AmericAn Home HeAltH News

Q&A

Page 2

Spring Safety Tips

Page 3

Mandatory Skills Fair’s Directions

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April 2010Issue 1, Vol. 1

Before her transfer from a long-term facility to a hospital, a patient with diabetes receives a scheduled dose of

insulin. On her arrival at the hospital, she’s given a duplicate dose in error. A nurse discov-ers the mistake when the patient’s medication history catches up with her an hour later.

According to the Institute for Healthcare Im-provement (IHI), poorly communicated medical information at admission and other health care transition points is responsible for as many as 50% of all medication errors in hospitals. Transi-tion points include facility admission, transfers within the facility, transfers between facilities and agencies, and discharge.

To prevent errors and adverse drug events (ADEs) stemming from oversights, duplication, and other discrepancies in a patient’s medication record, American Home Health has made reconciliation a key strategy in our fight. We define medication reconciliation as “the process of creating the most accurate list possible of all medication a patient is taking – including drug name, dosage, frequency, and route – and comparing that list against the physician’s admission, transfer, and/or discharge orders, with the goal of providing correct medica-tion to the patient at all transition points within the setting.” Determining the timing of a drug’s last dose is a critical part of the process, as the opening scenario illustrates.

Medication reconciliation is also a National Patient Safety Goal for Joint Commission (JC). All Joint Commission accredited facilities/agen-cies must have protocols in place for document-ing and reconciling medication across the con-tinuum of care.

Three-step ProcessMedication reconciliation is a three-step

process: - verification (collecting the patient’s

medication history and other medica-tion information)

- clarification (ensuring that medication and dosages are appropriate for the patient)

- reconciliation (resolving any discrepan-cies and documenting communication and changes in orders)

Here’s how it works. On admission, a list of the patient’s home medication is compiled and compared with the initial primary health care provider’s orders. At the time of transfer to another unit, all the medications she’s taking are compared with the orders in the new unit. At discharge, medications she’s taking in the hospital are compared with the primary health care provider’s discharge medication orders.

When a discrepancy is detected between any of these lists, the nurse, pharmacist, or health care provider must reconcile or correct the discrepancy and document the action. An independent check performed by a nurse or pharmacist provides an extra safety net to screen for potential ADEs before they occur.

Communication and clarification of infor-mation should involve the patient and others as appropriate; for example, family members who help care for her at home, other health care providers who care for her, and the pharmacist who fills her prescriptions at home.

Assessment tipsWhen interviewing a patient about her

medication, use these tips to compile an ac-curate and complete list:

- Ask open-ended questions starting with what, why, and when, and bal-ance them with yes-no questions.

- Ask simple questions and don’t use medical jargon. Avoid leading ques-tions that might elicit inaccurate in-formation.

- Prompt the patient to try to remem-ber all medication products she uses, including sample medications, “shots,”

herbal or mineral supplements, and vitamins.

- Pursue unclear information until it’s clarified. For example, check previous medical records, ask a family member to bring in the patient’s medication, or call her home pharmacy for a list of prescriptions she’s been filling.

- Encourage her to get all her medication from the same pharmacy.

- When questioning her about ADEs, educate her about the difference be-tween an expected adverse effect and a true allergy and make sure she knows which signs and symptoms require im-mediate attention.

- Ask her to describe how and when she takes her medications, which may help you determine if she’s adhering to the prescribed regimen.

- Advise her to keep a medication wallet card and to bring her medications or a list of her medications to the hospital and appointments with heath care pro-viders. The client may also use Ameri-can Home Health’s medication profile or medication administration record.§

How Medication Reconciliation Saves Lives!

Q&A

2 American Home Health News |April 2010

American Home Health NewsEditors: Karen Centowski & Edward LaraDesigner: Edward LaraContributions: Jan Fulfs, JanelleFulfs, Shawn Pickett

For Contributions, please e-mail hr@ahhc-1.com or write to 1660 N.

Farnsworth Ave., Ste.3, Aurora, IL 60505

Helpful Hints for Charting

Too Generic Appropriate Documentation

Aspiration Precautions HOB up 30 degrees/up in chair/oral suctioning.

Appears infected Site warm to touch/erythemic/tender/swollen.

Report given to caregiverReport given to mother, Sue Smith. Off shift, client left in mother’s care.

Report received from caregiverReport received from teenage sister, Sally Smith, an untrained caregiver.

QI have a copy of a DSCC grading tool that exclusively uses nursing notes to grade our patients. Can you explain

this? Can this documentation also put me and AHHC at a huge disadvantage in a court case?

AThank you for this important ques-tion. I have recently been addressed by several DSCC Case Managers who

use this tool to sift through all nursing docu-mentation to derive a score. Their concerns were a lack of information in nursing notes required to complete it. First, who is DSCC and what’s with this tool?

DSCC (Division of Specialized Care for Children) is funded by Title V of the Social Security Act, through HFS (Illinois Dept. of Healthcare and Family Services). As the payer of over 90% of Private Duty home care in the state, DSCC is tightening their belts like the rest of us. All Clients’ qualification for Waiver program services are assessed via a “Level of Care Tool.” The LOC tool quantifies the need for services with a point system. Clients who do not score enough points may be dropped from the DSCC Waiver program and would have to seek out less prolific funding.

The SOLE SOURCE for points is found in the Nursing and Organizational Docu-mentation. Remember the term “If it’s not documented, It wasn’t done”? Well, the state is taking that literally. Points are assigned by DETAILS of care and FREQUENCY of care. This means that generic and blan-ket documentation generates no points for the Client and places them at risk for loss of health care services.

What exactly is meant by DETAILS AND FREQUENCY of care? For example:

Details; CPAP via trach-45 points; CPAP via mask-35 points. Continuous Tube Feed-ings with reflux-35 Pts; Continuous Tube Feedings without reflux-15 pts.

Frequencies; Oxygen Therapy Continuous -35 Pts; Oxygen Therapy Intermittent (Per Sats)-20 Pts; Suctioning more than hourly- 5 Pts; Q 1-4 Hrs- 3 Pts; Less Than Q 4 Hrs -2 Pts.

The ramifications of poor documentation. A loss of services can be quite devastating to a deserving client and his family. The HFS Waiver program is designed to allow working families to continue to do so and others to be able to seek out productive work. Poor docu-mentation may result in the unnecessary loss

of a client, causing nurses w/ stable work to be scrambled to new clients and new scheduling. Also, I don’t want this to sound like some new fangled professional requirement for nurses. It has been a long standing standard for nurses not to document in ambiguous or subjec-tive verbiage, but rather in specific objective details. A nurse legal consultant once told me; “In court, cases are won and lost by not only what’s documented, but by what’s not documented. Omission of documented care is virtually an admission of neglect.”

So, of all the wonderful things we do to provide excellent health care services to our Patients, it’s critical that we be attentative to our daily documentation. We all want our practices to reflect our innate caring nature and create ramifications that are Positive, Professional, and livelihood sustaining for Clients and ourselves.

Shawn A. Pickett, BSN, RNClinical Manager / Supervisor, AHHC

Q&A

Notice From: IDFPRDate: February 25, 2010

Important Notice Regarding Continuing Education and Registered Nurses

Pursuant to Section 60-40 of the Nurse Practice Act, registered nurses are required to complete 20 hours of Continuing Education per pre-renewal period. The pre-renewal period is the twenty-four (24) month’s preceding the expiration date of the license. This requirement will go into effect for the upcoming 2010 – 2012 pre-renewal cycle. Beginning June 1, 2010, registered nurses must complete 20 hours of CE between June 1, 2010 and May 31, 2012. CE taken before June 1, 2010 cannot be used to satisfy this requirement. Registered nurses that renew their licenses for the 2010 – 2012 renewal cycle will receive written notice of the CE requirement with their new licenses. Licensees may also consult the resource guide avail-able at the Illinois Center for Nursing website: http://nursing.illinois.gov/NursingCE.asp.

April 2010 | American Home Health News 3

With warmer weather and longer days approaching, people in [name of town or county] are emerging from

their winter cocoons to focus onlong-neglected projects like spring cleaning,

home repairs, and yard work. Many are also lacing up their shoes for their first outdoor walk or jog of the season. These activities can be extremely beneficial, but they also involve a variety of health and safety hazards that can be avoided with the proper precautions. To help ensure everyone in our community stays safe this season, the members of

[name of your organization] offer the fol-lowing tips and suggest you post them where they can be seen by your family members and co-workers.

CLEANING FOR SAFETYNature is undergoing a fresh start and so

are homeowners who are ready to clean up the debris that has been accumulating in basements, storage sheds, and garages over the winter.

• Household and pool chemicals, paints, and poisons should be properly marked and stored under lock and key, away from children’s reach. Dispose of any that are leaking, expired, or that look bad.

• When cleaning up hazardous chemicals wear rubber gloves and follow the safety direction on the packaging. Never mix chemicals in the same container. If you don’t’ know how to dispose of them, seek outside advice. Never put them into the trash or pour down the drain.

• Make sure gasoline and cleaning fluids are well marked and stored in a cool, dry place away from the house and out of the reach of children and pets. Use only approved containers for gasoline

storage.• Never use gasoline to clean skin, clothes,

auto parts, or floors.• Clean up work areas. Put dangerous

tools, adhesives, matches, or other work items away from children’s reach.

• Check your barbecue grill for leaks and cracks, and be sure to store any propane tanks away from your house and garage.

• Remove all fire hazards, including stacks of rags, newspapers, and magazines. Pay special attention to the spaces around your furnace, hot water tank, fireplace, space heaters, and dryer, as well as under the stairs.

YARDWORK SAFETYItching to get the yard into shape for the

summer? Here are ways to help ensure your spring spruce-up is disaster-free.

• Limber up. Yard chores may seem easy, but they involve muscles you probably haven’t used in a while.

• Always wear protective clothing when you handle pesticides and fertilizers.

• More than 60,000 people are treated in emergency rooms each year for lawn-mower injuries. » Rake before you mow to prevent

any stones and loose debris from launching into the air.

» Never operate a mower in your bare feet and avoid wearing loose clothing.

» Never start a mower indoors. » When refueling your mower,

make sure the engine is off and cool. Don’t spill gasoline on a hot engine — and don’t smoke while pouring gasoline.

» Never leave your mower opera-

tional while unattended. » Don’t use electrical mowers on wet

grass.• At least 55,000 people each year sustain

injuries from trimmers, lawn edgers, pruners and power saws. » Read the manufacturer’s instruc-

tions carefully before using the tools.

» Inspect the product for damage and don’t use it if there are prob-lems.

» Use proper eye protection. » Make sure blade guards are in place

on all cutting equipment. » Don’t let tools get wet unless they

are labeled “immersible.” » Unplug all tools when not in use. » Make sure the tool is in the “off”

position before you plug it in. » Store gasoline-powered equipment

away from anything that uses a pi-lot light.

» Make sure you use the right saw for the task, and always wait for the saw blade to stop before pulling away from a cut to avoid kickback.

OUTDOOR SAFETY• When pruning trees, be careful not to

let metal ladders or trimmers contact overhead wires.

• Before you do any “hands on” weed removal, make sure you know how to identify poison ivy, sumac, oak and similar toxic plants. Find out ahead of time how to treat the rashes they cause to reduce the irritation.

• Ready for some outdoor exercise and adventure? Here are a few pointers.

American Home Health Offers Spring Safety Tips for the Community

…the air is warming, the snow is melting and the trees are budding. This means it’s time for spring cleaning, yard work, home repairs, and new exercise regimens…all of which can present a variety of health and safety hazards. Your organization is often called upon to respond when problems occur, which provides an excellent opportunity to educate your community about spring safety and gain some solid public relations points in the process.

Below and on the reverse side is an adaptable press release featuring a variety of spring safety tips. You can re-typeit or download it in Word format at www.vfis.com and place it on your organization letterhead. You may also wish to add tips specific to your area. Simply insert your local information in the areas indicated in brackets and mail the news release to the health or feature editor at your local newspaper as well as the news producers at television and radio stations in your area. Better yet, call them to find out the appropriate person to receive the release. You may even wish to offer your health and safety officer for interviews.

4 American Home Health News |April 2010

Spring safety tips for our walkers, runners, and bi-cyclists; all of whom have to

share our narrow roads and streets with motor vehicles:

Pretend that you’re invisible - Sounds sort of funny but it’s a good way to keep from getting run over. Make it irrelevant whether drivers see you or not. If you al-ways assume that a driver doesn’t see you, you’ll be a lot safer.

Never run or walk more than two-abreast, and make sure you face traffic, keeping as close to the shoulder-of-the-road as possible - incase you have to take evasive action. Bikers should travel with traffic, and obey the rules of the road, while always wearing a hel-met.

Wear reflective clothing - Take a look at the next police officer you see on traffic duty. Their wear-ing reflective colors - you should too, if you’re going to be in the

roadway.Be attentive to the lighting

conditions. It’s harder for drivers to see during dusk and dawn. Re-member that solar glare is a factor in a lot of accidents.

Keep a cell phone with you. It’s good to program the word “ICE” in your cell phone contact list. “ICE” stands for “In case of emergency”. Just enter your emer-gency contact person (Mom, dad, husband, wife, brother, sister, etc.) under the name “ICE”, so police, fire, or EMS personnel will have a point of contact in case you’re involved in an accident and we don’t know who you are.

Any finally, drivers should keep their windshields clean. It’s also an excellent idea to wash-off your headlights and taillights when you gas-up. It makes a big difference.§

Spring Safety TipsIt’s already time for the An-

nual SKILLS FAIR, formerly known as the Competency

Fair. Show us your Skills. Show us what you are really made of.

We often receive the question, “Why do I have to attend the SKILLS FAIR?” Well, why not?

We have hundreds of staff working independently in the homes of very fragile clients. This annual evaluation affords us the opportunity to meet with every staff member face to face to al-low you to impress upon us your knowledge, skills, reasoning and emotional capability of caring for these individuals.

Oftentimes some of the skills required of our staff are infre-quently used. This gives you the opportunity to brush up on those skills and to feel confident that you can perform those infrequent tasks if the opportunity arises.

We realize there are parts of your job you know how to per-form but do not have the ability

to perform them on a consistent basis, like changing a trach or inserting a g-tube. These are still important to keep up to date on the skills process.

One way to ensure we meet the skills requirement is by hold-ing the SKILLS FAIR (formerly known as the Competency Fair). At no time is the Skills Fair meant to make you feel like you are being tested. It’s actually meant for you to SHINE!

We will continue to provide all the material ahead of time for the in-services and the hands-on check-off lists.

CliniCal CompetenCe: “The habitual capability and judicious use of communication, knowl-edge, technical skills, clinical reasoning, emotions, values and reflection in daily practice for the benefit of the individual and com-munity being served.”§

Skills Fair

Spring is Here Continued from page 3

• Winter’s inactive muscles can take only so much strain. Don’t overdo it — build up slowly so you don’t have strains that can put you out of commission for some time.

• It may look appealing, but don’t wander on frozen rivers and lakes in the spring. The ice is beginning to thaw, and you never know just how thin the ice really is.

• Spring’s extra rain and thawing snow can cause normally safe rivers, streams, and creeks to turn treacherous. Even standing on banks can be risky as they can be un-dercut by rushing water and give in under your weight.

• Springtime is also severe weather time. If the skies look threatening, check to see if a storm watch or warning has been issued before you initiate outdoor activities. If you’re already outside and thunderstorms threaten, go im-mediately into a building or enclosed vehicle. For tornadoes, go to the nearest safe structure,

or the basement or interior first-floor room of your home. If there’s no time to follow these precautions, take cover in a ditch or depression in the ground.

LADDER SAFETYReady to do some home repairs? On average,

about 145,000 people visit the emergency room each year, because of ladder mishaps. Here are a few safety tips:

• Read the manufacturer’s instructions that come with your ladder. They contain guidelines for weight and height limits as well as for the proper use of their product.

• Inspect the ladder before using it to make sure there are no loose or broken rungs.

• Make sure the ladder is the right height for the job. Many accidents happen when people overextend their reach because their ladders are too short.

• Never stand on a ladder’s bucket shelf.• Make sure the ladder is completely open

and that all of its feet are planted on a

firm, level surface. Extension ladders should not be placed at an angle that is too extreme.

• Avoid using a metal ladder near electri-cal sources.

• Face the ladder when climbing down and make sure your weight is centered between the two sides.

“These are just a few of the safety precaution to consider during the spring,” says Janelle Fulfs of American Home Health. “It’s also a great time to replace your smoke detector batteries, make sure your fire extinguishers are placed in proper loca-tions around your home, and ensure you have a working flashlight and battery-powered radio for spring storms. By taking the right precautions when warmer weather beckons, you and those around you can enjoy a safer, healthier spring.”§

April 2010 | American Home Health News 5

You’re Invited!

Please Join Us for American Home Health’s

7th Annual

Mandatory SKILLS FAIR (formerly known as the COMPETENCY FAIR)

Plan Ahead …. Mark Your Calendars ….

WHEN: Wednesday, April 14th, 8 am – 6 pm

Thursday, April 15th, 8 am – 6 pm

Friday, April 16th, 8 am – 6 pm

Saturday, April 17th, 8 am – 6 pm

WHERE: (directions on back): Yorkfield Civic Center

15W354 Lexington

Elmhurst, IL 60126

Highlights:

- Free CPR Training presented by L.M. Cantone & AssociatesWednesday (4/14), Friday (4/16), Saturday (4/17) at 10 AM

- Private Duty Booths

- Intermittent Visit Booths

- Networking

- Refreshments

- Door Prizes

Note: Please keep in mind we are limited on how many nurses we can in-service at a time. This

makes time spots limited, and we need to allocate in the order RSVPs come in. Please allocate two

hours to complete the fair.

Please tear off this section and send it in.

→ → → → → → → → → → → → → → → → → → → → → → → → → → Name: __________________________________________ Title: RN / LPN

Date Preferred: ____________ / ____________ / ____________ Time: ________

CPR Reservation Date Preferred (circle one): Wednesday (4/14) / Friday (4/16) / Saturday (4/17)

6 American Home Health News |April 2010

From the WestTake I-88 East toward Chicago. Go through the York Toll Plaza. Merge right and Exit I-294 south toward Indiana. Keep right at the fork in the ramp. Turn right onto York Rd. Turn right onto Lexington St.

From The SouthTake I-294 N to Il-38 west (Roosevelt Rd.) Exit. Take the north York Rd. Ramp. Turn right onto Lexington St.

From the NorthSouth on I-94 (or-I294) to I-294. Take Cermak Rd. (22nd Street) exit. Keep left at Fork in the Ramp. Turn left onto W. 22nd st./Cermak Rd. Turn right onto York Rd. Turn right onto Lexington St.

From Chicago:Take I-290 West (Eisenhower). Merge onto westbound I-88. Merge onto IL-38/Roos-evelt Rd. Take the North York Road ramp. Turn right onto Lexington St.