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Home care Director of Nursing
Orientation power point

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  1. 1. Home CareDIrector of Nursing Orientation Orientation OrientationTammy Marie Baker RN
  2. 2. Orientation to AgencyIntroduction to Personal internal/ExternalCorporate Clinical/ Administrative LadderMission statement reviewedHours of Operation reviewedCorporate Compliance overviewExpectation of the Director reviewedPerformance Improvement overviewGrievance/Incidence/Risk OverviewProfessional Advisory Board OverviewOn call/Emergency policy 24/7Clinical /Administrative Ladder Direct Report overview
  3. 3. Core Clinical CompetenciesMaintains highest level of Self clinical competenciesAnnual Competencies via Regional or comped Clinical SupervisorBuilds/Maintains Skills lab/Stocks skills lab in officeMonitors /trains/ reinforces Clinical competencies of Field staff daily as neededand annually per policyAdheres to the Nurses code of EthicsContinuing Education evidenced by CEU’s and Inservice logsDOCS /colleagues Quarterly in-services participates in Educational initiatives oncorporate level
  4. 4. Core MAnagement CompetenciesDevelops effective Leadership StyleUtilizes transcultural LeadershipStrong CohesiveTeam building skillsDevelops management style and shows effective ability to handle difficult peopleand situationsMaintains proper decorum at all timesUtilizes Corporate support structures legal/HRFollows and Fosters PolicesFollows chain of command and reports to appropriate leadership
  5. 5. Hospital bed with side railsMedical mannequins Infant /Adult/ChildHoyer lift SKILLS LAB INVENtORYWheel Chair **Contact local DME for supplies and samples for training nurses**WalkerAir mattressTracheotomy tubes/ties/suppliesSuctions equipmentGastric tubes assortedFoley cathetersWound Vac supplieswound care suppliescolostomy suppliesIntravenous suppliesempty med bottles; syringes
  6. 6. Responsibilities for ClinicalDirectly responsible for all clinical operations within the branchOver see’s Intake process, service level determination; admissions;plan of care development; medical recordoversight; patient supervisory and assessments; transfers, on hold and dischargeOversees /directs/ supervises all clinical staffApproves all admissionsAudits all charts home/officeMonitors policy adherencePerformance improvement plans /Quality assurance Quarterly reports/AuditSupervises and trains all field staff, case managers, clinical supervisors
  7. 7. 485 PLAN OF CAREDeveloped after admission and completed with in 5 working daysReviewed/ edited/ printed and faxed to MD for signaturePrimary diagnosis is the reason for HHA servicesOriginal 485 signed on date of SOCRe-certifications (ROC) signed on date of VSOC after day 56/60 assessmentcompletedMD signed 485/POC is stamped with date received, and singedCopy to office chart and home chart
  8. 8. Clinical supplemental ordersDevelops and tracks 485/POC (Plan of care)Supplemental orders entered into EMS, printed, Signed x RN ;sent to MD via faxfor signature and trackedAll orders entered into plan of Care /485Physician Signed orders stamped dated received/by clinicianCopy of orders scanned to corporate and cc: to client chartOn Hold orders out for no service >48 hoursResume care orders out upon return to service After RN re assessment
  9. 9. Responsibilities for field StaffInterview /HireOrientation/trainingEducational In-servicesClinical competencies in Lab/home90 day appraisalsAnnual AppraisalsGrievance/IncidenceWorkmans comp reportsEmployee RecognitionPromotionsDisciplinary Action
  10. 10. Staffing responsibilitiesMonitors open cases and staffing for efficiency and clinical outcomesWorks with staffing team to align nurses skill sets and patient needsProvides clinical based input to staffing coordinators for best outcomesMonitors staff in field at home visits and clinicsMonitors patient Specific report/orientation
  11. 11. Quality Assurance measuresAuditing of all clinical documentationAudit state requirementsAudit ComplianceQuarterly metricsRisk ManagementPerformance improvement reports
  12. 12. Educational ResponsibiliTIESOrientation of StaffIn- service of StaffIn-service schedule Preplanned for on coming yearClinical Competencies of staffSelf Educational Development with continuing CEU’sMaintains resource library for Clinicians/ Field staff
  13. 13. Team CollaborationCollaborates with Accounts manager/ accounts executive and Business officer forfinancial growth of officeFollows Client data reports that affect revenue of officeWorks with Marketing team to foster office growth and cliental.Collaborates with Staffing teams and Monitors Employee staffing for overtimeand effective staffing strategies.Works with Personal coordinator to monitor employee compliance withMandatory requirementsDirect Report to Ladder reviewed
  14. 14. Management/LeadershipDevelops Effective Leadership style with trainingDevelops and maintains rapport with clinical andbusiness team and FamiliesActs as direct Liason for families and field team andcorporateLearns and implements Emergency ManagementProtocols and Patient staff safety
  15. 15. Financial Growth awarenessFamiliarizes with office financial goalsDefines financial terms: Spread, split, ectReviews weekly financials with Accounts manager or MBOMonitors overtime of staff/assist staffers to reduce OTMonitors office for financial waste and areas to improveMarketing initiatives with business Managers to foster growth
  16. 16. Risk ManagementFalls LogClient Acuity Log: HIGH/MEDIUM/LOWGrievance logsIncident logsInfection logs: Respiratory/UTI/woundMedication/narcotic ErrorsDecubitus Ulcers developed post admissionEmergency Management and preparedness
  17. 17. emergency/ Disaster preparednessCompany policies reviewedFire drills, Fire extinguishers date check, smoke detector test office quartetlyNJ211 Natural DisasterFEMAAmerican Red Cross Disaster Tips ( hurricane, floods, tornado, power outages,earthquakes) client preparedness call all clients with check list, place check list in chart and on call book; log onEMR that client was called.Evacuate Medically fragile or high risk clientsPower outage considerations for ventilator dependent clients in placeKnow the coastal Evacuation routes.Have a printed Emergency phone book ( computers down)
  18. 18. Governing BoardOn Call Book Mandatory & regulatory Manuals current/ Audit ready at all timesState Specific current/ Audit ready at all timesMSDS( material Safety Data Sheet)OSHARISK(Falls/Incidence/Grievance)Quality AssuranceWeekly meetingsComplianceClinical Competency ProtocolsState Lab/CLIAMD VerificationSignature Log
  19. 19. Maintains state/federal regulationsMonitors compliance with State/ Federal regulatory bodiesMaintains Current regulation manuals and monitors compliance of regulationswithin daily operationsExamples of regulatory bodies: ACHC/CACH/CHAP/Joint CommissionSelf audits for compliance, Performance Improvement Reports and notifiesadministrative ladder of deficits and corrective actionsTrains/Educates the internal/external employees on regulations and rational forcompliance to maintain licensure in good standing
  20. 20. OSHA /Safety StandardsBiohazard waste containment: syringe boxes, red bags,labeled and marked at point of origin and properlystored in locked closet until picked upBiohazard waste pick up logsHand washing signs in office/lavatories for employeesFire extinguisher and Fire drill Logs biannualNo smoking signs in office
  21. 21. Medication refrigeratorCold chain policy maintainedTemperature/ humidity log maintained bid NOTE: Auditors will check log for compliance and check forPENNY CUP in freezer expired medicationsNO FOOD ALLOWEDBiohazard sticker on FridgeLogs labeled month/office/Date and filed in log book with Mandatory manualLibrary shelfAll medications labeled and dated upon opening of vials by clinicianExpired medications properly wasted and discarded
  22. 22. weekly responsibilitiesAudit Nurses notesStaff /Team meetingClinical census/Requirement reportsCheck requirements ( supervisions/recerts)DOCS report to RDOCS
  23. 23. Monthly ResponsibilitiesMARS /Med Profiles for all clients printed by 1st ofmonth and mailed outMD Verification book print out and check expired onall active patientsEmployee recognition Awards
  24. 24. QUARTERLY responsibilitiesOffice/ state/ regional data reportsDirectors meetingsChart/ internal audit reportsParticipate in corporate Educational InitiativesMedical records Chart splitsHQM audits if required
  25. 25. Annual responsibilitiesOn call schedule for office for on call bookInservice schedule for new year CHHA/ RN/LPNAnnual inservice logs all employees printed/place in bookAnnual Risk reports printed for Q/A bookAnnual Census reports: Admissions; transfers; discharges and deaths cumulativeEmployee recognition awardsPAB meetingState 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 TEAMSPediatric Team TO DEVELOPAdult Team TO DEVELOPPCA Unskilled TeamClinical Wellness TeamWound Care TeamIntravenous teamRisk and Utilization Review Team
  28. 28. Clinical Lab License: CLIAState standards reviewedOrientation to wellness protocolsLab manualQ/A of all machines pre clinicAnnual training of all external wellness nurses to protocols/procedures/policies/and Lab lawsCore competencies in Lab/Field training with competency check listrefrigerator/temp / humidity logs reviewedMD orders for state protocols reviewed
  29. 29. personal Medical recordsMaintains HIPPA of personal medical recordsworks with PC to monitor annual requirements andinterpret results PPD/MMR/HEP BAdministers or Trains CS/CM to Administer PPD twostep to field nurses upon hire and once annual percompany/state policyFlu /Pneumonia shots per company policy ifrequired/requested
  30. 30. Intravenous therapy TeamCore competency reviewsDOCS/DON certified with certificateMannequin arm trainer and demo suppliesminimum IV trained RN’s only ( 10)Affiliation with IV supply companyNo case opened unless full team available 24/7
  31. 31. Develop wound care therapy teamRN core team 5-10 nursesWound Vac in-services by 2 companies KCI and Renaysis24/7 coverageMonthly wound care team case management roundsRN see’s wound weekly if LPN on caseMonthly wound care article or inserviceInfection tracking log
  32. 32. Develop Pediatric Nurse TeamPediatric modules on line ( see company on line train systemSchool nurse Certificate or Pediatric nurse care; with trauma or ER ExperiencerecommendedPediatric coarse in office with competenciesState School nurse manual reviewed with candidateSchool nurses must have 2 years pediatrics or ER training to work in school if notcertifiedSchool nurses with out certificate must get temp school nurse sub certificate fromcounty.Fingerprint all nurses for county and school working in .
  33. 33. Develops Risk and UTILIZATION REVIEW TEAMTrains staff in utilization review and recordsmonitoring/maintenanceDevelops plan for back up when DON is out of officeQuarterly self audits with team and discusses deficitsand performance improvement
  34. 34. IN-services requirementsQuarterly DOCS/DON meetings state wideAnnual Corporate state wide30 CEU/two years for State LicenseCompany Annuals/Mandatories: Compliance; OSHA; Safety; Bio Hazard;Pediatric Modules; Trach/Vent modules/ wellnessExternal In-services : 12 hours per year in-office/ in home/take home. DOCS musthave program in Excel Spread sheet with Quarterly In-service Schedule and logsIn-Service records on all personal files and in log book
  35. 35. Director of Nursing just the beginning.... Life is a learning processwhich is a continuum and our experiences change daily......