Nursing responsibilities and  resources

CSM.016 Tracking of Lab Tests and RN Lab Forwarding Guidelines

CSM.014 Telephone Advice and Triage during Office Hours

MR.006 Documentation and Locking Encounters

CSM.023 EHR Cross Cover Summary of nursing responsibilities:

Org-Wide Jellybean Cross Coverage (CC) System

• RNs assist in addressing urgent jellybeans (JBs) forwarded to the generic site RN inbox.

• If forwarding a JB or message to a cross-covering (CC) provider, RNs must route it back to the provider who is out of the office, not directly to the CC provider (as different CC providers may be assigned).

• For providers no longer with NH or those transitioned to "No Panel" status, RNs must route JBs back to "Cross Covering, Clinician."

Internal On-Site Cross Coverage System

• Review JBs of providers out for less than 5 consecutive days, prioritizing urgent tasks

  • Labs: Check for forwardable labs 

  • TEs: scan of TE inbox for urgent items only

• Mark normal results or non-urgent JBs with "hold for PCP and initial/timestamp (.ts)."

• Non-urgent documents can either wait for the provider's return or be handled at the discretion of the on-site clinical team.

• Forms requiring provider signatures must be reviewed and signed by an on-site provider.

LabCorp TE's

When a TE from LabCorp or another lab company is received, there are two tasks to complete:

1. Call LabCorp (even if the lab is already in the eCW record) to close the loop.

2. If the lab value falls under the critical lab forwarding guidelines, forward the lab to the ordering provider.  If the ordering provider is out of office, send to cross-cover provider.

Checking labs for out of office providers:  Checking Labs.mp4 

• Checking labs for out-of-office clinicians out of office 5 days or less

  • Always document in "Internal Notes" what was done, e.g. "Hold for provider" or "Forwarded to c/c provider Smith".  Name and date will automatically timestamp. 

• When a lab is held: Document action taken in "internal notes" and document "Hold for PCP", Initials and date in "Result" field.

• When a lab is forwarded to the cross-covering clinician:

  • Document action taken in "internal notes"

  • In "Result" field, write "FWD to C/C provider" and the reason why, e.g. "Hg 5.6"

  • Change "Assigned to" field to name of cross covering provider.

TE's: 

• High priority TE's should be checked/called by close of business if received before 3pm.

•  Do not give PHI in a voicemail unless patient has given specific permission to do so and that permission is documented in the chart.

• Documenting in the TE

  • Reason field: This should be the reason for the patient' call.  This field is editable.

    • • When RN calls a patient and there is no answer, document date and initials after the reason.

  • Messages box: This field is editable.  Keep documentation in this area to a minimum to prevent someone typing over important documentation.

  •  Action taken:

    • Document in "Action Taken".  This field is NOT editable.  It will timestamp your name and time automatically.

    • Telephone Triage Protocol for Nurses book should be used when triaging patients via phone.

    • Document the conversation with the patient, including the patient's symptoms (if any), actions taken by nurse, any follow-up appointments, advice given to patient. 

    • Include:

      • Subjective findings (what the patient says)

      • Objective findings when applicable (e.g. patient coughed frequently during conversation)

      • Disposition (e.g., patient seen by provider, future appointment scheduled, sent to ED, etc.)

  • TIP:  Before exiting the action taken box, copy the note you made - especially if it is a long one.  eCW has a bug, in which if another user tried accessing the TE while you have it opened, it WON'T SAVE your note.  You don't it doesn't save until after you exit the action taken box.  This is very frustrating, so copying your note just in case is a best practice.

  • Once documentation has been completed and the situation is resolved, close the TE.

  • If the situation is not resolved, for example, the TE needs to be sent to another person, do not close the TE.  Change the "Assigned To" name to the person the TE needs to go to next.

  • Closing a TE

    • TE's are closed by selecting the "Addressed" button.  Once a TE is closed, it cannot be reopened.

    • At least 2 attempts need to be made to contact the patient.  These should be via phone calls and can include text messaging the patient.

    • Document each attempt to reach the patient in the "action taken" field.

    • After documenting 2 attempts, send a letter to the patient.

    • Document "Unable to reach patient, letter sent" in "Action taken" field and close TE.  Printing letters 

D Jelly: Check clinic RN D jelly inbox for assigned documents.  D Jelly 

CSM.155 Infection Control Plan  

CSM.095 Aerosol Transmissible Disease Plan

CSM.055 Bloodborne Pathogens and Waste Management

CSM.134 Sharps Incident and/or Body Fluid Exposure

Rash triage; Communicable disease isolation

Neighborhood does not dispose of patient sharps or medications.

CSM.116 Patient Needle and Syringe Disposal

Patient Resources

 
San Diego County

• City of San Diego Enviromental Services Needles, Lancets and Sharps

  • City of San Diego Household Hazardous Waste Brochure English

  • City of San Diego Household Hazardous Waste Brochure Spanish

• San Diego County Safe Disposal of Home Sharps

Riverside County

• Riverside County Needles and Sharps Residentially Generated

  • RivCo Sharps & Medication Disposal English

  • RivCo Sharps & Medication Disposal Spanish

California

• Safe Disposal of Home-Generated Sharps Waste 

  • CA Sharps Educational Brochure - English 

  • CA Sharps Educational Brochure - Spanish 

Lab Sharepoint page

In House Lab Training 

NHC Critical Policy 15% Calculation.xlsx

AccuDraw  LabCorp website that provides guidance on specimen collection

• Enter LabCorp account number see NHC Lab Directory 2024.xlsx

• Enter test codes

Refill Center: Staff who refill medications for general medicine providers based on protocols. 

• Does not refill meds for BH, peds, prenatal, residents, etc.

• Send a TE to Refill, Center with refill request. 

• We also have a Refill Center-RN Teams chat for urgent refill needs.   Examples of when to use the Refill Center-RN Teams chat:

  • Emergency contraception

  • Medication that could cause harm to patient if not refilled in a timely manner (insulin)

RN-LVN Duties List

Expectations:

• Expiration dates checked in the first week of the month and expired medications removed from stock

• On emergency cart:

  • E-kit medications and supplies list posted on the emergency cart

  • Policy and Laminated Emergency Response Procedure booklet posted

  • Adults & Peds ambu-bag mask

• O2/AED log posted and checked

• O2 tank above 2000 PSI

  • All size masks/nasal cannulas on O2 tank(s) for easy access; bags NOT punctured

• Medications inventoried and expiration dates checked in the first week of the month and expired meds are removed from stock

• Drug samples are reviewed and documented for expired drugs

• Multi-dose vials (MDV) dated and initialed when opened and discarded 28 days from date opened

• Expired/wasted medications placed in the correct bin and documented on record

• Medications have thermometer and temperatures are recorded.

• Waste bins are emptied when full or 1 year after initiation of use; whichever comes first

• PSR tool

• FM.006 Multiple Patient Visits on Same Day

• PSR.010 Late Arrival Policy

• PSR.002 Patient Access to Appointments

The VEC is a staffed by clinicians who see patients via video platform. 

• ONLY CCR's and RN/LVN's may schedule on VEC schedules.

• Schedule no more than 24 hours in advance UNLESS approved by a VEC MA.

• Triage patients prior to scheduling on VEC.  Document this triage in the TE or WI/RN visit note that you are using, not the VEC appointment that is being scheduled.

• New patients may be scheduled during business hours, established patients only for after hours.

Scheduling guidelines for Virtual Express Care (VEC or VXC)