Skilled Nursing Care - Intranet UnityPoint Health .2012-04-12  Skilled Nursing Care Skilled...

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Transcript of Skilled Nursing Care - Intranet UnityPoint Health .2012-04-12  Skilled Nursing Care Skilled...

  • Skilled Nursing Care

    Skilled Nursing Care may include, but not be limited to:

    I. Administration of Medications:

    A. Medications are administered by Agency licensed nurses according to Agency policies

    and procedures, and within the scope of the State Nurse Practice Act. Medications are

    administered only by individuals holding a current license or permit in the state as a

    registered nurse or a licensed practical nurse.

    B. Agency licensed nurses will administer all FDA approved medications by all

    approved routes in accordance with their skills and training with the following


    1. IV Aminophylline loading doses

    2. IV Pitocin

    3. IV Phenothiazine derivatives

    4. IV chemotherapy agents which are not included on the Agency=s approved list

    5. IV Iron-Dextran Complex

    C. Licensed Practical Nurses will not administer IV medications. In addition, licensed

    practical nurses may not administer parenteral anticoagulants or parenteral cardiac drugs.

    D. The Agency reserves the right to refuse to administer medications if such medication

    is determined to be harmful, contraindicated, expired, improperly labeled, contaminated,

    or there is no physician=s order. If a medication is withheld, the physician shall be promptly notified and the events documented in the clinical record.

    E. No experimental drugs are administered unless the patient has signed a voluntary

    consent form. The Agency will consider patients who are part of research, experimental

    studies or clinical trials on a case-by-case basis with consideration for staffing and the

    Agency=s ability to meet the needs of the patient effectively. For investigational drugs, such as AIDS drugs specifically exempt from FDA review procedures, the Agency will:

    1. Obtain a specific physician=s order in accordance with policy

    2. Verify that the drug is an acceptable investigational drug for the condition

    3. Obtain written literature on the drug action and side effects


  • 4. Obtain specific orders for treatments of reactions or side effects

    5. Obtain approval of a subcommittee of the Professional Advisory Committee

    physicians, nurses and a pharmacist, if possible

    The Administrator is to be made aware of all potential cases in which experimental drugs

    may be administered.

    Participation of the patient in experimental drug therapy is strictly voluntary and must be

    an informed decision by the patient. The physician is responsible for educating the

    patient on the specific drug/procedure, benefits and risks, potential outcomes,

    consequences, and alternative courses of intervention. Patients admitted to service who

    are in the course of experimental drug therapy will be accepted on a case by case basis.

    The patient=s physician will be responsible for educating agency staff in the proper care of patient. All items listed above will be included in that education.

    F. A written physician=s order must be obtained for all medication administered by Agency personnel. Written physician orders must specify:

    1. Patient name

    2. Medication name, dose, route, purpose (where appropriate) and frequency

    3. Medication start date

    4. Medication stop date, if indicated

    5. Special instructions or precautions, if indicated

    6. Standing orders in case of a drug related adverse reaction, if indicated

    7. Laboratory blood work to be routinely collected

    G. In the case of an in-home administration of the initial dose of a new medication, the

    Agency reserves the right to decide on an individual basis whether or not to administer

    the initial dose. If indicated following the administration of any injectable or intravenous

    medication, the employee will remain in the home to observe for possible side effects.

    H. Medications, dose, route and frequency should be considered generally reasonable and

    acceptable therapy for the condition for which they are prescribed. In the event the RN or

    LPN has reason to question the orders of the attending physician, such as unusual route or

    dosage, Agency guidelines for questioning a physician=s orders will be followed. The physician will be contacted for specific written orders to include drug name, dose,

    frequency, route, expected effects, untoward and adverse reactions. The physician will be


  • requested to participate in patient education and will assist in obtaining informed and

    voluntary consent by the patient. A copy of the informed consent and any applicable drug

    protocol will be retained in the patient=s clinical record. MMSC pharmacy staff will also be available for additional education as needed.

    I. The nurse administering each medication is responsible for researching unfamiliar

    medications for:

    1. Actions

    2. Indications

    3. Side effects

    4. Special precautions

    5. Usual dose

    6. Route of administration

    J. The nurse shall routinely monitor all medications to determine their action,

    indications, special precautions, patient=s response to therapy, side effects, allergies and contraindications. The RN will be responsible for updating and keeping accurate the

    medication profile or medication listing in the patient=s clinical file. This will be done as soon as possible after the order is received. The medication profile will include the name

    of the medication, date ordered, dose, route, frequency, duration of therapy if appropriate,

    action or effect, side effects, and contraindications. This profile will include over-the-

    counter drugs. The profile may also serve as a tool for the purpose of patient/caregiver

    education, and/or for drug therapy review by pharmacist(s) as appropriate or required by

    policy, regulation or accreditation standards.

    K. The Agency may instruct the patient and/or caregiver on the administration of

    injectable medications only with a written physician=s order.

    L. If the patient expires, all medications become the property of the patient=s family who shall be responsible for their disposal.

    M. Injections for the prevention of flu and pneumonia may be given with an order from

    the physician at the discretion of the Agency to its home care patients.

    N. Controlled Substances. Only RNs and licensed practical nurses are authorized to

    handle controlled substances.

    1. All controlled substances are to be counted daily or at specified intervals.

    2. A controlled substance may be given only with a physician=s order


  • 3. Each medication is to be accounted for according to Agency procedure as it is

    removed from the container and before it is administered to the patient

    4. If a medication is not given because the patient refused it, a partial dose is

    given or the medication is contaminated, documentation is required

    5. Any amount of controlled drug that is missing and can not be accounted for

    requires an incident report that details particular information regarding the loss of

    the drug. A nurse is required to complete the incident report. The incident report

    must then be signed by the Supervising Nurse, and reviewed by the Quality

    Improvement Committee or other appropriate departments such as pharmacy.

    O. A medication error is anything that requires discontinuing the medication, modifying

    the dose, hospitalization, treatment with a prescription medication, or an error resulting in

    disability, cognitive deterioration or impairment, congenital anomalies, death or is life

    threatening. All medication errors will be documented via a variance report.

    P. The Agency will attempt to obtain specific orders for treatment of adverse drug

    reactions on each patient where such a reaction is possible. The specific orders will be

    followed should an incident occur. In the absence of specific orders, the nurse will

    implement standing drug reaction/anaphylactic shock orders contained in this policy

    manual and remain with the patient until the paramedics arrive. ADR/variance reports

    are to be filed with the pharmacy for review by medical staff and appropriate committee.

    Adverse Drug Reactions:

    Adverse medication reaction is defined as any medication that elicits specific abnormal signs and

    symptoms that are not normally or directly associated with the medication. These abnormal signs

    and symptoms may include, but are not limited to: headache, tremors, dizziness, muscle spasms,

    confusion, nausea, vomiting, diarrhea, cramps, abdominal pain, skin rash or flushing, dizziness,

    hypotension, a diffuse feeling of warmth, arrhythmias, tachycardia, bradycardia, shortness of

    breath, dyspnea on exertion, and/or respiratory depression.

    A significant or severe adverse reaction is defined as those signs/symptoms that are so severe that

    the patients requires immediate emergency medical treatment. These may include respiratory

    distress, choking sensation, difficulty swallowing, tightness or pain in the chest, wheezing,

    dyspnea, respiratory stridor, vascular collapse, cyanosis, imperceptible pulse, or circulatory


    A mild adverse reaction may demonstrate the above signs and symptoms but with lesser severity,

    and the patient is not in immediate danger. A mild reaction can progress to a significant or

    severe reaction and the patient should be mon