Home CareDIrector of Nursing

Orientation

Tammy Marie Baker RN

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

Core Clinical CompetenciesMaintains 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

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

SKILLS LAB INVENtORY

Hospital bed with side rails

Medical mannequins Infant /Adult/Child

Hoyer lift

Wheel Chair

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

bath basin/ personal hygiene items

vent circuits

O2 tank

Ventilator if procurable

**Contact local DME for supplies and samples for training nurses**

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

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

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

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

Discharge from Duty/Terminations

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

Quality Assurance measures

Auditing of all clinical documentation

Audit state requirements

Audit Compliance

Quarterly metrics

Risk Management

Performance improvement reports

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

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

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

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

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

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) http://www.redcross.org/prepare/disaster-safety-library

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)

Mandatory & regulatory Manuals current/ Audit ready at all times

Governing Board

On Call Book

State Specific

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

Auditors Regulation Book( CAHC/ACHC/JCAH/CHAPP)

Temp logs for Med refrigerator

Inservice log internal/ external

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

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

Medication refrigerator

Cold chain policy maintained

Temperature/ humidity log maintained bid

PENNY CUP in freezer

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

NOTE: Auditors will check log

for compliance and check for expired

medications

weekly responsibilities

Audit Nurses notes

Staff /Team meeting

Clinical census/Requirement reports

Check requirements ( supervisions/recerts)

DOCS report to RDOCS

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

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

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

Meetings ReQuired

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

*(Meeting agendas printed and placed in PI book)

CORE MANAGEMENT TEAMSTO DEVELOP

Pediatric Team

Adult Team

PCA Unskilled Team

Clinical Wellness Team

Wound Care Team

Intravenous team

Risk and Utilization Review Team

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

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

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

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

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 .

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

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

Director of Nursingjust the beginning....

Life is a learning process which is a

continuum and our experiences change

daily......