Caregiver Training Manual Part 2
Contents
1. Engrave all Agency equipment with the Agency s name Maintain a contract with a security company to monitor premises Employees should sign a confidentiality agreement not to disclose Agency s trade secrets proprietary information or assets Limit the use of Agency equipment off site If a laptop pager cell phone etc is taken off site the individual should sign it out with the understanding it is his her responsibility to protect it and return it Avoid dangerous clutter that blocks pathways and or stairs Perform periodic inspections to identify and evaluate workplace security hazards Store chemical and flammables in separate safe and secure areas Employees will not steal or willfully damage company property Agency follows the requirements of the HIPAA Security rule to assure the confidentiality and availability Physical safeguards to guard data integrity confidentiality and availability of information and Technical security services to guard data integrity Depending on employees classification Agency limits or does not allow employee access to the internet All employees will be taught about Material Safety Data Sheets and will know where these are kept in the Agency Orientation training includes the Agency s response to a disaster or emergency including bomb threats terrorism hurricanes etc Management is responsible for securing Agency s vital information Management encourages employees to report workplace sec2. Use groups of larger stronger muscles that are found in the shoulders upper arms thighs and hips to lift an object Position yourself so that you are whole body to change direction Avoid twisting the neck or back Push pull or slide heavy objects when possible Ask for assistance to lift loads that may be too heavy or too large Count one two three with the person assisting you and lift the load smoothly to avoid strain Avoid sudden jerky movements Stand close to your work area Avoid reaching and bending when possible Face your work area this prevents unnecessary twisting Bend your hips and knees keep your back straight and push using the thigh muscles when lifting a heavy object from the floor Never bend at the waist Wear sensible close toe low heeled shoes Use a back belt if instructed by your supervisor Immediately report an y employee injury to the office rN CareServe v Private Duty Services Caregiver Training CARE OF THE DYING PATIENT The Agency wants all of the employees to provide appropriate care to meet the needs of the dying patient and his her caregiver s The patient should be allowed to die with the optimal level of comfort and dignity according to his her requests concerning death This includes knowing whether or not Advance Directives including an out of hospital do not resuscitate order are in place Furthermore all Agency staff should be
3. Maintain contact with the office Maintain contact with patients clients as needed As appropriate notify the patient s client s physician medical advisor director and other disciplines involved in care Recovery Document any incidents that occurred Contact all patients clients Notify physicians and or medical advisor director of patient client status Meet with other disciplines providing care and reclassify patients clients for triage if needed Resume visits as scheduled Assist patient client family with updating their emergency preparedness and response plan Review activities and provide feedback for improvement rN CareServe Ne Private Duty Service Caregiver Training Additionally the Agency should include actions and responsibilities in the response and recovery phases in the event a warning of the impending emergency disaster was not provided For example what will you do if you did not have a radio on in the office to know a tornado was in your area Other examples include What will you do if someone opens mail that has anthrax spores in it What will you do if an armed terrorist enters the office The Administrator Disaster Coordinator and other staff should meet to plan for the Agency s actions in the event there is no warning Document the decisions made POTENTIAL DISASTERS Now let s look at a few potential disasters with examples of specific instructions about what to do No matter
4. oN CareServe Ne Private Duty Services Caregiver Training ABUSE NEGLECT AND EXPLOITATION You must be aware of your patient s safety at home including his her safety from harm done by others This harm is called abuse neglect and exploitation DEFINITIONS Abuse Physical force that results in bodily injury physical pain or impairment This includes hitting beating biting pushing shoving shaking or burning Emotional abuse includes the infliction of anguish pain or distress through verbal or non verbal acts such as intimidation insults threats humiliation and harassment Neglect Failing to give proper attention or care Examples are failure to provide life necessities such as food water clothing shelter personal hygiene and or medicine Exploitation Illegal or improper use of patient s funds property or assets gt If you suspect that your patient is being abused neglected or exploited you MUST report it to both the Texas Department of Protective and Regulatory Services and the Texas Department of Human Services The telephone numbers are in the Agency s Policy Manual Also report it to your supervisor and document WHAT TO LOOK FOR Abuse bruises especially in the shape of gingers or a belt burns lacerations sudden difficulty walking or sitting the patient appears fearful of the primary caregiver or withdraws from him her Neglect dehydration or hunger because fluids and food are being with
5. e Veracity telling the truth e Confidentiality keeping the patient s information private Some say that all ethical decisions are based on the economic or money interest of the provider and of society In other words what will the decision cost and is it worth it Here are ways you can PUT THESE ETHICAL PRINCIPLES INTO PRACTICE e Respect the culture and customs of your patients e Be truthful in all communication e Do not speak badly of patients coworkers or the Agency e Avoid exploitation of relationships for personal advantage e Do not discriminate e Assure confidentiality of patients do not talk about them to others who do not have the need to know e Assure autonomy of patients let them participate in deciding their care and treatment THINK ABOUT THESE SAMPLES OF ETHICAL DILEMMAS Your elderly patient who is disoriented needs a blood transfusion Her son has medical power of attorney See Advance Directives He is a devout Jehovah s Witness who doesn t believe in blood transfusions and she is a Methodist What s the right thing to do You are the Home Health Aide for a patient who is receiving insulin twice a day She told you she had just eaten a large piece of strawberry shortcake She asked you not to tell the nurse What s the right thing to do By the way there may not be a right answer to any of these rN CareServe v Private Duty Services Careg
6. a younger person will accept emails and text messages as teaching tools And keeping in mind political correctness an older man probably means nothing negative by calling the nurse honey or sweetheart but a younger nurse might see that as harassment Some of the general ways you can help your patients from other cultures include Ask your patient how he she wants to be addressed Ask your patient if you may touch him her Ask your patient if he she wants the family present during care or at the time of death Ask how others in the patient s community can provide support Be patient and give the patient time to talk about his her care or upcoming procedures Be aware that the patient may avoid eye contact or maintain a distance from you It does not mean he she is not responding or is not friendly e Use an interpreter trained in medical terminology It s preferable to using family members who may not understand fully or may not interpret exactly due to their own cultural beliefs If your services are being provided to people from a specific culture on a regular basis then learn more about that culture A web search will reveal many sources of information about the culture Additionally the public library and or library at the local high school or college may have materials that will help Attend events such as fairs and festivals held by a cultural group Overall however remember that your patient still maintains co
7. and driveways as soon as possible Melting and refreezing of layered snow can cause heavy patches of ice Use ice melting products regularly If this isn t possible then there should be a free clearance of 18 inches for safe passage according to the Occupational Health and Safety Administration OSHA Here are safety tips from www ehow com 1 Wear boots or sturdy shoes with non skid soles Don t walk on ice in shoes that have no traction 2 Take your time Getting in a hurry increases your chances of a fall because you re not paying attention 3 Pay attention to ice that can be covered with snow When you think you re in the clear you could still hit a patch and fall 4 Balance yourself with your arms Get your hands out of your pockets and distribute the weight of packages evenly to give you better balance Take short shuffling steps and avoid an erect posture Walk as flat footed as possible Get help from someone who is wearing appropriate shoes or is more confident than you Never be ashamed to ask for someone s arm to help you across a patch of ice Ce 7 If you feel yourself beginning to fall try to relax and roll as much as possible This will help lessen the Impact and may keep you from breaking a bone Protect your head if at all possible by trying to keep it up and away from impact with the ice U a CareServe Ne Private Duty Service Caregiver Training EXITS According to OSHA there must b
8. and email enabled PDA s or any other designated method Register patients clients with 211 the special assistance registry in Texas Ensure on call books a CareServe W Private Duty Services Caregiver Training Secure the office building Secure the computers per HIPAA Security rules and other best practices Prepare for financial needs Prepare for utility disruptions Mitigation Ensure the office is adequately staffed Use the calling tree Disaster Coordinator will monitor public information systems Response Initiate plan Activate patient client triage Notify local emergency medical services Notify the TX Department of Aging and Disability Services of the disaster in progress Document all aspects of the disaster including names decisions made and times of actions taken Make appropriate patient client referrals to assure continuation of care Notify local TV radio stations as appropriate to communicate with staff and patients clients If necessary remove patient client records personnel records and financial records Discontinue the Plan when appropriate Recovery Hold a briefing of all activities that took place during the disaster Develop action plans for any areas on which improvement is needed If appropriate offer support groups for staff Replenish office and patient client supplies Contact insurance carrier contain current patient client information Response
9. and having disaster drills Mitigation Reducing or eliminating the Agency s risks by coordinating with state federal private sector and or other community resources and the public immediate and short term effects Response Actions taken immediately before during and or after a disaster to address its Recovery The Agency s actions implemented during and after the disaster to enable the Agency to return to its normal operations as quickly as possible In each step specific responsibilities are assigned to administrative staff and clinical staff It is important for you to know what your assigned responsibilities are in the event of a disaster Sample responsibilities in each step include but are not limited to Administrative Staff Preparedness Have a calling tree with all contact numbers for all staff Meet with local emergency planners to coordinate services Maintain a list of current patients clients prioritized by their care needs such as Life Threatening II Not life threatening but individual can t go 24 hours without care and III visits could be postponed for 24 72 hours without adverse effects Clinical Staff Preparedness Keep vehicle full of gas Provide training to patients clients families on disaster preparedness Rotate on call Mitigation Communicate with the office and clinical team members using telephones cell phones pagers walkie talkies
10. cooking and after using the restroom v Wear gloves when you have direct contact with moist body substances or the fluids mentioned above Wear gloves if you have cuts abrasions puncture wounds or a hangnail o your hand s Use face masks eye protection and disposable gowns when there s a potential for splashing blood or other infectious materials vY All sharps must be left uncapped and disposed of immediately AN a Qa oN CareServe Ne Private Duty Service Caregiver Training HIPAA The federal government passed a law in 1996 called the Health Insurance Portability and Accountability Act HIPAA that makes confidentiality of a person s Protected Health Information OHI extremely important HIPAA is intended to protect the privacy of people receiving health care if the provider of that care conducts even one covered transaction electronically The covered transactions are Health care claims or equivalent encounter information Health care payment and remittance advice Coordination of benefits Health care claim status Enrollment and disenrollment in a health plan Eligibility for a health plan Health plan premium payments Referral certification and authorization First report of injury Health claims attachments and Other transactions that the Secretary of the Department of Health and Human Services may prescribe by regulation fFRFRFEFEFRFE FEF Title Il of HIPAA defines the Administrative Sim
11. or other potentially hazardous areas e Move away from sidewalks or streets that will be used by others still getting out of the building or by emergency vehicles CareServe v Uii a Caregiver Training TERRORISM Be aware of your surroundings Move or leave if you feel uncomfortable Do not accept deliveries from unauthorized personnel Promptly report unusual behavior suspicious or unattended packages and strange devices to the police or security personnel o Learn where emergencies exits are Plan on how to get out of the building oO00 0 Remember There are many other disasters that could happen including but not limited to tornados thunder storms lightning high temperatures heat earthquakes winter storms cold hurricanes hazardous materials incidents nuclear power plan emergencies and chemical attacks Bottom line BE PREPARED rN CareServe v Private Duty Services Caregiver Training ENVIRONMENTAL SAFETY In addition to Agency s other policies procedures and trainings as well as the information in other lessons environmental safety at the office may include but is not limited to in no particular order S Icy areas Exits Stairways and Storage areas Let s look at these individually x S x x ICY AREAS Outside surfaces should be maintained in winter so they are free of ice and snow Get snow cleared away from walkways
12. the home is to assess the environment Be aware of the hazards such as those related to using medical equipment and oxygen smoking in bed and having a cluttered environment Be ready to respond by making sure smoke detectors work knowing where the exits are and how to reach one fast and how to reach the fire department All occurrences such as accidents and injuries that result in injury to the patient or Agency staff must be documented on an Incident Occurrence Report Samples of these include but are not limited to e Patient falls while staff is present attended falls e Ifa patient falls when an employee is not there this is an unattended fall and can be put on the progress note If the physician is contracted and there is a significant change in the patient s condition then an Incident Occurrence Report must be completed Medication errors Equipment malfunction Motor vehicle accidents while on agency business and Staff injury while on the job rN CareServe v a oeraiter Caregiver Training WORKPLACE FIRE SAFETY To know what to do in case of a fire remember the letters in the word RACE R Remove people from the area of danger A Alarm Activate the fire alarm if applicable and or call the fire department C Contain the fire Close all doors and windows as you leave the area of the fire E Extinguish the fire Try to extinguish a small fire but if the fire gets larger or out of control leave the ar
13. what the disaster is however if you are working in the field contact the office for any concerns to receive instructions and to find out if there are any patient client needs that should be addressed Disasters include but are not limited to FIRE If your clothes catch on fire stop drop and roll Running only makes the fire burn faster Know where the fire extinguishers are know the escape routes The universal principles of fire control are RACE o Rescue rescue anyone in immediate danger o Alarm sound the fire alarm and or dial the fire department o Confine close all doors in and around the fire Turn off all oxygen in use Turn off all equipment not needed to sustain life o Extinguish Only if it is safe to do so put out a small fire using portable fire extinguisher baking soda or water if it is not an electrical or grease fire o Listen to the radio or television for information and follow any instructions given o Move to higher ground o Do not walk in moving water Even six inches of moving water can make you fall o Do not drive into flooded areas EXPLOSION During an explosion Once you are out of the building e If things are falling get under e Do not stand in front of windows glass a table e When things stop falling get out as soon as you can Don t stop to get personal belongings e Don t use elevators g 9 e Watch for weakened floors stairways and falling debris doors
14. ACTIVITY What is the patient s range of motion Does he she need help walking Arthritis Does he she sleep well SAFE ENVIRONMENT Is there any compromise of skin Are there problems with medication management Does the patient get annual exams such as for prostate mammograms etc Do all caregivers practice standard precautions OXYGEN Does the patient have breathing problems such as with emphysema COPD pneumonia Does he she have circulatory problems such as CHF MI hypertension NUTRITION How is the patient s ability to chew Can he she feed self What assistance is needed she he overweight Keep these psychosocial aspects of patient care in mind and looking at your patient as a PERSON will enable you to provide quality care and service oN CareServe Ne Private Duty Service Caregiver Training RIGHTS OF THE ELDERLY In the United States of America We the People were given a number of rights in the Constitution s first ten amendments known as the Bill of Rights Since the time our nation was founded these rights have been expanded and clarified In 19647 the Civil Rights Act was passed prohibiting discrimination based on race national origin gender and religion Later age was added in an amendment based on the law known as the Age Discrimination Employment Act of 1967 In 1983 the Texas Legislature passed a law as part of the Human Resources Code Services for the Elderly Chapt
15. Do not block slots or vents SN SANNA rN CareServe v Private Duty Services Caregiver Training 7 A special not about cell phones Follow your Agency s policy on the use of cell phones In general the use of cell phones in the office is discouraged When driving pull off the road to make the call or use a hands free system Keep the call short so you can pay attention to your driving Office Machines and Equipment There are many other office machines and various pieces of equipment in your office including computers copiers fax machines typewriters etc As stated above always follow the instructions in the user s manual that came with the office machine and equipment Because this information is so varied we will look at some general tips for you to follow for the use of any office machine or piece of equipment Secure machines that tend to move during operation so they don t fall off the work surface Y Donot place machines near the edge of a table or desk Y Donotremove any safety guards on machines with moving parts yY Do not use any machine that smokes sparks shocks or appears defective in any way Unplug the machine A v Ifyou do open a copier be very careful because some of the mm _ surfaces may be hot v Close hand operated paper cutters after using and secure the guard Work station arrangement is another important safety consideration Keep all supplies within easy reach Have adequate lig
16. client s bed o If the patient client has pets that are aggressive ask that they be put away Do not allow strangers to enter the patient s client s home o If you are being harassed by a patient client or family member maintain a quiet attitude never argue with or strike the person and notify your supervisor at once o If you feel uncomfortable while providing care to a patient client ask a family member to be present o Follow your Agency s emergency preparedness plan O Driving Safety o Keep your car in good running condition o Always keep your car doors locked and the windows up when in slow traffic or at a traffic light o Have a spare set of keys in an appropriate location o Carry your keys in your hand This enables you to get into your car immediately and it is also a form of self defense Hold the key ring in the palm of your hand and put a key between each of your four fingers with the sharp ends sticking out o Have enough fuel for the day s travel e o Do not pick up hitchhikers o If you see a stranded motorist drive to the nearest phone or use your cell phone and call the police o Ifyou fear you are being followed drive to the nearest police fire or gas station o Ifa person tries to car jack your car give it to him her o Plan your route Know exactly where you are going ahead of time Contact the patient client or the office if directions are not clear o Park as close to your destination as possible o Pa
17. cultural competencies What is culture One definition includes those beliefs values and practices shared by a group The group may be t ethnic regional religious or based on some other identifying characteristic such as age An individual from another culture may have different beliefs from your or those that are considered normal for a particular geographic area The beliefs may impact communication interaction with others nutritional preferences and views about illness and health care How one communicates and views illness or injury for example influences how he she expresses pain if at all In some cultures it is not accepted to express pain In others the expression of pain might be minimized The expression may be through verbal or non verbal means Providing information to the person in his her own language may help him her feel more at ease and may foster his her understanding the material more effectively Other factors the health care professional should consider include gt Does the patient see the illness or injury as having a supernatural cause such as being God s will or a punishment for sins Does the patient think the only cure is a traditional herb remedy or special diet Does the patient believe his her family should be allowed to visit or be present at any time Does the patient believe his her family should be involved in the care Does the patient believe the room should be arranged a c
18. d an infection Aninfectious agency such as a virus bacterium or fungus A susceptible host such as one who is in a weakened condition or is ill and Achain of transmission for the infectious agent to move to the susceptible host Remember that the most important thing for you to do is to prevent the spread of infection from you to the patient or the patient to you which could then go on to those around you You must do everything you can to prevent the spread of infection pea If you have a cold or other infection check with your supervisor who will determine if job duties can be performed without risk to the patient according to Agency Policies If you learn that the patient has an infection report it to your supervisor Learn everything you can about preventing the spread of infections ALWAYS PRACTICE STANDARD PRECATUIONS o Wash your hands o Wear gloves when there is a reasonable chance you will come into contact with blood other body fluid or airborne bugs o Clean and disinfect any surface which has come in contact with blood other body fluids or could be exposed to airborne bugs o Dispose of infected materials per Agency Policies o transportation of lab specimens Ifit s appropriate to your job position document according to Agency Policies o rN CareServe v Private Duty Services Caregiver Training MEDICAL EQUIPMENT SAFETY In addition to the Agency s other
19. e It means that the patient does not want to be revived if his her heartbeat or breathing stops because of cardiac or respiratory arrest It is our policy not to withhold care based on whether or not the patient has an advance directive Each patient will be given information about his her right to refuse medical treatment and the right to have advance directives If the patient already has advance directives in place we will ask for a copy to put in the medical record and we will document that advance directives are in place If the patient does not have advance directives in place but wants them we will make a referral to social services worker As a member of our staff it is important for you to know that gt Wewill not provide any medical treatment that the patient has not consented to receive gt Wewill not withhold treatment or discriminate in any other way against the patient based on whether or not he she has an advance directive gt Wewill recognize and honor advance directives as evidence of the patient s desire to have medical treatment withheld rN CareServe v Private Duty Services Caregiver Training BODY MECHANICS Basic Principles of Good Body Mechanics Maintain good posture and proper body alignment Keep your back straight wit knew slightly bent and your body weight evenly distributed on both feet Place your feet about 12 inches apart to maintain a broad base of support when lifting
20. e enforcement authority for the Privacy Standard The eHealth Standards and Services Department of the Centers for Medicare and Medicaid Services CMS is responsible for enforcing the Security Standard and the Transaction and Code Set Standards The penalties have recently been revised and are Civil Penalties o 100 per incident up to a maximum of 50 000 per violation Criminal Penalties o Upto 50 000 and one year in prison for obtaining or disclosing PHI o Upto 1000 000 and up to five years in prison for obtaining PHI under false pretenses and o Upto 250 000 and up to 10 years in prison for obtaining or disclosing PHI with the intent to transfer sell or use it for monetary gain or malicious harm Ax Ay CN PN CareServe v Private Duty Services Caregiver Training INFECTION CONTROL No matter how you look at it infections are nasty An infection is an invasion of the body by pathogenic microorganisms which we usually call bugs These bugs can cause a variety of symptoms such as redness swelling pain and or fever Infections can be transmitted in three ways Direct contact touching blood or other body fluids Indirect contact touching items that have infectious material on them such as bed linens bedpans drinking glasses etc Vectors by flies mosquitoes or other insects that are carrying the bug Three things have to be present in this vicious circle in order to sprea
21. e exit routes for employees to leave the workplace lt f fe gt safely during emergencies Cl For the most part there should be at least two exit routes remote from one another to provide alternate means for employees to leave the workplace safely during an emergency Free and unobstructed access to each exit route must be provided to ensure safe exit during an emergency The exit route must be free of material or equipment An exit must lead directly outside or to a street walkway refuge area or to an open space with access to the outside The street walkway refuge area or open space to which an exit leads must be large enough to accommodate all building occupants likely to use that exit An exit door must be able to be readily opened from the inside without keys tools or special knowledge A device that locks only from the outside such as a panic bar is permitted An exit door must be free of any device or alarm which if it fails could restrict emergency use of an exit An exit route must not require employees to travel toward materials that burn very quickly emit poisonous fumes or are explosive unless those materials are effectively shielded from the exit route An exit door must be free of signs or decorations that obscure its visibility Each exit route must be illuminated adequately Each exit must be clearly visible and must be marked by a distinctive sign reading Exit Signs must be posted along the exit
22. ea immediately e Have emergency numbers near the phone e Plan escape routes and the place outside to gather prior to an emergency Know where the evacuation plans are posted e Install a smoke alarm in the kitchen area Check and or replace the batteries when you change the clocks in the spring and fall e Know where the fire alarm s is are if your office has them e Know where fire extinguishers are located and know how to use them e To avoid injury from smoke stay low and cover your mouth with a wet cloth or towel If you are trapped in a room block the bottom of the door with towels blankets clothes linens or cloth e Feel the doors before you open them Do not open a door if it is hot or if you see smoke coming from around the door e If your clothing catches on fire stop drop to the ground and roll to smother the flames e After the event talk about the response and what could be improved 4 rN CareServe v Private Duty Services Caregiver Training WORKPLACE SECURITY Security in the office is everyone s responsibility It includes security of the property itself the Agency s assets and security for the employees while at work Itis part of your responsibility to follow the Agency s security procedures to protect the Agency s property your fellow employees property and yours The Agency provides security training as part of your orientation and annually It takes workplace security very seri
23. er 102 provides for the Rights of the Elderly and it too has been amended several times including the latest revision in 1997 The divisions of this Code include Definitions Prohibition Rights of the Elderly List of Rights and Rights Cumulative The definition of elderly is an individual 60 years of age or older Prohibition means the provider of services may not deny an elderly individual any of the rights in the Code A provider of services must give the elderly individual a written list of the Rights of the Elderly exactly as it appears in the Code The elderly individual s rights are cumulative with all of his her other rights Even though the provider of services such as a home health agency must give a written list of the Rights of the Elderly exactly as it appears in the Code for our lesson they will be summarized v An elderly individual has all the rights benefits responsibilities and privileges given by the Constitution federal laws and Texas laws This includes being free of interference coercion discrimination and reprisal when using these rights v An elderly individual has the right to be treated with dignity and respect without regard to race religion national origin sex age disability marital status or source of payment Specifically o He she has the right to make his her own choices about personal affairs care benefits and services o He she has the right to be free from abuse neglect and e
24. ertain way to enhance his her prayer life Does his her religion allow all forms of medical intervention Does his her religious beliefs allow the foods the patient may need to promote healing Does the patient s beliefs impact whether or not she he signs Advance Directives or what end of life care is allowed Does the patient s cultural beliefs encourage touching even between spouses 2e 0 ko 0 ko ae You don t need to be an expert in every culture there is but you should develop a baseline understanding for those cultures from which your patients may come and those beliefs they may practice Your patients may come and those beliefs they may practice Your patients and their families will sense your respect for their culture This will enhance their trust in you It may promote compliance with care and lead to improved health Your awareness of their culture will help patients feel better about the care being provided rN CareServe Ne Private Duty Services Caregiver Training Although not often thought of as a cultural diversity age differences play an important part in the interactions between a patient and the caregiver A younger person may not accept his her diagnosis as readily as an older person who might see it as just part of growing older Teaching methods need to be altered based on the patient s age An older person might respond more readily to rote whereas
25. held new pressure ulcers physical problems because meds are being withheld absence of aids such as eyeglasses and hearing aids Exploitation Does the patient express fear or anxiety when discussing finances Does he she mention that a relative has been expressing an interest in his her finances Do the caregiver and patient resist assistance that costs money If you re attentive to the signs you may help to keep you re patient out of harm s way rN CareServe v Private Duty Services Caregiver Training Advance Directives Your patient has the right to make and direct decisions concerning his her medical care She he can choose the doctor and can accept or refuse the care the doctor gives or the suggestions the doctor makes The patient can also decide ahead of time or in advance what care should be given when he she can no longer make decisions Advance Directives include a living will medical power of attorney and an out of hospital do not resuscitate order gt A living will defines the medical treatment to be given if the patient is unable to communicate at the end of life This could include the withholding or withdrawal of life sustaining medical treatment gt Amedical power of attorney allows the patient to appoint someone to make decisions about the medical care if the patient cannot gt An out of hospital do not resuscitate order is put in place if the patient has six months or less to liv
26. hting Keep walkways clear Use proper body mechanics and good posture Use adaptive equipment such as document holders and wrist supports if needed SSSss In conclusion YOU are responsible for keeping the office safe and for using office machines and equipment safely Be sure you are rested and alert at all times rN CareServe v Private Duty Services Caregiver Training ALWAYS USE COMMON SENSE WHERE SAFETY IS CONCERNED PAIN MANAGEMENT Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage Imagine hitting your elbow on the door It hurts doesn t it That s called acute pain But you re health and before you know it you ve forgotten all about it Now imagine that you are 84 years old You have several ailments including arthritis heart disease and diabetes all of which cause pain Imagine that this pain is with you 2 hours a day 7 days a week This is chronic pain And chronic pain is what most of the patients you care for have The first step in helping the patient is to make an accurate assessment of the pain and how it feels to the client Pain is subjective In other words the level you can tolerate or put up with is not the same as another person can tolerate Also the words used to describe pain might mean one thing to the patient and another thing to you Add to that cultural differences such as not under
27. iver Training EXPOSURE CONTROL AIRBORNE BLOODBORNE PATHOGENS As a health care worker you are exposed to airborne and bloodborne pathogens in the everyday tasks you perform for your patients These pathogens are spread just as their names tell us Airborne means the pathogens are in the air and they can enter your body just by breathing them in and v Bloodborne means they are in the blood and can be passed on to you through direct contact v This definition includes contact with moist body substances and other body fluids such as urine saliva vomit pus feces and drainage Some tasks that you do for your patient carry a higher risk than others for exposure to pathogens You need to be aware of these to protect other patients your family and yourself They include but are not limited to f amp Ly Blood sugar checks by finger stick 9 All venipunctures Dressing changes removal of fecal impaction Emptying changing urinary drainage bags colostomy bags and would drainage devices and Bathing patients who have urine or feces on their skin SASSSS Standard precautions have been set up to help you cut down on his her chance of exposure to the pathogens The first step is to assume that all patients are infectious and then to take precautions that include v Wash your hands with soap and water for 30 seconds before and after any care to a patient before putting gloves on and after taking them off before
28. mation to assure the confidentiality of electronic protected health information It includes 4 Administrative procedures to guard data integrity confidentiality and availability Physical safeguards to guard data integrity confidentiality and availability of information and Technical security services to guard data integrity hat are the permitted uses and disclosures of PHI An Agency can use PHI for a amp Treatment payment and health care operations Treatment activities of any health care provider For payment activities of the entity to which PHI is disclosed and For the health care operations of another covered entity In all instances the Agency must make reasonable efforts to limit the PHI used disclosed or requested to the minimum amount necessary to achieve the purpose of the use disclosure or request This also means the agency must decide the minimum amount of PHI needed by employees to perform their duties Due to the nature of your work you will be exposed to sensitive and confidential information This information must never be used as the basis for social conversation or gossip You must never talk to a client about another client Failure by an employee to observe confidentiality may result in disciplinary action up to and including termination oN CareServe Ne Private Duty Services Caregiver Training What are the penalties for non compliance The Office for Civil Rights OCR has th
29. ment shod be used following the manufacturer s guidelines and used only as intended Electric Equipment Safety Since almost all of the equipment used in the office is electric let s look at some general electric equipment safety tips These include but are not limited to gt Do not put cords under rugs where they can be walked on and damage go unnoticed gt Repair or replace broken frayed damaged or melted cords promptly gt If extension cords must be used for office equipment requiring grounding use one with a three pronged plug Insert and remove plugs by grasping the plug not by pulling on the cord Do not overload an outlet with the plugs from too much office equipment gt Use office equipment with the Underwriters laboratories Inc UL symbol This shows the equipment has been safety tested Vv Now let s look at a couple pieces of office equipment specifically and review safety tips on using each one Shredders Although this sounds simple the key safety tip for using a shredder is to keep fingers clothing and hair away from the opening Telephones Never use a telephone near water Avoid using the telephone during a storm as there may be a risk of electrical shock from lightning Do not use the telephone to report a gas leak if you are near the source of the leak Use a damp cloth for cleaning and unplug the telephone from the wall outlet before cleaning Place the phone on a stable surface
30. mmonalities with patients from all cultures that impact health and health care Don t lose sight of these which include the disease process and how age influences it Treating each patient as an individual and respecting his her cultural beliefs and practices will build trust and promote effective response to the care you provide oN CareServe esd Private Duty Services Caregiver Training EMERGENCY PREPAREDNESS It is important for the Agency to develop maintain and be ready to implement an Emergency Preparedness Plan in the event of a disaster A disaster is defined as The occurrence or imminent threat of widespread or severe damage injury or loss of life or property resulting from a natural or man made cause such as fire flood earthquake wind storm wave action oil spill or other water contamination epidemic air contamination infestation explosion riot hostile military or paramilitary action or energy emergency The Agency s leaders including the Disaster Coordinator will develop the Emergency Preparedness Plan Plan First a risk assessment is completed that will help in developing an appropriate Plan The steps of the Plan include preparedness mitigation response and recovery Preparedness Preparing for the potential disaster including but not limited to training knowing your community s resources developing organizing Plan and the response and recovery activities
31. n in other lessons personal safety security may include in no particular order Leave valuables at home or locked in your vehicle desk or locker Be sure car is locked at all times Take only a small amount of money to work Store your purse and or briefcase in a secure area out of site of routine passers by Ensure you have an unobstructed exit from your work station Employer will perform background checks on all employees who have direct patient client contact to protect them Possessing firearms or weapons concealed or otherwise on or in Agency property may threaten the safety of yourself and others You may not bring weapons onto Agency property or possess them while conducting Agency business Failure to comply with this policy will result in discipline and potential criminal charges o Illegal drug or alcohol use or possession may threaten the safety of yourself and others You may not use or possess them on Agency property or while conducting Agency business If threatened by co worker or intruder don t argue beg plead or minimize his her comments and stay calm In any emergency or disaster situation stay calm Use safe work practices follow all directives Do not open suspicious packages Don t work alone in the office Don t walk to your car alone after dark have a buddy system 00000 0 fe e 0000 0 Personal Safety While Working with Patients Clients in the Communit General guidelines to assi
32. ndividual fails to pay for services v Ifan elderly individual is going to be transferred or discharged from a residential facility the provider of services must give a 30 day written notice except in case of an emergency The written notice must contain certain elements including the reason the date and that the elderly individual has the right to appeal v An elderly individual may have Advance Directives in place rN CareServe Ne Private Duty Service Caregiver Training RISK MANAGEMENT SAFETY IN THE HOME CARE ENVIRONMENT Safety is freedom from danger risk or injury Risk management is what we do to keep ourselves safe We work together as a team to keep our patients and ourselves as employees safe We work safely and attend safety training classes when offered Agency staff should assess the patient s home for anything that could be a hazard to the patient such as poor lighting frayed carpets uneven floors etc Since about one third of patients fall in their homes be especially alert for hazards that might increase the risk for falls such as e Stairs that are cluttered ill repaired and have no railings A e Poor lighting e Electrical cords that are stretched across areas where the patient walks e Poor fitting shoes and e Narrow uneven or cluttered surfaces Another potential hazard in the home care environment is fire and or a poor response to it by the patient or employee The first step in avoiding a fire in
33. nt meals ability to chew and swallow sit up during and after meals indigestion The patient and caregivers also face the following tasks Adjusting to decreasing physical strength and health Adjusting to retirement and reduced income Establishing satisfactory physical living arrangements and Cope with the death of friends and loved ones SANNA CareServe v Private Duty Services Caregiver Training CHEMICALS IN THE WORKPLACE In the home or in the office you might be exposed to injury from hazardous chemicals or gases that are used Itis your responsibility to be aware of this risk by attending all in services on Hazardous communication by reading labels on the materials you use and by knowing where the Material Safety Data Sheets MSDS are kept More about these below Even then if you are ever in doubt about the potential hazard talk to your supervisor General Safety Tips Never mix chemicals For example never mix ammonia and bleach for cleaning Report the faintest smell of a gas leak Only use chemicals if it is clearly stated in your job description and your supervisor has given permission Read labels carefully and follow the safety warnings and instructions x ko x ko 2e 7 Material Safety Data sheets are put out by the manufacturer of the product and describe what materials are in the product what precautions to take in using it and first aid measures to
34. o Pain and symptom control o A desire not to be a burden o Not to be left alone at least not most of the time rN CareServe Ne Private Duty Services Caregiver Training CARE OF THE GERIATRIC PATIENT Usually a person is considered a senior citizen at age 65 Each person ages differently though so the effects of aging may not be present for some until later If you look at your elderly patient from a psychosocial perspective the needs of the PERSON become greater due to common changes of aging Because of this the way you care for the geriatric patient must also change Let s look at some of the changes and ways you can adjust your care CATEGORY AGING CHANGES ADAPTATIONS PSYCHOLOGICAL Difficulty with memory Give reassurance be patient personality changes wanders redirect limit stimulation delusions ELIMINATION Incontinence Encourage regular voiding schedule use adaptive aids such as commode REST AND ACTIVITY Falls decreased range of motion Provide adequate lighting gait changes handrails promote activity exercise SAFE ENVIRONMENT Thinning skin and hair Avoid daily baths avoid harsh decreased blood supply to nails soaps inspect skin carefully provide nail care OXYGEN Decreased activity tolerance due Frequent rest periods change to reduced blood flow coronary positions slowly artery blood flow decreased NUTRITION Decreased appetite decreased Smaller more freque
35. ously so when necessary the Progressive Discipline Policy will be enacted for infractions AGENCY PROPERTY AND ASSETS The Agency s property is considered to include but not be limited to the grounds the office site desks telephones and computers Physical security may include in no particular order e Well lit parking areas areas for walking to from the office and entrances Well lit workspaces hallways rest rooms etc Sign Only authorized persons allowed on property Sign No solicitation Limit access to employees authorized visitors and business associates only Identification badges for employees Identification badges with separate design to be worn by visitors and business associates L Require all visitors and business associates to sign in amp Require all visitors and business associates to be escorted when on the premises Sign Limited cash is on premises Keep petty cash checkbooks etc in a locked drawer or safe Cameras inside and outside with motion sensors Ensure the doors close completely and have adequate locking systems as well as a fire department approved crash bar or alarm Ensure windows lock Have corner view mirrors in hallways and elevators Receptionist should have a silent alarm button in the event of an intrusion Establish a code phrase to be used over the intercom if it is safe to do so in the event of an intrusion rN CareServe v Private Duty Services Caregiver Training
36. plification A S requirements for health care providers such as the agency hospice for which you work A S is divided into three components Transaction Rule Privacy Rule Security Rule What is the Transactions Rule The Transactions Rule adopts standards for electronic transactions and for code sets to be used in those transactions The basic intent is to establish a uniform and comprehensive set of standards for the electronic transmission of health information by all providers Electronic transmission includes using Internet Extranet information is accessible only to collaborating parties Leased lines Dial up lines Private networks and Transmissions that are physically moved from one location to another using magnetic tape disk or compact disk fFRERFFEFE rN CareServe v Private Duty Services Caregiver Training What is the Privacy Rule Essentially the Privacy Rule is intended to give individuals a level of protection of their Individually Identifiable health information is used and disclosed The Protected Health Information PHI is any information shared orally or recorded electronically or on paper related to an individual s health condition that is found in amp Patient medical records Patient billing records Databases and Formal and informal discussions What is the Security Rule The Security Rule adopts standards for the security of electronic health infor
37. policies procedures and trainings as well as the information in the other lessons consideration should be given to safety related to the use of medical equipment in the home In today s home care environment patients clients have the opportunity to use many types of home medical equipment Also called durable medical equipment DME the items are intended to withstand repeated use by non professionals and are appropriate for home use There must be a doctor s order Medicare or private insurance may pay for the DME The nurse will document its use in the patient s client s record The Registered Nurse RN will assess the patient s client s and or caregiver s ability to set up monitor and change equipment reliability and safely as well as clean store dispose of equipment or supplies using proper technique learned from the DME supplier The DME supplier is responsible for proper delivery and initial setup of the equipment The DME representative should ensure the home environment is suitable and safe for proper usage of the equipment The DME representative is responsible for training the patient client family and caregivers on the proper usage and maintenance of the equipment There should be 24 hour contact information provided as well in the event of equipment malfunction or other emergency The nurse will reinforce using the DME correctly and reviewing any areas of on compliance with the patient client regula
38. rkin well lighted areas o Ifyou have car trouble put on your flashers raise the hood tie a white cloth on the door or put a Call Police sign in the window Stay in your car with the doors locked and windows closed Ask anyone who stops to call the police do not go with this ee o rN CareServe v Private Duty Services Caregiver Training PSYCHOSOCIAL ASPECTS OF PATIENT CARE You are taking care of the patient because he she has a physical illness But that illness is not all that impacts how the patient feels The patient also has nutritional environmental psychological emotional spiritual and lifestyle needs and values that have impact Taking all of these areas into consideration means that you are looking at the psychosocial aspects of patient care Remember that your patient is a PERSON who has many needs The needs fall into categories that can address all psychosocial aspects such as Psychological Elimination Rest and activity Safe environment Oxygen Nutrition As you take care of a patient in the home you can use PERSON to identify the patient s physical and functional health Here are examples PSYCHOLOGICAL How is the patient coping with pain Is there depression spiritual or emotional distress What is the level of consciousness ELIMINATION How is the bowel and bladder function Does the patient have a UTI colon cancer renal failure prostitis and sexual dysfunction REST AND
39. rly It is expected the patient client will follow the manufacturer s instructions and those given by the DME representative The Agency will also follow the requirements of the Safe Medical Device Act the Act to identify report and correct medical device incidents These include serious injury and death to the patient client Agency staff will be oriented to the Act upon hire and annually thereafter The Administrator or designee will be responsible for determining when a reportable event has occurred and he she will complete all required documentation and if applicable the Food and Drug Administration s FDA reports oN CareServe Ne Private Duty Services Caregiver Training NON SOLICITATION Kickbacks Bribes Gifts ee 3 ee Brec payments All of the above are examples of receiving something from someone for client referrals to the Agency or solicitation In other words someone gives you money or a gift for getting as many clients as you can to the Agency Or another example is that YOU or someone at the Agency gives the client money or a gift to transfer from the agency he she is at now to come to your Agency And doing any of these things could result in prosecution leading to a civil penalty of up to 10 000 for each day of violation and each act of violation Or to put it a different way every time this is done the person doing this solicitation could pay a fine up to 10 000 Every payor source and regula
40. route indicating the direction of travel to the nearest exit Any doorway or passage that might be mistaken for an exit must be marked Not an Exit or with an indication of its actual use The line of sight to an exit sign must be uninterrupted Hl p rN CareServe v Private Duty Services Caregiver Training STARIWAYS OSHA has specific requirements to protect employees on stairways 1 Stairs with four or more risers shall be provided with at least one handrail A stair rail system shall be provided on all unprotected sides or edges of stairways with a fall hazard of four feet or more 2 Stairs shall be capable of supporting without failure at least five times their maximum intended load SAFETY TIPS Stair treads prevent slips and falls Never run on stairs Staircases should be well lit Wipe up spills and remove any clutter Handrails should be mounted directly by brackets attached to the lower side so there s nothing in the way of your hand The surface along the top and sides should be smooth so you don t get slivers STORAGE AREAS Storage areas should be conveniently located Doors should be marked Not an Exit or Storage The room should be well lit and well organized There should be an aisle at least three feet wide for safe movement within the storage area Choose shelving cabinets and other storage units used to meet the storage needs of the agency Tall shelves should be fa
41. rsonal and or clinical records v The provider of services shall inform an elderly individual of his her condition and any changes in his her condition This must be in a language the elderly individual understands v An elderly individual may choose his her own physician and be informed in advance about the treatment and or care v An elderly individual may participate in developing his her plan of care to meet his her medical nursing and psychological needs as well as how they will be met v An elderly individual may refuse medical treatment once it has been explained and he she understands what will happen by doing so v An elderly individual may keep his her own clothing and furnishings if there is a space for these without harming the health and safety of others v An elderly person may refuse to perform services for the provider of services Within 30 days of admission the provider of services shall explain if he she is entitled to Medicare and or Medicaid benefits and for which services there will be no charge v The provider of services may not transfer or discharge an elderly individual unless o It is for the good of the elderly individual o The elderly individual s health has improved so that services are no longer needed o The elderly individual or another would be endangered if the transfer discharge didn t take place o The provider of services closes or cancels a contract with a payor source and or o The elderly i
42. sensitive to the unique needs of the dying patient and his caregiver Care should be respectful and responsive to the patient s needs Interventions care will include but are not limited to Assess and care to facilitate the management of pain and symptoms by documenting patient s statements of level of pain Assess and care to manage and or prevent other symptoms such as nausea vomiting Care to address the psychosocial emotional and spiritual concerns of the patient caregiver regarding dying and grieving Respect the patient s cultural beliefs about dying Help the patient express his her thoughts and feelings Help the patient to maintain as much independence as possible Make appropriate referrals to meet patient s needs and Monitor the patient s response to interventions care fHREREFE FF The patient is probably grieving for the inevitably of loss and death and will go through the stages of grieving denial anger bargaining depression and acceptance Know what the dying patient wants and be prepared to help him her Research tells us that they want a Empathetic Presence someone to listen recognize feelings and be supportive of the patient s uniqueness Teacher Expert nurse demonstrates technical skill and shares knowledge in an honest and understandable manner Acknowledges the normalcy of experiencing episodes of grief related feelings o Ongoing invitations to participate in their healthcare
43. st you with various safety issues o Do not carry excessive amounts of money with you and avoid carrying a purse If you must carry your purse lock it in the trunk of your car before you leave home o When driving keep purse cell phone etc on the floor not on the seat o Wear closed toe shoes o Wear your ID at all times You may want to carry additional forms of identification in your pocket as well as your Agency s phone number o When walking alone avoid groups of people lingering on the street rN CareServe v Private Duty Services Caregiver Training o Do not take short cuts down alleys through buildings or across private property Avoid narrow or confined spaces o Watch what s going on around you o Be familiar with your surroundings Know where to find pay phones Always have enough change with you for the pay phone o Present yourself in a confident manner do not appear nervous or anxious o Never walk into a home uninvited Never walk into a vacant home o If you see you have a reason to suspect illegal drug use or alcohol abuse by a patient client or patient s client s family member report this to Agency management o If any weapons are present in a patient s client s home either ask that they be put away or leave Report this to your Supervisor immediately When changing the client s bed li8nen carefully handle linens and be aware of sharp items such as needles which might be in the patient s
44. standing the language and you can see that it can be difficult to assess the patient s pain A tool that has been developed to assist in this is the Wong Baker FACES scale Just have the patient point to the face that describes how he she is feeling The treatment of pain has to be individualized What works for you might not work for someone else There are several medical treatments and other interventions that can be done to help to decrease pain or increase one s tolerance to pain Of course you would do only those for the patient that are allowed within your job description They include but are not limited to Position your patient to reduce pain This helps to increase blood supply to damaged tissues Apply heat or cold to the painful area as appropriate This helps to relax painful muscle spasms and reduce swelling Massage the painful area unless contraindicated This provides stimulation to sensory fibers which limits the transmission of pain impulses to the brain Encourage your patient to use relaxation techniques such as rhythmic breathing These help to decrease tension Administer medication as ordered and teach the patient the importance of doing so This keeps a steady level of the pain reducing med in the bloodstream rN CareServe Nat Drinte Diay Sree Caregiver Training PERSONAL SAFETY In addition to Agency s other policies procedures and trainings as well as the informatio
45. stened to the wall to prevent them from tipping over Place heavier items on the bottom shelves Use a sturdy step stool to reach the smaller items on the top shelves Individual well labeled bins can be placed on the shelves for storing small items This will also make taking inventory much easier and more efficient The agency is responsible for maintaining patient client records safely after discharge Don t let the file cabinets become overly full so that records are damaged when trying to stuff them into drawers Doing so could lead to hurting yourself too TIN If cleaning products or other combustibles are kept in the storage room be sue the containers are well labeled and tightly closed There should be adequate space between them and any other item to allow for good ventilation If sharps are returned to the office they should be placed in the area designated for medical waste rN CareServe v Private Duty Services Caregiver Training ETHICS DEFINITIONS e Ethics moral principles morally right a standard of conduct e Ethicist a specialist in ethics e Dilemma any situation requiring a choice between unpleasant alternatives Most ethicists say there are seven ETHICAL PRINCIPLES e Beneficence doing good caring e Non maleficence doing no harm e Justice being fair e Autonomy respecting the patient s right to make decisions e Loyalty Fidelity keeping promises
46. tory body governing the Agency s right to provide services to clients has rules about not soliciting or non solicitation These include TEXAS RULES AND REGULATIONS CMS MEDICARE TEXAS DEPARTMENT OF AGING AND DISABILITY SERVICES Equally the Agency you are working for has a policy against soliciting clients It says something like this Agency does not reimburse or provide incentives to employees for patient referrals to the Agency Claims of solicitation and or remuneration will be thoroughly investigated my management Employees found in violation of this policy will be subject to discipline up to termination of employment Physicians clients and other legitimate sources may refer clients to the Agency but none should be as a result of payment for the referral The Agency is relying on YOU to avoid even the appearance of solicitation rN CareServe Ne Private Duty Service Caregiver Training OFFICE EQUIPMENT SAFETY In addition to Agency s other policies procedures and trainings as well as the information in other lessons office equipment safety is essential for you to take into consideration As part of the orientation staff should be educated on the safe and appropriate use of equipment owned by the Agency and or used in the office Any identified equipment hazards or defects should be reported to the appropriate person immediately Equipment repairs or replacements should then take place All equip
47. urity hazards Workplace security information is posted or distributed as applicable
48. use if you come in contact with the product These are kept in the office One product that direct care personnel come in contact with is oxygen Oxygen is a colorless odorless gas that is needed for respiration It does not burn but it does support and accelerate combustion When the patient needs it in the home it can be supplied by a tank cylinder or a concentrator Read and follow the manufacturer s instructions and follow these DO s and DON T S x ko Do store oxygen handling equipment in a clean dry location Don t use equipment that is visibly dirty Do protect masks cannulas tubing etc in plastic bags to keep them clean Don t allow smoking around oxygen Do open cylinder valves slowly If released suddenly there is enough power to drive the heavy cylinder through a wall Do not use oil grease or products containing them near oxygen as these substances are ideal fire starters igniting almost spontaneously in oxygen This includes oil from your skin Wear gloves when working on oxygen hardware to keep oil from your hands off the parts 2e S x ko S rN CareServe v Private Duty Services Caregiver Training CULTURAL DIVERSITY In order to provide effective care to people from other countries and at times people who are from various parts of the United States it is important t to have a basic understanding of cultural diversity and to develop baseline
49. xploitation o He she has the right to appoint a guardian representative to ensure his her affairs are being handled properly v An elderly individual has the right to be free from physical and mental abuse including corporal punishment or physical chemical restraints for discipline or convenience v Ifthe elderly individual is mentally retarded his her guardian may give informed consent for participation in a behavior modification program including the use of restraints v An elderly individual may communicate in his her native language for the purpose of acquiring or providing treatment care or services v Anelderly individual may services and the provider of punish the elderly make a complaint about the services may not discriminate or individual for making a complaint a CareServe Ne Private Duty Service Caregiver Training v An elderly individual has the right to privacy while attending to personal needs and a private place for receiving visitors This includes medical treatment telephone calls meeting with family and friends and access to resident councils Also his her mail must be sent and delivered promptly An elderly couple who is married may share a room v An elderly individual may participate in activities of social religious or community groups v An elderly individual may manage his her own finances or authorize in writing another person to do so v An elderly individual may have access to his her pe
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