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    1. 1. Home Care DIrector of Nursing Orientation Orientation Orientation Tammy Marie Baker RN
    2. 2. Orientation to Agency Introduction to Personal internal/External Corporate Clinical/ Administrative Ladder Mission statement reviewed Hours of Operation reviewed Corporate Compliance overview Expectation of the Director reviewed Performance Improvement overview Grievance/Incidence/Risk Overview Professional Advisory Board Overview On call/Emergency policy 24/7 Clinical /Administrative Ladder Direct Report overview
    3. 3. Core Clinical Competencies Maintains highest level of Self clinical competencies Annual Competencies via Regional or comped Clinical Supervisor Builds/Maintains Skills lab/Stocks skills lab in office Monitors /trains/ reinforces Clinical competencies of Field staff daily as needed and annually per policy Adheres to the Nurses code of Ethics Continuing Education evidenced by CEU’s and Inservice logs DOCS /colleagues Quarterly in-services participates in Educational initiatives on corporate level
    4. 4. Core MAnagement Competencies Develops effective Leadership Style Utilizes transcultural Leadership Strong CohesiveTeam building skills Develops management style and shows effective ability to handle difficult people and situations Maintains proper decorum at all times Utilizes Corporate support structures legal/HR Follows and Fosters Polices Follows chain of command and reports to appropriate leadership
    5. 5. Hospital bed with side rails Medical mannequins Infant /Adult/Child Hoyer lift Wheel Chair **Contact SKILLS LAB INVENtORY local DME for supplies and samples for training nurses** Walker Air mattress Tracheotomy tubes/ties/supplies Suctions equipment Gastric tubes assorted Foley catheters Wound Vac supplies wound care supplies colostomy supplies Intravenous supplies empty med bottles; syringes
    6. 6. Responsibilities for Clinical Directly responsible for all clinical operations within the branch Over see’s Intake process, service level determination; admissions;plan of care development; medical record oversight; patient supervisory and assessments; transfers, on hold and discharge Oversees /directs/ supervises all clinical staff Approves all admissions Audits all charts home/office Monitors policy adherence Performance improvement plans /Quality assurance Quarterly reports/Audit Supervises and trains all field staff, case managers, clinical supervisors
    7. 7. 485 PLAN OF CARE Developed after admission and completed with in 5 working days Reviewed/ edited/ printed and faxed to MD for signature Primary diagnosis is the reason for HHA services Original 485 signed on date of SOC Re-certifications (ROC) signed on date of VSOC after day 56/60 assessment completed MD signed 485/POC is stamped with date received, and singed Copy to office chart and home chart
    8. 8. Clinical supplemental orders Develops and tracks 485/POC (Plan of care) Supplemental orders entered into EMS, printed, Signed x RN ;sent to MD via fax for signature and tracked All orders entered into plan of Care /485 Physician Signed orders stamped dated received/by clinician Copy of orders scanned to corporate and cc: to client chart On Hold orders out for no service >48 hours Resume care orders out upon return to service After RN re assessment
    9. 9. Responsibilities for field Staff Interview /Hire Orientation/training Educational In-services Clinical competencies in Lab/home 90 day appraisals Annual Appraisals Grievance/Incidence Workman's comp reports Employee Recognition Promotions Disciplinary Action
    10. 10. Staffing responsibilities Monitors open cases and staffing for efficiency and clinical outcomes Works with staffing team to align nurses skill sets and patient needs Provides clinical based input to staffing coordinators for best outcomes Monitors staff in field at home visits and clinics Monitors patient Specific report/orientation
    11. 11. Quality Assurance measures Auditing of all clinical documentation Audit state requirements Audit Compliance Quarterly metrics Risk Management Performance improvement reports
    12. 12. Educational ResponsibiliTIES Orientation of Staff In- service of Staff In-service schedule Preplanned for on coming year Clinical Competencies of staff Self Educational Development with continuing CEU’s Maintains resource library for Clinicians/ Field staff
    13. 13. Team Collaboration Collaborates with Accounts manager/ accounts executive and Business officer for financial growth of office Follows Client data reports that affect revenue of office Works with Marketing team to foster office growth and cliental. Collaborates with Staffing teams and Monitors Employee staffing for overtime and effective staffing strategies. Works with Personal coordinator to monitor employee compliance with Mandatory requirements Direct Report to Ladder reviewed
    14. 14. Management/Leadership Develops Effective Leadership style with training Develops and maintains rapport with clinical and business team and Families Acts as direct Liason for families and field team and corporate Learns and implements Emergency Management Protocols and Patient staff safety
    15. 15. Financial Growth awareness Familiarizes with office financial goals Defines financial terms: Spread, split, ect Reviews weekly financials with Accounts manager or MBO Monitors overtime of staff/assist staffers to reduce OT Monitors office for financial waste and areas to improve Marketing initiatives with business Managers to foster growth
    16. 16. Risk Management Falls Log Client Acuity Log: HIGH/MEDIUM/LOW Grievance logs Incident logs Infection logs: Respiratory/UTI/wound Medication/narcotic Errors Decubitus Ulcers developed post admission Emergency Management and preparedness
    17. 17. emergency/ Disaster preparedness Company policies reviewed Fire drills, Fire extinguishers date check, smoke detector test office quartetly NJ211 Natural Disaster FEMA American Red Cross Disaster Tips ( hurricane, floods, tornado, power outages,earthquakes) Emergency client preparedness call all clients with check list, place check list in chart and on call book; log on EMR that client was called. Evacuate Medically fragile or high risk clients Power outage considerations for ventilator dependent clients in place Know the coastal Evacuation routes. Have a printed Emergency phone book ( computers down)
    18. 18. Governing Board On Call Book Mandatory & regulatory Manuals current/ Audit ready at all times State Specific current/ Audit ready at all times MSDS( material Safety Data Sheet) OSHA RISK(Falls/Incidence/Grievance) Quality Assurance Weekly meetings Compliance Clinical Competency Protocols State Lab/CLIA MD Verification Signature Log
    19. 19. Maintains state/federal regulations Monitors compliance with State/ Federal regulatory bodies Maintains Current regulation manuals and monitors compliance of regulations within daily operations Examples of regulatory bodies: ACHC/CACH/CHAP/Joint Commission Self audits for compliance, Performance Improvement Reports and notifies administrative ladder of deficits and corrective actions Trains/Educates the internal/external employees on regulations and rational for compliance to maintain licensure in good standing
    20. 20. OSHA /Safety Standards Biohazard waste containment: syringe boxes, red bags, labeled and marked at point of origin and properly stored in locked closet until picked up Biohazard waste pick up logs Hand washing signs in office/lavatories for employees Fire extinguisher and Fire drill Logs biannual No smoking signs in office
    21. 21. Medication refrigerator Cold chain policy maintained Temperature/ humidity log maintained bid PENNY CUP in freezer NOTE: Auditors will check log for compliance and check for expired medications NO FOOD ALLOWED Biohazard sticker on Fridge Logs labeled month/office/Date and filed in log book with Mandatory manual Library shelf All medications labeled and dated upon opening of vials by clinician Expired medications properly wasted and discarded
    22. 22. weekly responsibilities Audit Nurses notes Staff /Team meeting Clinical census/Requirement reports Check requirements ( supervisions/recerts) DOCS report to RDOCS
    23. 23. Monthly Responsibilities MARS /Med Profiles for all clients printed by 1st of month and mailed out MD Verification book print out and check expired on all active patients Employee recognition Awards
    24. 24. QUARTERLY responsibilities Office/ state/ regional data reports Directors meetings Chart/ internal audit reports Participate in corporate Educational Initiatives Medical records Chart splits HQM audits if required
    25. 25. Annual responsibilities On call schedule for office for on call book Inservice schedule for new year CHHA/ RN/LPN Annual inservice logs all employees printed/place in book Annual Risk reports printed for Q/A book Annual Census reports: Admissions; transfers; discharges and deaths cumulative Employee recognition awards PAB meeting State Lab Requirements and Bi Annual Meetings with quarterly monitoring
    26. 26. Meetings ReQuired *(Meeting agendas printed and placed in PI book) Weekly staff meeting Weekly District meeting with Regionals Monthly Case manager/ Clinical supervisor meetings Monthly Regional Updates Quarterly Directors meetings Annual In-services 12 /year PAB /State Lab Meeting Annual Corporate meetings Biannual Regional corporate meetings
    27. 27. CORE MANAGEMENT TEAMS TO DEVELOP TO DEVELOP Pediatric Team Adult Team PCA Unskilled Team Clinical Wellness Team Wound Care Team Intravenous team Risk and Utilization Review Team
    28. 28. Clinical Lab License: CLIA State standards reviewed Orientation to wellness protocols Lab manual Q/A of all machines pre clinic Annual training of all external wellness nurses to protocols/procedures/policies/ and Lab laws Core competencies in Lab/Field training with competency check list refrigerator/temp / humidity logs reviewed MD orders for state protocols reviewed
    29. 29. personal Medical records Maintains HIPPA of personal medical records works with PC to monitor annual requirements and interpret results PPD/MMR/HEP B Administers or Trains CS/CM to Administer PPD two step to field nurses upon hire and once annual per company/state policy Flu /Pneumonia shots per company policy if required/requested
    30. 30. Intravenous therapy Team Core competency reviews DOCS/DON certified with certificate Mannequin arm trainer and demo supplies minimum IV trained RN’s only ( 10) Affiliation with IV supply company No case opened unless full team available 24/7
    31. 31. Develop wound care therapy team RN core team 5-10 nurses Wound Vac in-services by 2 companies KCI and Renaysis 24/7 coverage Monthly wound care team case management rounds RN see’s wound weekly if LPN on case Monthly wound care article or inservice Infection tracking log
    32. 32. Develop Pediatric Nurse Team Pediatric modules on line ( see company on line train system School nurse Certificate or Pediatric nurse care; with trauma or ER Experience recommended Pediatric coarse in office with competencies State School nurse manual reviewed with candidate School nurses must have 2 years pediatrics or ER training to work in school if not certified School nurses with out certificate must get temp school nurse sub certificate from county. Fingerprint all nurses for county and school working in .
    33. 33. Develops Risk and UTILIZATION REVIEW TEAM Trains staff in utilization review and records monitoring/maintenance Develops plan for back up when DON is out of office Quarterly self audits with team and discusses deficits and performance improvement
    34. 34. IN-services requirements Quarterly DOCS/DON meetings state wide Annual Corporate state wide 30 CEU/two years for State License Company Annuals/Mandatories: Compliance; OSHA; Safety; Bio Hazard; Pediatric Modules; Trach/Vent modules/ wellness External In-services : 12 hours per year in-office/ in home/take home. DOCS must have program in Excel Spread sheet with Quarterly In-service Schedule and logs In-Service records on all personal files and in log book
    35. 35. Director of Nursing just the beginning.... just the beginning.... Life is a learning process which is a continuum and our experiences change daily......