right to expect that within its capacity
the clinic must make reasonable response to the request of a patient
for services. The clinic will provide evaluation, service, and
or referral as indicated. When medically permissible, a patient
may be transferred to another provider or clinic.
- The patient has the right to reasonable continuity of care.
He/she has the right to know in advance what appointment times
and providers are available and where.
- The patient has the right for know what rules and regulations
apply to his/her conduct as a patient.
- The patient has the right to unrestricted access to communication.
If any restrictions are considered due to therapeutic reasons
or concerns for the rights of others, the patient is included
in this decision. All restrictions will be documented in the medical
record.
- The patient has the right to information about pain management
an appropriate treatment for pain
PATIENT’S RESPONSIBILITIES
As a patient, you are a vital part of your health care team. Providing
you with quality medical care depends upon you fulfilling your responsibilities
as a patient.
- You have the responsibility to provide accurate and complete
information about your present condition and other matters relating
to your health.
- You are responsible for following the treatment plan recommended
by your health care provider, including following instructions
of other health care personnel.
- You are responsible for your decisions and the consequences
thereof, should you refuse treatment or decline to follow your
health care provider’s instructions.
- You have the responsibility to tell your health care provider
about any changes in your health.
- You have the responsibility for following clinic rules and
regulations.
- You are responsible for keeping appointments. Should you be
unable to keep an appointment, please notify the appropriate individuals
as soon as possible.
- You have a responsibility to be considerate of the rights of
others, including assisting in the control of noise, smoking,
and being respectful of the property of others.
- You are responsible for providing and making application to
any alternate resource, which is available to you.
- You are responsible to work with your health care provider
to develop a pain management plan.
Table of Contents
Health and Medical Division
Woman's Wellness
SUBJECT: Annual
Patient Rescreening
PURPOSE: Ensure patients are notified of annual
breast and cervical cancer rescreening due dates.
STAFF GOVERNED BY THIS POLICY: Cherokee Women's
Wellness Center
EFFECTIVE DATE: 10-16-00
DATE REVIEWED/REVISED: 11-07-02
DISTRIBUTION: CWWC, HMD
POLICY:
CWWC patients will be notified of their annual breast and cervical
cancer rescreening due dates.
PROCEDURE:
- Utilizing BCCDMS the Data Manager will generate a list of patients
due for annual breast and cervical cancer rescreening due dates
by the 15 of each month due the following month.
- Patients on the list will be sent an annual reminder letter
(SEE TTACHED).
- A copy of the notice will be placed into the patient’s
medical record.
- Women aged 50 to 64 on the list who have not made an appointment
for annual rescreening within 60 days will be contacted by the
outreach worker by home visit and encouraged to make appointment.
Health and Medical Division
Woman's Wellness
SUBJECT: Appointment
Reminders
PURPOSE: To define the process of
reminding patients of appointments.
STAFF GOVERNED BY THIS POLICY: Cherokee
Women's Wellness Center
EFFECTIVE DATE: 10-16-00
DATE REVIEWED/REVISED: 07-17-01
DISTRIBUTION: CWWC, HMD
POLICY:
The CWWC will remind patients of pending appointments by mail
and phone.
PROCEDURE:
- The receptionist will mail a reminder letter to each patient
who is scheduled for an appointment at least one week prior to
the appointment date utilizing the address given by the patient
when the appointment was made.
- The receptionist or the outreach worker will call patients
the day before an appointment to follow up the mailed reminder.
For Monday appointments, a call will be placed on the Friday prior.
Health and Medical Division
Woman's Wellness
SUBJECT: Appointment
Scheduling
PURPOSE: To define the process of scheduling appointments
at the CWWC
STAFF GOVERNED BY THIS POLICY: Cherokee Women's
Wellness Center
EFFECTIVE DATE: 10-16-00
DATE REVIEWED/REVISED: 07-17-01
DISTRIBUTION: CWWC, HMD
POLICY:
The CWWC schedules appointments for patient s to allocate time
for medical encounters.
PROCEDURES:
- When a patient calls for an appointment, it will be ascertained
at that time what the visit is for.
- The patient will then be informed of the next available appointment
time.
- The patient will be asked for name, DOB, IHS chart #, current
phone #, and address.
- This information will then be repeated back to the patient
along with the appointment time and date.
Health and Medical Division
Woman's Wellness
SUBJECT: Bloodborne Pathogen
Exposure (Needlestick) Protocol and Post Exposure Prophylaxis
PURPOSE: To define a procedure to reduce the chance
of possible complications from an exposure to bloodborne pathogens,
including Hepatitis B, Hepatitis C, and HIV through blood or body
fluids.STAFF GOVERNED BY THIS POLICY: All hospital
staff, volunteers, and students providing services at Cherokee Indian
Hospital.
EFFECTIVE DATE : 3/3/97
DATE REVIEWED/REVISED : 2/10/00
APPROVED BY: Infection Control Practitioner, Infection
Control Physician, Director of Pharmacy, Director of Nursing, Clinical
Director, HSA, Administrative Officer, Governing Board Chair, Reviewed
by Union Official
DISTRIBUTION: Emergency Room, Inpatient Nursing,
Outpatient Nursing, Community Health Nursing, Laboratory, Radiology,
Pharmacy, Housekeeping, Physical Therapy
POLICY:All employees with an exposure to blood
or body fluids will be evaluated for the extent of the exposure,
documentation of the incident, provided counseling and follow-up
care. After a blood or body fluid exposure, the employee will be
evaluated for risk of hepatitis B and C, and HIV. Employees will
be offered medications for HIV prophylaxis if the exposure is determined
by CDC algorithms to be at risk for HIV transmission.
Reduction of Hepatitis B and C, and HIV transmission risk through
accidental occupational exposure is an important element of workplace
safety. All employees who have a reasonable chance of exposure to
blood are offered the hepatitis B vaccine upon employment. Precautions
and safety measures, including needleless systems and storage and
disposal of sharps are in place in order to reduce the chances of
accidental exposure. The Centers for Disease Control and Prevention
(CDC) have issued new post-exposure prophylaxis (PEP) guidelines
to reduce HIV the chance of HIV transmission after an accidental
exposure. Health-care workers who experience an at risk incident,
are urged to consider PEP. It is Cherokee Indian Hospital policy
to adhere to CDC and OSHA Guidelines to protect the health and safety
of its employees.
BACKGROUND
Healthcare workers who have developed immunity to Hepatitis B (HBV)
through the vaccine are at virtually no risk for infection. For
an unvaccinated person the risk from a single needlestick or cut
exposure to HBV in infected blood ranges from 6-30%. The risk depends
on the Hepatitis Be antigen tatus of the source individual. Based
on a limited number of studies, the risk of HCV after a needlestick
or cut exposure is about 1.8%. Hepatitis B immune globulin (HBIG)
is effective in preventing HBV infection after an exposure. The
need for treatment after an exposure is based on whether the source
individual is positive for hepatitis B surface antigen, and whether
the healthcare worker was vaccinated, and has immunity from the
vaccine. Treatment should start preferably within 24 hours, and
no later than 7 days. If the healthcare worker had not previously
been vaccinated, the vaccine is recommended. There is no vaccine
for protection against hepatitis C, and no post exposure treatment
recommended. Immune globulin is not recommended for hepatitis C
exposures. (“Exposure to Blood”, CDC,1999)
The HIV transmission risk level from needlestick-associated injuries
is approximately 0.3% (one in 333) n healthcare workers untreated
with PEP (post exposure prophylaxis). Studies of Zidovudine (ZDV)
used alone for PEP have demonstrated a 79% reduction in risk for
HIV seroconversion after percutaneous exposure to HIV-infected blood.
A trial of ZDV administration to HIV-infected pregnant women and
their infants, showed a 67% reduction in perinatal HIV transmission.
Exposure risk is increased for exposures involving:
- Deep penetrating injury to the health-care worker
- Visible blood on the injury-causing device
- Device was previously in the source patient's vein or artery
- Source patient dies of AIDS within 60 days of the exposure incident
(therefore presumed to have a high titer of HIV)
Case studies done have shown that the risk of sero conversion when
the above risk factors are present is probably higher than 0.3%.
The risks after mucous membrane exposure is approximately 0.1% and
after skin exposures to HIV-infected blood is < 0.1%.
Information about the potency and toxicity of antiretroviral drugs
is available from studies of HIV-infected patients, however, it
is uncertain as to the extent that this information can be applied
to uninfected persons receiving PEP. In HIV-infected patients, combination
therapy with the nucleosides ZDV and lamivudine (3TC) has greater
antiretroviral action than with ZDV used alone and is active against
ZDV-resistant HIV strains. The addition of a protease inhibitor
provides even greater antiretroviral activity, ie., prevention of
production of infectious virus in infected cells.
Adverse Effects, Drug Interactions, Food Interactions,
Use During Pregnancy
See the attached patient information handout on the medications
used for PEP for HIV infection risk. This handout has been developed
by pharmacy as part of the healthcare employees counseling prior
to the initiation of PEP (attachment A).
Counseling and Documentation
Health care workers with a blood or body fluid exposure will receive
counseling re: the level of risk, post exposure prophylaxis, and
followup care or monitoring. Counseling, treatment and followup
plan for care will be documented by the ER physician and HIV counselor
(when available).
Documentation of the exposure will be initiated by the health care
worker.The IHS Form 516 ( Incident Report) and the CA-1 (Federal
Employee’s Notice of Traumatic Injury and Claim for Continuation
of Pay/Compensation) need to be completed on all employee injuries.
An ER visit form or PCC also will be completed at the time
of treatment.
A packet with a copy of this procedure, patient education and counseling
forms, the IHS 516 and CA-1, and required consent forms will be
kept in the ER and Inpatient nursing unit.
The packet contains:
- Post Exposure Prophylaxis Procedure – including algorithims
and medication regimen
- IHS 516
- CA-1
- Medication Information Sheet – zidovudine, lamivudine
and indinavir
- HIV Counseling Forms
- HIV Exposure Information Form – “…after a
possible exposure to HIV….”
- Consent for post exposure prophylaxis treatment
- BBP investigation form (Bloodborne pathogen standard exposure
incident investigation form)
PROCEDURE:
Post Exposure Evaluation and Prophylaxis (PEP) Steps
- The exposed worker will wash the exposure site thoroughly with
soap and water.
If the site is mucous membranes or eyes, the site will be rinsed
thoroughly with normal saline or tap water if normal saline is
not readily available. Using caustic agents such as bleach or
the injection of antiseptics or disinfectants into the wound is
not recommended.
- The exposed worker will report to the Emergency Room for evaluation
and follow-uplab testing that may include hepatitis B and C, and
HIV counseling and testing. A consent form for HIV testing will
be signed.
- If source patient is known, the patient will be asked by the
MD on duty, or a member of the nursing staff, to consent to baseline
HIV and hepatitis B and C testing. The health care worker with
the exposure should not be the person to approach the patient
about testing. HIV counseling and consent must be obtained prior
to HIV testing. If the patient is known to be HIV positive, additional
information about viral load, previous or current treatment received,
etc. should be obtained.
- The physician will determine the level of exposure the health
care worker has received,
and the HIV status code. The algorithims developed by the CDC
will be used to guide decisions regarding use of post exposure
prophylaxis. See attachments B (STEP 1 : DETERMINE THE EXPOSURE
CODE) and attachment C (STEP 2: DETERMINE THE HIV STATUS CODE).
- The physician on duty in the ER will discuss risks and available
treatments, including HIV PEP, with the healthcare worker if it
is determined through use of the exposure code and HIV status
code that PEP may be warranted for the exposed worker.
*If initiation of PEP is elected, baseline lab studies will be
obtained (CBC, Chem 7, LFTs).For women of childbearing age, it
may be advisable to perform pregnancy testing.
* The healthcare worker may receive the hepatitis vaccine if not
previously immunized and/or hepatitis B immune globulin if needed
for a possible hepatitis B exposure. Hepatitis B immune globulin
(HBIG) is effective in preventing HBV infection after an exposure.
The need for treatment after an exposure is based on whether the
source individual is positive for hepatitis B surface antigen,
and whether the healthcare worker was vaccinated, and has immunity
from the vaccine. Treatment should start preferably within 24
hours, and no later than 7 days. If the healthcare worker had
not previously been vaccinated, the vaccine is recommended. There
is no vaccine for protection against hepatitis C, and no post
exposure treatment recommended. Immune globulin is not recommended
for hepatitis C exposures.
- The exposed health-care worker will be given an informed consent
to read and sign (attachment D) prior to initiation of PEP therapy.
It is important when an exposure has occurred to initiate therapy
within hours after exposure. Starting therapy within one to two
hours is considered optimal. Since communication is often difficult
during the initial acute crisis period, health-care workers may
have difficulty making a decision about beginning antiviral treatment..
These workers may benefit from starting therapy and then reconsidering
their options when they feel more objective. This is a useful
approach when it is unknown whether the source patient is infected
with HIV or when the source patient is unknown.
- The basic or expanded medication regime for HIV prophylaxis
will be prescribed based on the Determination of PEP Recommendation
(Step 3 on Attachment C). The medications (zidovudine, lamivudine
and indinavir) will be kept together in a packet in the Inpatient
Pharmacy. This packet contains an initial three day supply of
the medications. The health care worker will need to return to
pharmacy for the remainder of the medications to complete the
four week course. The basic regimen is four weeks of combivir
tablets (lanivudine 150mg and zidovudine 300mg) 1 tablet twice
a day. The expanded regimen is the basic regimen plus crixivan
400 mg – 2 tablets three times a day. Treatment should begin
as soon as possible (within a few hours) after the exposure.
- Completion of incident forms will take place after the evaluation
and treatment of the exposed healthcare worker. The exposure report
should include: the date and time of the exposure, how it occurred,
the type of device and how in the course of handling the device
the exposure occurred, the extent of the injury and severity of
the exposure, information on the exposure source, and counseling,
post exposure management and followup plan. Treatment must not
be delayed.
- Follow-up labs will include a CBC, Chem 7 and LFTs two weeks
after the initiation of HIV PEP therapy. Follow-up HIV testing
will be done at six weeks, twelve weeks, and six months. A follow-up
physical exam by the physician will be done two weeks after initiation
of therapy or before that time if the exposed worker complains
of possible side effects. The employee should be advised to report
any symptoms consistent with retroviral illness/seroconversion
or side effects of the medications.
- HIV exposed health care workers should be advised to use prevention
measures during the followup period, especially during the first
6 to 12 weeks after exposure when most HIV infected persons are
expected to seroconvert. The precautions include: use sexual abstinence
or condoms to avoid sexual transmission and pregnancy, refrain
from donating blood, plasma, organs, tissue or semen. Discontinuation
of breastfeeding should be discussed and considered due to the
risk of HIV transmission through breast milk.
- Followup hepatitis C testing should be done in 4-6 months after
the exposure. Because of the effectiveness of treatment for hepatitis
B (vaccine or immune globulin) there are no recommendations for
followup labs related to hepatitis B.
CONSENT FOR POST EXPOSURE
PROPHYLAXIS
Health and Medical Division
Woman's Wellness
SUBJECT: : Blood Pressure Screening
PURPOSE: To define the process for BP screening
STAFF GOVERNED BY THIS POLICY: Cherokee Women's
Wellness Center
EFFECTIVE DATE: 10-16-00
DATE REVIEWED/REVISED: 07-17-01
DISTRIBUTION: CWWC, HMD
POLICY:
It is the policy of the Women’s Wellness Center to have a
plan in place for situations when a client walks in and requests
a BP be taken.
PROCEDURE:
A client may be instructed to have the BP checked or the client
may decide on her own that she would like a BP taken.
If a client walks in to the center for a BP check, anyone trained
to do a BP may obtain the reading. The BP will be written down for
the client.
The client may receive counseling and education from the person
checking the BP if that person is trained and feels comfortable
educating the client.
CNA:
The CNA will take the BP and write it down for the client to take.
The CNA will also provide a card for he client that has BP follow
up on it to let the client determine what to do.
NURSE:
The nurse will take the BP and write it down for the client. The
Nurse will council the client on the BP and needed follow-up. A
card with normal and abnormal BP’s will hang in the screening
room to assist the nurse with needed follow-up. The nurse may help
the patient to arrange follow-up care at the Women’s Wellness
Center or the clinic at CIH.
The person obtaining the BP will fill out a PCC. A copy will be
kept in the chart and the original will be sent to CIH.
Health and Medical Division
Woman's Wellness
SUBJECT: Bomb Threat
PURPOSE: To define the process of dealing with
a bomb threat received at the center.
STAFF GOVERNED BY THIS POLICY: Cherokee Women's
Wellness Center
EFFECTIVE DATE: 10-16-00
DATE REVIEWED/REVISED: 07-17-01
DISTRIBUTION: CWWC, HMD
POLICY:
A bomb threat may be received by various means; staff must be prepared
to obtain certain information that may be helpful in reporting the
threat. See attached form.
PROCEDURE:
- The recipient of the threat will immediately notify the center
manager or designee.
- The manager will notify the Cherokee Police.
- The building will be evacuated and clear the building at least
500 feet until notice to return by the search team.
- The recipient will complete the form.
- No search of the premises will be made by the CWWC staff; however
any unusual items should be reported to the law enforcement team
on the scene.
- Doors will be left open if possible.
Health and Medical Division
Woman's Wellness
SUBJECT: Capillary
Blood Glucose Check of a Walk In
PURPOSE: To define the process for obtaining a
capillary blood glucose from a walk in client
STAFF GOVERNED BY THIS POLICY: Cherokee Women's
Wellness Center
EFFECTIVE DATE: 10-16-00
DATE REVIEWED/REVISED: 07-17-01
DISTRIBUTION: CWWC, HMD
POLICY:
It is the policy of the Cherokee Women’s Wellness Center
to have a plan in place for clients who walk in and request a CBG
test.
PROCEDURE:
- Client walks in and requests a CBG test
- The CNA/Nurse will obtain the CBG
- The CNA/Nurse will write the result down and give to the client
- If the Nurse is comfortable educating the client and suggesting
follow-up then this is to be done
- If the sugar is > 300 the person should be referred to clinic
Health and Medical Division
Woman's Wellness
SUBJECT: Community
Relations
PURPOSE: Define Affiliate and Community Relations
STAFF GOVERNED BY THIS POLICY: Cherokee Women's
Wellness Center
EFFECTIVE DATE: 10-16-00
DATE REVIEWED/REVISED: 07-17-01
DISTRIBUTION: CWWC, HMD
POLICY:
It is the policy of the Cherokee Women’s Wellness Center
to maintain harmonious and effective relationships with the Cherokee
Indian Hospital and other agencies serving the residents of the
Cherokee Indian Reservation.
Relations with the Cherokee Indian Hospital
The principal liaison with the Cherokee Indian hospital is the Center
Director. The Director transits information about the day- to -day
procedures, services and plans which effect the Cherokee Women’s
Wellness Center interface to the appropriate staff. This reciprocal
exchange of information between the two agencies is required for
effective planning of client services.
In addition to her form of liaison, the Center Director will meet
periodically with the Director of Cherokee Health Delivery system
to discuss matters of mutual interest such as Cherokee Women’s
Wellness Center policies, procedures and services.
At appropriate times as necessary the Center Director will meet
with the Medical Director of the Cherokee Indian Hospital.
Community Relations
The Center Director will carry out appropriate activities to inform
the Cherokee Indian Hospital and agencies and organizations providing
services to them of Cherokee Women’s wellness Center activities
and receive feedback from them. These activities may include:
- Publishing announcements about Cherokee Women’s Wellness
Center activities.
- Meeting with community groups and organizations.
- Meeting with other health organizations in the community to
coordinate planning and delivery of services.
Health and Medical Division
Woman's Wellness
SUBJECT: Compiling A Medical
Record
PURPOSE: To define the process for compiling
a medical record for patients of the CWWC.
STAFF GOVERNED BY THIS POLICY: Cherokee Women's
Wellness Center
EFFECTIVE DATE: 10-16-00
DATE REVIEWED/REVISED: 07-17-01
DISTRIBUTION: CWWC, HMD
POLICY:
The CWWC will maintain a medical record for all patients of the
center.
PROCEDURE:
- Receptionist will obtain a current face sheet and health summary
from the RPMS system and place in CWWC medical record.
Established Patient:
- Pull medical record from CWWC files.
- Place health summary and face sheet in chart.
- Place following forms into chart:
PCC
Billing Form
Cytology
Labels
Culture Form
Lifestyle assessment
Health History
All forms must have patient name, DOB, Chart #, and SS#.
New Patient:
- Check the chart list for the next available chart # and
assign to patient. This is a white note pad located on the
black file holder in medical records.
Place all forms as above into new chart.
Health and Medical Division
Woman's Wellness
SUBJECT: Complaints to CWWC
PURPOSE: To document and process complaints.
STAFF GOVERNED BY THIS POLICY: Cherokee Women's
Wellness Center
EFFECTIVE DATE: 10-16-00
DATE REVIEWED/REVISED: 07-17-01
DISTRIBUTION: CWWC, HMD
POLICY:
Whereas the CWWC is a medical clinic and deals with the public
on a daily basis, occasionally a compliant may occur.
PROCEDURE:
- All complaints are to be referred to the center manager or
designee.
- All staff receiving a complaint should encourage the person
to put the complaint in writing.
- Once the complaint has been verified the information will be
given to the Health Operations Director.
- The Director will follow up with the complaining party and if
able/needed to verify that corrective action has been taken and
was acceptable.
- Written documentation of the concer/problem and solution are
to be placed in the complaint folder.
Health and Medical Division
Woman's Wellness
SUBJECT: Consent
for Patient Care Services
PURPOSE: Define patient consent for services of
the CWWC.
STAFF GOVERNED BY THIS POLICY: Cherokee Women's
Wellness Center
EFFECTIVE DATE: 10-16-00
DATE REVIEWED/REVISED: 07-17-01
DISTRIBUTION: CWWC, HMD
POLICY:
General Consent:
It is the policy to obtain a general written consent from all patients
(or parents or guardians if appropriate) as a prior condition to
receiving any care or treatment at the Center. This consent is contained
on the front of the patient medical record and must be signed by
the patient, parent or guardian as applicable.
Consent for Minors:
Persons under age eighteen, a parent or legal guardian must sign
for the patient to receive
care at the CWWC. A child does not have the right to consent on
his on behalf. If minor is affected by legal separation or divorce,
consent should be secured from the parent who has custody of the
child unless a life-threatening emergency is presented.
Emancipated Minors:
A minor who has obtained a court order acknowledging his/her emancipation,
is making his own living, has a residence away from his family,
married, or is economically separated from his family is considered
emancipated and may sign his/her own permit.
A. Consent by minors who are married or pregnant:
married or pregnant minor may consent to their own treatment.
B. Minors with STDs, Drug or alcohol problems:
North Carolina law permits minors to authorize Health Care professionals
to prevent, diagnose, and treat STDs and other communicable diseases
that have been declared reportable. North Carolina law also provides
that minors may receive medical health services for the prevention,
diagnosis and treatment of pregnancy.
When a minor is treated for an STD, or reportable disease, or if
the minor is found to need birth control, treatment for pregnancy,
alcohol and drug abuse, without parental consent, the health care
professional may not notify the parent or guardian without the minor’s
permission.
Only in rare cases in which the notification of parent or guardian
is essential to the child’s life or health, may the professional
notify a parent of guardian, only after the patient has been informed.
Oral or Telephone Consent for Minors:
- Oral consent is not accepted.
- Telephone consent may be used if the practitioner notes the
number called, the person to whom he/she spoke and the content
of the conversation.
- Consent must be signed by parent or guardian within 72 hours
or three business days.
Health and Medical Division
Woman's Wellness
SUBJECT: Consultation
and Referral
PURPOSE: Define the Consultation and Referral
Process of the Women’s Wellness Center
STAFF GOVERNED BY THIS POLICY: Cherokee Women's
Wellness Center
EFFECTIVE DATE: 10-16-00
DATE REVIEWED/REVISED: 07-17-01
DISTRIBUTION: CWWC, HMD
POLICY:
Except in emergencies, medical consultation and or referral to
another qualified professional is required in the following types
of cases:
- The diagnosis is obscure
- There is doubt as to the best therapeutic measures to be utilized
- In other cases when deemed necessary in the professional judgment
of the care provider.
It is the duty of each professional to make certain that all necessary
consultations are requested and that a Referral Form is completed
including the necessary history, physical findings and laboratory
findings appropriately.
PROCEDURE:
Consultation of Patients:
Obtaining a Consultation:
Medical consultation should occur with the Tribal Medical Director.
If the Tribal Medical Director is unavailable the next level will
be the Officer of the Day at the Cherokee Indian Hospital, or any
available Physician on staff.
Documentation of the consultation shall be placed on the patient’s
medical record.
Referral of Patients:
All referrals shall include a PCC indicating:
- Patient’s name, medical record number, date of birth
and date.
- Pertinent personal information.
- Diagnosis and findings.
- Consultation or specialty services required.
- Name and title of professional providers.
The CWWC provider will sign the referral and forward it to the
Tribal Medical Director for signature and then will deliver to the
CIH Contract Health Services Department. If the Tribal Medical Director
is unavailable for signature, obtain signature from a physician
at the CIH.
A copy of the signed referral will be placed in the patients CWWC
medical record.
Referral for Laboratory, X-ray, EKG, is made to Cherokee
Indian Hospital:
- Consult with CIH physician if NP orders any test other than
routine, approved tests (see procedure).
- Order approved tests at the Cherokee Indian Hospital on the
standard CWWC laboratory PCC or CIH radiology request form. EKG
‘s are ordered by utilizing a PCC and signing . (See Attachments)
- Give the patient a copy of the requisition and direct them to
the Cherokee Indian Hospital.
Health and Medical Division
Woman's Wellness
SUBJECT: Personnel Administration
PURPOSE: Define Process for Corrective Action
STAFF GOVERNED BY THIS POLICY: Cherokee Women's
Wellness Center
EFFECTIVE DATE: 10-16-00
DATE REVIEWED/REVISED: 07-17-01
DISTRIBUTION: CWWC, HMD
POLICY:
The CWWC will adhere to the Corrective action procedures found
in Article XIII in the EBCI policy and procedure manual.
Health and Medical Division
Woman's Wellness
SUBJECT: Administration
of Depo- Provera Injections
PURPOSE: To define the policy and procedure for
the administration of Depo-Provera at the Cherokee Women's Wellness
Center (CWWC).
STAFF GOVERNED BY THIS POLICY: CWWC
EFFECTIVE DATE: 10-16-00
DATE REVIEWED/REVISED: 07-17-01
DISTRIBUTION:CWWC, Health and Medical Division
POLICY:
Contraception care is available to eligible patients. The CWWC
follows the guidelines set forth by the state of North Carolina
G.S. 90-21.5 which states that a minor may give effective and sufficient
consent for certain medical health services: prevention, diagnosis
and treatment of pregnancy encompasses the direct ability of a minor
to obtain contraceptive in the absence of parental consent. As per
this statute the CWWC dispenses Depo-provera for any female who
meets criteria and wants to start birth control.
PROCEDURE:
The patient will be counseled on all means of birth control including
barrier methods, oral contraceptives, Depo-provera , and abstinence.
The patient will be evaluated by the Mid-level provider to determine
whether Depo-provera is appropriate for this patient.
Contraceptive screening forms (attached) will be completed by the
provider and patient and signed by both to assess for any contraindications.
If it is determined that a patient may receive the injection the
order is written to dispense the medication and given by the Mid-level
provider, RN, or other licensed person.
For the initial start of Depo-provera the patient must not have
had sexual intercourse for 7 days. A pregnancy test will then be
given, if the pregnancy test is negative the patient may receive
the injection.
If the patient is having her menses she must still take a pregnancy
test to certify that she is not pregnant.
All females who receive the injection will be informed of side
effects and warning signs to report to medical provider.
After medication order is written the Provider , RN, or LPN will
administer the Depo-provera using correct technique for an IM injection.
Patient will remain in the office for approximately 15 minutes
to make sure no adverse reaction is taking place.
After 15 minutes the Provider , RN, or LPN will assess/evaluate
the patient. If the patient is stable and there are no signs of
adverse reactions, the patient will be discharged to home/school/work.
If patient is xperiencing adverse reactions refer to the Emergency
Procedure.
All subsequent shots to patients who have demonstrated no reaction
to medication will be discharged from the clinic after injection
is given.
Patient to return to the clinic every 11-12 weeks for subsequent
injections.
If patients do not return to clinic in the required 12 week interval
the patient must start the process from the beginning with 7 days
of abstinence and a pregnancy test.
Patients on the Depo-provera must have Pap and Pelvic exams every
year if they are sexually active.
Patient will be given a copy of the information sheet (Attached)
and a depo-provera calandar.
The signed original consent for depo will be placed in the medical
record and a copy given to the patient.
Health and Medical Division
Woman's Wellness
SUBJECT: Eligible Patient Population
PURPOSE: Define the patients that are eligible
for CWWC services.
STAFF GOVERNED BY THIS POLICY: Cherokee Women's
Wellness Center
EFFECTIVE DATE: 10-16-00
DATE REVIEWED/REVISED: 07-17-01
DISTRIBUTION: CWWC, HMD
POLICY:
The CWWC provided medical services to all women who are eligible
for services at the Cherokee Indian Hospital Service Facility. This
includes enrolled members of the EBCI, first descendents of enrolled
members, enrolled members of other federally recognized tribes and
anyone else designated by the CIH.
PROCEDURE:
1. When a patient calls for an appointment the person answering
the phone will inquire if the patient has been seen previously at
the CIH and established a medical record. If the patient has not
been seen and established a medical record they will be required
to do so prior to their initial appointment at CWWC.
Health and Medical Division
Woman's Wellness
SUBJECT: Environmental Health
and Safety
PURPOSE: Define Process for Disposal of Infectious
Waste
STAFF GOVERNED BY THIS POLICY: Cherokee Women's
Wellness Center
EFFECTIVE DATE: 10-16-00
DATE REVIEWED/REVISED: 07-17-01
DISTRIBUTION: CWWC, HMD
POLICY:
The CWWC is a medical facility and has a daily need for bio-hazardous
materials to be disposed of properly.
PROCEDURE: Infectious and potentially infectious
waste shall be defined as and disposed of as follows:
Infectious wastes are defined as follows:
- Containers with 20 cc or more of body fluids.
- Accumulated waste. More than one pelvic or procedure.
- If fluid is compressed, runs or flakes.
- Laboratory wastes including pathological specimens (which includes
all tissues, specimens or blood elements, excrete and secretions)
obtained from patients and disposable formats (which shall include
any substance which may harbor or transmit pathogenic organisms
or diagnosed communicable disease.)
- Surgical pathologic specimens and disposable fomites.
- Equipment, instruments, utensils and fomites (dressings) if
a disposable nature from patients with diagnoses communicable
disease.
Disposal Procedures:
Infectious wastes will be placed in Bio-Hazard Waste Bags.
Needles and wep prep slides will be places in the red sharps container.
Items not required to be placed into red bags:
Urine specimen cups
Urine HCG tests
Ordinary waste, gowns, paper covers, and towels.
When sharps boxes are 2/3 full they will be closed and a new one
stated.
All red bags will be placed in the red waste container in the storage
area. The Safewaste company will be notified when the red containers
are 2/3 full and they will pick up from the center.
Health and Medical Division
Woman's Wellness
SUBJECT: Environmental Health
and Safety (Housekeeping)
PURPOSE: Define the Housekeeping Procedures of
the Women’s Wellness Center
STAFF GOVERNED BY THIS POLICY: Cherokee Women's
Wellness Center
EFFECTIVE DATE: 10-16-00
DATE REVIEWED/REVISED: 10-16-00
DISTRIBUTION: CWWC, HMD
POLICY:
A high standard of cleanliness should be maintained in any patient
or allied patient area. Sub-critical areas refer to those areas
directly related to patient care and to areas where patients will
receive treatment.
Patient Exam Rooms:
Empty wastebasket container (not infectious waste). Wipe interior
of container and refill with plastic bag.
Wash all surfaces with disinfectant solution (Calco-San) including
tables, counter, fixtures and handles.
Damps or dust furniture with sponge or cloth dipped in Calco-San
solution, including chairs, desk, stools and exam table.
- Wash all horizontal and vertical surfaces.
- Wash down top of exam table.
- After exam table has been washed, be sure to pull fresh paper
from roll to cover tabletop.
Wash all floors daily with Calco-san solution.
Wash all sinks and counter tops in clinics with Calco-san.
Wipe off all chairs used for patients waiting with Calco-San
Refill all paper towel dispensers.
Empty all waste cans in clinic, wipe with Calco-san and relive with
plastic.
Wipe off benches in patients waiting area daily with Calco-san solution.
Damp dust telephone and cord daily with Calco-san.
Toilets, suits and floors are washed daily with Calco-San solution.
Paper towel dispensers are filled daily.
Health and Medical Division
Woman's Wellness
SUBJECT: Environmental Health
and Safety
PURPOSE: Define External Disaster Plan
STAFF GOVERNED BY THIS POLICY: Cherokee Women's
Wellness Center
EFFECTIVE DATE: 10-16-00
DATE REVIEWED/REVISED: 07-17-01
DISTRIBUTION: CWWC, HMD
POLICY:
The Women’s Wellness Center Disaster Preparedness Plan is
designed to supplement and coordinate its efforts with those of
the safety/evacuation plan and the existing community health care
service delivery system.
When disaster strikes, health care begins with the immediate activation
of all health professionals from the Center, volunteer and paid
staff, to:
-Plan with the Tribal/HIS officials for utilization as needed.
Leadership:
A nurse practitioner is appointed as the health care supervisor
in the absence of the Center Director, with her concurrence. A currently
licensed registered nurse may assist the health care supervisor.
The key functions of the health care supervisor include assessment
of potential health risks and vulnerability of health personnel,
mobilization and supervision of trained health personnel and the
provision of the first aid and first aid supplies in the event of
a disaster.
In-service education and training is provided annually for fire,
safety and disasters. Additionally, two fire drills are provided
annually.
Once personnel are trained, it is important to maintain interest
and preparedness. This can be done in a number of ways.
- Assign nurses to supervise personnel in practicing first aid
skills.
- Assign health personnel to work on special disaster-related
projects.
- Offer short-term continuing education seminars about concerns
such as crisis intervention, winter or summer health conditions,
providing disaster health services.
Health and Medical Division
Woman's Wellness
SUBJECT: Environmental Health
and Safety
PURPOSE: Define Facilities and Management
STAFF GOVERNED BY THIS POLICY: Cherokee Women's
Wellness Center
EFFECTIVE DATE: 10-16-00
DATE REVIEWED/REVISED: 07-17-01
DISTRIBUTION: CWWC, HMD
POLICY:
It is the policy of the Center to establish adequate facilities,
property maintained, for the benefit and protection of Program personnel,
staff and other using the facility,
The administrative Offices are responsible for coordinating and
carrying our all requirements of this Part not specifically assigned
to other personnel.
Facilities Requirements:
Adequate space will be available for properly providing all Center
services. Suitable means to assure privacy will be established in
all examination and dressing rooms, reception areas, and classroom
areas.
Adequate lighting and ventilation will be available in all areas.
Appropriate signs or markings will be maintained on reception,
toilets, and other areas requiring such identification.
In the event of a power stoppage or outage-flashlights or other
portable light sources shall be made available and in readiness
for use if needed.
Cleaning and Maintenance:
The facility shall be maintained in a sanitary and clean condition
and in good repair at all times.
Written instructions shall be prepared for the building custodian
on procedures to be followed in cleaning and maintaining of articles
and surfaces, such as floors, walls, furniture, exhaust grills and
light fixtures.
Clinic Equipment:
All equipment used in the clinic will be maintained in proper operating
condition at all times. Preventive maintenance will be performed
periodically if necessary in accordance with the manufacturers specifications.
Health and Medical Division
Woman's Wellness
SUBJECT: Fire Plan
PURPOSE: To provide a plan of action in the event
of a fire.
STAFF GOVERNED BY THIS POLICY: Cherokee Women's
Wellness Center
EFFECTIVE DATE: 10-16-00
DISTRIBUTION: CWWC, HMD
POLICY:
To establish a plan for action in the event of a fire in the clinic.
PROCEDURE:
The following anagram will be utilized in case of fire.
R= RESCUE: Staff will safely remove and rescue
any patients in the immediate area.
A= ALARM: The fire alarm will be activated and
911 will be called.
C= CONTAIN: Contain the fire to prevent spread
by closing doors and windows in the immediate area.
E= Extinguish: Use proper fire extinguisher to
extinguish fire.
Plan of Action:
In the event that a smoke detector signals without evidence of
visible smoke or fire:
- Patients will be evacuated from the nearest exit.
- The manager will call 911 and report that a smoke detector has
sounded.
- All staff will search the building for any visible signs of
fire and attempt to extinguish it.
- After the Fire Department Personnel has inspected the building
and called an all clear the staff may be allowed to reenter.
- The manager will notify the Health Delivery of the current condition.
In case of actual fire:
- The staff members and patients will evacuate the building.
- 911 will be called from the nearest location.
- If possible the staff will attempt to contain the fire.
Health and Medical Division
Woman's Wellness
SUBJECT: Follow up of patients
requiring Contract Health Services
PURPOSE: To ensure that all patients requiring
Contract Health for follow up of abnormal screening tests are notified
and offered services.
STAFF GOVERNED BY THIS POLICY: Cherokee Women's
Wellness Center
EFFECTIVE DATE: 10-16-00
DATE REVIEWED/REVISED: 11-07-02
DISTRIBUTION: CWWC, HMD
POLICY:
Ensure that a referral system is in place for the diagnosis and
treatment of all abnormal screening findings requiring contracted
services.
PROCEDURE:
- Provider who performed the screening test will notify the patient
of the screening results and recommend follow up.
Three attempts to contact patient will be made and noted in the
medical record. The third attempt will be by certified letter
to the last known address.
- Provider will initiate a Contract Health Referral form (SEE
ATTACHED EXAMPLE).
- Contract Form will then be delivered to MD for co signature
and delivered to CHS at the Cherokee Indian Hospital.
- Case manager will be notified of all breast and cervical cancer
referrals and case manager will initiate the case management process
per NCBCCCP guidelines.
- Case manager will ensure follow up of abnormal breast and cervical
cancer screenings referrals will be completed within 60 days of
initial screening date.
- Case manager will ensure that 100% of women with diagnosis of
breast or preinvasive/invasive cervical cancer will be made within
30 days of the final diagnostic disposition due date.
- Case management tracking form will be placed into the patient’s
medical record after final diagnosis and treatment is initiated.
Health and Medical Division
Woman's Wellness
SUBJECT: Environmental Health
and Safety
PURPOSE: Define Infection Control
STAFF GOVERNED BY THIS POLICY: Cherokee Women's
Wellness Center
EFFECTIVE DATE:
DATE REVIEWED OR REVISED:
DISTRIBUTION: CHEROKEE WOMEN’S WELLNESS
CENTER STAFF
POLICY/PROCEDURE:
A sanitary environment will be maintained within the Center to
ensure the safety and comfort of patients and staff and to control
the spread of infection.
The Cherokee Indian Hospital Infection Control Manual will be followed
as guidelines for procedures.
Communicable Infections:
The Center Director, with the assistance of other staff will monitor
the patients and their environment to identify any communicable
diseases or infectious condition which might represent health hazard.
The Center Director will take immediate steps with the assistance
of the Nurse Practitioner, if necessary, to control or eliminate
any such hazard discovered.
Infection Control Committee
Purpose: The infection control committee receives input, identifies
problems, formulates solutions, reviews and revises infection control
policies and procedures for the Women’s Wellness Center with
regulatory and accrediting agencies.
Objectives: The committee will:
- Utilize the Women’s Wellness Center Infection Control
Manual as procedure monitoring guidelines.
- Formulate new infection control policies and procedures as needs
are identified including all aseptic, isolation and sanitation
practices.
- Distribute and implement new and revised infection control policies
and procedures to staff.
- Review and update established infection control policies and
procedures on an annual basis.
- Recommend solutions to control problems in the center.
- Advises staff of real and potential control problems.
Membership:
The committee is to be composed of a nurse epidemiologist, one Nurse
Practitioner from the Center. A physician if possible and other
interested faculty and staff. Committee membership is reviewed annually
or as often as needed. The composition of the membership should
be adjusted when needed to ensure a meaningful membership.
Meetings:
The committee will meet at least bi-monthly.
Health and Medical Division
Woman's Wellness
SUBJECT: Personnel Administration
PURPOSE: Define In-Service Education
STAFF GOVERNED BY THIS POLICY: Cherokee Women's
Wellness Center
EFFECTIVE DATE: 10-16-00
DATE REVIEWED/REVISED: 07-17-01
DISTRIBUTION: CWWC, HMD
POLICY:
Women’s Wellness Center Staff are to be prepared through
appropriate education and training programs for their job responsibilities.
Pertinent professional books and current periodicals should be
made available to Center staff.
Education/training programs for health center personnel should
be ongoing and designed to augment their knowledge base and to maintain
current competence in their job performance.
The scope and complexity of programs are to be based on the documented
educational needs of center personnel and the resources available
to meet those needs.
The in-service/educational needs are identified through appropriate
educational assessment techniques.
The extent of participation in an in-service/educational program
is documented for each health center personnel.
The individual(s) responsible for developing and coordinating educational
training programs is knowledgeable in educational methods and current
nursing/health education service practice.
An evaluation of educational activities is performed.
The educational programs may be mandatory and/or voluntary.
Types of In-Service/Educational Programs
Mandatory Educational Offerings:
Definition: Mandatory in-service/education programs are those programs
which are required by law, licensing agencies and/or the Center
Director to provide staff with necessary knowledge/skills to perform
vital functions to maintain licensing requirements or current knowledge
base in specific areas.
Voluntary Educational Offerings:
Definition: Voluntary in-services are those in-services that are
not mandatory, however, are educational programs which staff member
may choose to participate in, in an effort to broaden their knowledge
base.
Mandatory Education/In-Service Programs
Mandatory in-services include, but are not limited to:
Initial orientation of new employees; Yearly Cardiopulmonary Resuscitation
(CPR) certification for MDs, NPs, RNs, LPNs,; Yearly fire safety
for all center staff, yearly infection control for all center staff,
yearly disaster/emergency preparedness for all center staff.
Initial Orientation
New employees will be oriented to their job responsibilities and
the structure and function of the center. This will include, but
will not be limited to policies and procedures.
CPR
CPR in-services should meet current American Heart Association/American
Red Cross standards. 3.1.2.2 If the individual is unable to meet
AHA/ARC certification requirements because of physical disability
as determined by their primary care provider and/or CPR instructor,
they must successfully pas a written CPR test, verbalize current
CPR procedures and receive documented evidence by a certified CPR
instructor that the above was met.
It is recommended that all non-professional center staff undergo
yearly CPR training or re-certification.
Fire Safety
All Center staff are required to attend a fire safety presentation
which meets the standards of the Eastern Band on Fire Safety annually.
All Center employees are to participate in simulated fire drills
at least semi-annually in an effort to review and maintain fires
safety skills.
Disaster/Emergency Preparedness
All health center employees are to participate in a yearly disaster/emergency
preparedness in-service that includes, but is not limited to a review
of emergency procedures, equipment, and the roles and responsibilities
of health center members in a disaster.
Infection Control
All center staff must attend yearly in-services on infection control
procedures such as, but not limited to a review of hand washing,
proper cleaning/disinfecting procedures, and/or methods of disease
prevention and control.
Voluntary Education/In-Service Programs
Staff members are encouraged to seek out learning experiences that
will improve their knowledge base and/or personal growth on their
own time.
Efforts to provide these experiences on Tribal time will be sought
out at staff meetings or other times as staffing time periods.
Center members who are covered by specific Eastern Band of Cherokee
Indians contacts will be allowed to attend voluntary education/in-service
programs as deemed by their individual contracts and based on staffing
and center needs.
Implementation of Programs
The center Director or designee, in collaboration with the health
center Director is responsible that the above in-services are planned
and implemented.
Mandatory in-services should be provided during regular working
hours so that the majority, if not all staff may attend.
Attendance
Members who are unable to attend mandatory in-service/education
programs are to make arrangements with the Center Director for attending
in-services at another time or by participating in an alternate
teaching/learning strategy whereby the content material and objectives
may be met or mastered, i.e. self-learning packet.
Members who have not met the mandatory in-service requirement will
be subject to disciplinary action by their immediate supervisor.
Records of attendance will be kept in each employees personnel
file.
Health and Medical Division
Woman's Wellness
SUBJECT: Environmental
Health and Safety
PURPOSE: Define Internal Disaster Plan
STAFF GOVERNED BY THIS POLICY: Cherokee Women's
Wellness Center
EFFECTIVE DATE: 10-16-00
DATE REVIEWED/REVISED: 07-17-01
DISTRIBUTION: CWWC, HMD
POLICY:
A disaster is an occurrence such as fire, explosion, earthquake,
storm, tornado or other situation that causes human suffering or
creates human needs that the victims cannot alleviate without assistance.
Priorities for persons after a disaster has struck or in advance
of potential disaster are safety and survival.
In the event of a disaster/emergency, the most important thing
to remember to do is to remain calm. DO NOT PANIC.
One can contribute to the safety and welfare of yourself and all
concerned by doings things in a deliberate and careful manner. If
every one responds in this manner, loss of life, property and/or
injury will be minimized. Four different disaster/emergency examples
(with appropriate actions) are provided.
Bomb-Anonymous Phone Call-
- Notify the Center Director
- Then call the fire department.
- Evacuate the building using the posted evacuation routes.
- Return to building only after it has been inspected and is determined
to be safe.
Fire-Burning Odor Smoke or Flames-
- Sound Fire Alarm
- Notify the Center Director
- Call the fire department and tell them the location and size
of the fire.
Threat of Explosion-Leaking Gas -
- Evacuate the building using the posted evacuation routes.
- Notify the fire department.
- Return to building only after it has been inspected and is determined
to be safe.
Earthquake-Tremors/Shaking -
- During the shaking, instruct people to take cover and do the
same yourself. Stay away from
glass.
- After the shaking, assist others if necessary.
- Evacuate the building if is severely damaged.
Health and Medical Division
Woman's Wellness
SUBJECT: Medical Emergencies
PURPOSE: To develop a plan for handling medical
emergencies
STAFF GOVERNED BY THIS POLICY: Cherokee Women's
Wellness Center
EFFECTIVE DATE: 10-16-00
DATE REVIEWED/REVISED: 07-17-01
DISTRIBUTION: CWWC, Health and Medical Division
POLICY:
Whereas the CWWC is not designated as an ER but does have a plan
to respond to any serious situation/ urgencies/ emergencies that
unexpectedly arise at the CWWC or in the immediate vicinity. The
CWWC also provides injections for their population and is prepared
to deal with any anaphylactic problem which could arise from these
injections. The CWWC is located across the street from the Cherokee
EMS station which has paramedic level certification.
PROCEDURE:
The Mid-level providers and clinic RN will have been trained and
preferably have current certification in ACLS. All CWWC staff will
be certified in Basic Life Support.
An Emergency Kit will be on hand at the CWWC. This kit will be
located in the treatment room of the clinic. The kit will be checked
monthly by the CWWC staffs RN to make sure all medicines are within
date and that all materials are present in kit. Included in the
Kit are the following:
- Bag/Valve/Mask
- Diphenhydramine Hydrochloride 25 mg capsules
- Epinephrine 1:1000
- Syringes
- Alcohol wipes
- Gloves
- IV start Kit
- Tape
- Gauze sponges
- Kling wrap
- Band aids
- Bandage scissors
- Oxygen tank with nasal cannula attached
- Pad and pen
The Emergency Kit will be kept in a secure area. It will also
contain a dosing guide for Epinephrine and Diphenhydramine Hydrochloride.
All patients with potential emergent conditions will be immediately
evaluated by the Mid-level provider or, if not available, clinic
RN.
Triage for patient care:
- CWWC for minor conditions only example: contusions, abrasions,
lacerations (those not requiring ER care)
- Hospital for all other emergencies.
The Mid-level provider or clinic RN will assess patient to determine
type of emergency. The CWWC will provide emergency stabilization
to include CPR till EMS is on scene.
Mid-level provider or clinic RN will decide whether EMS transport
or transport by private vehicle is appropriate.
The Certified Nurse assistant / Office Manager will be responsible
for dialing EMS/911 during the emergency, as instructed by the Mid-level
provider or Clinic RN.
The CWWC staff will function as support staff form EMS after their
arrival on the scene.
The Mid-level provider or clinic RN will document and record all
events that occurred at the CWWC during the emergency.
DOSING FOR EPI AND DIPHENHYDRAMINE HYDROCHLORIDE
EMERGENCY KIT
PEDIATRIC DOSING:
EPINEPHRINE: 0.01 ML/KG OF 1:1000 SOLUTION GIVEN
SUBCUTANEOUSLY REPEAT EVERY 20 MIN.
DIPHENHYDRAMINE: 1-2 MG/KG GIVENPO EVERY 6 HOURS
AS NEEDED
MAY BE GIVEN IV OR IM ALSO.
ADULT DOSING:
EPINEPHRINE: 0.1 TO 0.5 ML OF 1:1000 SUBCUTANEOUSLY
OR IM. REPEAT EVERY 10 TO 15 MIN.
DIPHENHYDRAMINE: 25 TO 50 MG BY MOUTH, 10 TO 50
MG IM OR IV.
Health and Medical Division
Woman's Wellness
SUBJECT: Patient
Care Services (Medical Records Content and Security)
PURPOSE: Define the Content and Security of Medical
Records Created by the Women’s Wellness Center
STAFF GOVERNED BY THIS POLICY: Cherokee Women's
Wellness Center
EFFECTIVE DATE: 10-16-00
DATE REVIEWED/REVISED: 07-17-01
DISTRIBUTION: CWWC, HMD
POLICY:
Content of Records:
The Patient’s record will be composed of the elements listed
below:
Data Base:
A patient’s database is a compilation of all known facts
about the patient that have relevance to her health care.
The data base include the following:
- Chief complaint (on first visit).
- History of present illness.
- Patient’s personal and family profile.
- Past medical history – past surgical history.
- Family medical history.
- Review of symptoms.
- Physical exam
- Pelvic exam – speculum and bimanual.
- Breast exam
- Laboratory studies/findings.
- Tuberculosis record/immunization records.
- Risk factors.
Continuing Problem List:
The continuing problem list is a list of the patient’s health
problems that were resolved by one or two visits, such conditions
as chronic illnesses or conditions. This list and an acute problem
list make up the “Table of Contents” for the patient’s
record.
Immunization Record:
The immunization record includes names and dates of all immunizations
received by patient.
Allergy Notice:
A medication allergy notice is placed separately in a prominent
place on the cover of the file as an additional safeguard.
Progress Notes:
Notes of each visit are written in the standard SOAP format:
S Subjective:
Information told by the patient or family about the problem (e.g.
onset, duration, severity, current symptoms, current medication
use).
O Objective:
Information from physical exam and laboratory test and provider
observation.
A Assessment:
Interpretation by the provider of the subjective and objective data;
diagnosis and identification of problem and patient’s current
health and functional status, discussion of diagnostic questions
to be answered.
P Plans:
Specific course of action for the problem describes including:
1. Dx-Diagnostic. Plans for further investigation to establish a
diagnosis.
2. Rx-Treatment. Plans for patient care and problem management.
3. Ed-Patient Education. Information given to the patient and/or
family.
4. Fu-Follow-up. Schedule of return visits or referrals to other
agencies and/or consultants.
Security, Retention, and Usage of Patient Medical Records:
A patient medical record is a collection of information concerning
a patient and his/her health care. The information may be from any
source and in any tangible form, including pathology specimens and
X-ray films.
- Each medical record shall contain sufficient and accurate information
to identify the patient, support the diagnosis, justify the treatment,
and document the results and plans for follow-up.
- An adequate medical record shall be maintained for every individual
who is evaluated or treated. All significant clinical information
pertaining to a patient shall be included in the medical record.
Security:
- The medical records of Women’s Wellness Center patients
are the property of the Center. Original records may be removed
from the Center only by court order, subpoena, or according to
statute.
- Patient medical records shall be released from this area only
in accordance with the provisions of this policy and policy covering
Privacy of Patient Records (p.).
- The medical record shall not be hand carried by a patient.
- All medical records shall be maintained in their original form.
The contents of health records should not be edited, altered,
or removed. If information in a record must be corrected, or revised,
a line should be drawn through the incorrect entry and the correction
should be timed, dated, and signed by the person making the revision.
- Medical records are subject to the Women’s Wellness Center
disposition schedules and shall be retained as needed by the Center
in accordance with federal and state government regulations and
Women’s Wellness Center disposition schedules.
Usage:
- The medical record should be available at all times for the
benefit of the patient, nurses, physicians, and the Center. Nurse
Practitioners and Physicians should have access to a patient’s
medical record at the time of a patient care encounter.
- Only authorized users may access or borrow medical records.
Authorized users include: Health Educator, Nutritionist, and Students.
To ensure the availability of each medical record, the following
procedures should be observed.
- The authorized user, who borrows a medical record, is responsible
for knowing and controlling the record’s location, and for
returning the record as soon as he/she has finished using it.
- A nurse or physician should not retain medical records overnight.
- Authorized users must keep borrowed records intact and in accessible
locations. Records should not be placed in inaccessible locations
such as desk drawers, file cabinets, lockers, or closets.
Health and Medical Division
Woman's Wellness
SUBJECT: Missed Appointments
PURPOSE: To define the process of DNKA, Cancelled
and rescheduled appointments.
STAFF GOVERNED BY THIS POLICY: Cherokee Women's
Wellness Center
EFFECTIVE DATE: 10-16-00
DATE REVIEWED/REVISED: 07-17-01
DISTRIBUTION: CWWC, HMD
POLICY:
Whereas the CWWC is a medical facility and is responsible for
contunity of care, the CWWC will maintain a policy to follow up
missed patient appointments.
PROCEDURE:
The receptionist is responsible for noting the reason for the
missed appointment in the appointment book and proceeds as follows
according to reason missed.
DNKA:
- The receptionist will send a DNK letter urging the patient
to reschedule the appointment.
- The receptionist will then place a copy of the letter and PCC
into the patient’s medical record and forward it to the
provider the appointment was made with.
- The NP will then review the DNKA chart and determine appropriate
follow up and referral to outreach, case management, or personal
phone contact.
- Documentation of disposition will be placed on PCC in medical
record.
- “DNKA” will be placed beside the patients name in
the appointment book and a pink marker will be used to highlight
the patients name on clinic schedule.
CANCELLED/RESCHEDULED:
- If a patient calls to cancel and or reschedule an appointment,
the caller will be asked the reason the appointment is being cancelled
ex: menses, illness, work conflict etc.
- The caller will be asked if they wish to reschedule at that
time and an alternate appointment will be given.
- “Resch”. Will be placed beside the callers name
in the appointment book.
- A blue marker will be used to highlight the patients name on
the clinic schedule for a reschedule and a green to hightlight
a cancelled appointment.
- A missed appointment PCC will be place into the medical record
and forwarded to the NP who will sign and date then deliver back
to the receptionist.
RESCHEDULING DUE TO UNAVAIBLE PROVIDERS :
If the provider is unavailable to be in clinic and patients have
been scheduled for that day, the patient will be notified as soon
as possible and rescheduled.
- The receptionist will make every attempt to contact the patients
to reschedule.
Health and Medical Division
Woman's Wellness
SUBJECT: Non Disposable Gowns
Use and Care
PURPOSE: To define the process for the storage,
use and cleaning cloth client gowns.
STAFF GOVERNED BY THIS POLICY: Cherokee Women's
Wellness Center
EFFECTIVE DATE: 7-21-01
DATE REVIEWED/REVISED: 7-21-01
DISTRIBUTION: CWWC, HMD
POLICY:
It is the policy of the Cherokee Women’s Wellness Center
to have a plan in place for the care and use of cloth gowns that
will be used by the clients of the center.
PROCEDURE:
- When a client is seen for an exam a cloth gown will be provided
when available.
- Cloth gowns will be kept in the cabinet in clinic and separated
by size. Gowns are placed in the exam room after a patient has
been screened so the correct size can be selected for patient
comfort.
- After the exam, the dirty gown will be placed in the hamper
in the clinic area.
- The dirty gowns will be taken to housekeeping at the Cherokee
Indian Hospital for cleaning each Monday, Wednesday, and / or
Friday before 9 am. Dirty gowns will be exchanged for clean gowns
at this time.
- If a cloth gown is not available, a paper gown will be used.
- It is the responsibility of the clinic CNA or LPN to monitor
the gown supply and transport to and from the Cherokee Indian
Hospital.
Health and Medical Division
Woman's Wellness
SUBJECT: Patient
Care Services
PURPOSE: Define Nurse Practitioner
STAFF GOVERNED BY THIS POLICY: Cherokee Women's
Wellness Center
EFFECTIVE DATE: 10-16-00
DATE REVIEWED/REVISED: 07-17-01
DISTRIBUTION: CWWC, HMD
POLICY:
General
The role of the Nurse Practitioner includes:
- Using the knowledge and skills appropriate to the expanding
nursing role.
- Being personally accountable for patient care including examination,
diagnosis, and treatment plans, according to the standardized
procedure regulations of the State of North Carolina.
The Nurse Practitioner provides services under the direction of
a licensed medical practitioner either on site or by telephone contact
in accordance with a written agreement.
The Nurse Practitioner will follow the Center protocols that have
been evaluated and agreed upon by the administration, the Physician
and the Nurse Practitioners practicing at the center.
Health Care Services Provided:
- Taking complete histories and performing physical examinations,
or those assessments pertinent to the reason for the visit, in
order to provide a patient data base and/or basis for therapeutic
or health maintenance plan.
- Diagnosing and treating common gynecological condition under
established protocols.
- Recording health, psychosocial problems and data in the medical
records.
- Ordering routine medications and treatments under established
protocols.
Health Education Services:
- Planning and initiating maintenance and rehabilitation for
each patient through such measures as the ordering of special
diets, exercise programs, vitamin supplements and immunizations.
- Teaching and counseling patient and/or family in areas such
as preventive health care, management of health problems, nutrition
use, and possible side effects of drugs, etc.
- Coordinating the implementation and continuity of patient care
through guidance of patients to appropriate community resources.
- Participating in professional meetings, workshops, seminars,
and other continuing education programs in order to keep abreast
of changes in professional practice, to contribute to one’s
own professional growth.
Health and Medical Division
Woman's Wellness
SUBJECT: Patient
Flow and Relationship
PURPOSE: To ensure patient satisfaction
and consistency.
STAFF GOVERNED BY THIS POLICY: Cherokee
Women's Wellness Center
EFFECTIVE DATE: 10-16-00
DATE REVIEWED/REVISED: 07-17-01
DISTRIBUTION: CWWC, HMD
POLICY:
The Center Director is responsible for supervision and implementation
of the procedures used in reception area.
Patient Relation Procedures:
The following procedures will be followed by the receptionist and
CNAs in dealing with all patients in order to maintain favorable
relationships.
- Use a friendly and courteous manner.
- Address the patient by proper name whenever possible.
- Explain the scheduling procedures and hours of Center.
- Answer any questions the patient may have.
- Determine the nature of the problem quickly in order to allow
best service to the patient.
- Problems which can not be handled at the Center due to limited
resources may be referred elsewhere and referral follow-up instituted.
- If an excessive waiting time exists, explain this to the patient
and present alternatives.
Patient Flow:
The Center Director is responsible for assuring that patients move
through the reception/waiting area and Center offices in a timely
and efficient manner to receive the needed services. Other staff
will provide assistance and cooperation toward this objective.
Efficient patient flow includes elements such as seeing that appropriate
forms are in the medical record for each patient.
Patient Flow Procedures:
The following procedures will be followed for the movement of patients
through the clinic.
Responsibility Action
Receptionist
1. Registers Patient
2. Pulls medical record.
3. Routes patient to CAN
CNAs
4. Takes vital signs.
5. Completes lifestyle assessment and patient
history.
Nurse Practitioner
6. Review patient history and lifestyle
Assessment.
7. Conduct reproductive history.
8. Perform physical assessment.
9. Make diagnosis.
10. Consult with MDs as appropriate.
11. Develop treatment Plan.
12. Provide patient education.
13. Make referrals as appropriate.
Health and Medical Division
Woman's Wellness
SUBJECT: Patient Care Services
PURPOSE: Define Patient Transportation Needs
STAFF GOVERNED BY THIS POLICY: Cherokee Women's
Wellness Center
EFFECTIVE DATE: 10-16-00
DATE REVIEWED/REVISED: 07-17-01
DISTRIBUTION: CWWC, HMD
POLICY:
Types of Services
The CHR (Community Health Representative) transports patients to
clinics if notified
Two days before their appointment date. The CHRs hours for transportation
are from
8:00 A.M. through 4:30 P.M. Monday through Friday.
Wellness Center patients will be encouraged to use the CHR services
if transportation is
Needed.
The Women’s wellness Center will provide limited transportation
for patients/clients with reproductive health care needs.
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