1. Home Care
DIrector of Nursing
Orientation
Orientation
Orientation
Tammy Marie Baker RN
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. 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. 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. 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. 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. 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. 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. 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. 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. Quality Assurance measures
Auditing of all clinical documentation
Audit state requirements
Audit Compliance
Quarterly metrics
Risk Management
Performance improvement reports
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. 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. 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. 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. 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. 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)
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. 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. 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. 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
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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Director of Nursing
just the beginning....
just the beginning....
Life is a learning process
which is a continuum and
our experiences change
daily......
