Measuring is Monitoring

We have all been taught since Nurs-ing 101 that all the data we collect as Healthcare providers must be mea-surable and objective. Of course, for me and many of you, NSG 101 was a long time ago. Wikipedia notes that objective data is: expressing or dealing with facts or conditions as perceived without distortion by personal feelings, prejudices, or in-terpretations. Many of us do a great job of doing this in our charting, but, when it comes to charting Level Of Consciousness on our less responsive Patients, we sometimes get stuck when we can’t just quote a temp, weight or use words like “diapho-retic, tachy and brady.” Patients with altered responsiveness usually make progressive or regressive changes that are slow and subtle and not eas-ily detected.

One of the wonderful tools we have in our bags to help us describe and recognize these changes is the Glasgow Coma Scale. This scale is named after Glasgow University in Scotland (1974) where it was developed for two reasons. 1) To facilitate the assessment and record-ing of initial severity of traumatic brain dysfunctional patients by using simple terms. 2) The monitoring of improvement or deterioration in conscious level as an indication of recovery. Here at American Home Health #2 is our goal. The Glasgow gets rid of difficult verbiage and al-lows us all to speak the same digital language while catching changes not easily seen. Pick only one score from each section, then add them for a total score of 3 to 15.

Healthcare for All AgesFebruary 2009

Glasgow Coma Scale Cont....

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Handwashing Game

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Universal Precau-tions Policy

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Universal Precau-tions Policy Cont...

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Joint Commission Was Here

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Mandatory Com-petency Fair

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Inside this issue:

Glasgow Coma Scale

American Home Health is celebrating its 6th Manda-tory Competency Evalu-ation Fair. The dates will be April 29th - May 2nd. Please call the office for more information, or go to www.ahhc-1.com.

For our Pediatric patients less than 3 years old or of equal mentation the verbal response section presents a problem, so for these patients the Pediatric Glasgow Coma Scale is more accurate it calculates the same way but looks like this.

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For our Pediatric patients less than 3 years old or of equal mentation the verbal response section presents a problem, so for these patients the Pediatric Glasgow Coma Scale is more accurate. It calculates the same way but looks like this.

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Interpretation is best left up to the doctors. Our job is to catch, describe and document the changes. Some of us are shy to use these tools because of the term “Coma.” Use of the tool does not declare the patient comatose. There are many factors that must be accounted for when interpreting the score; i.e., Intubation, edema or other compounding diagnoses.

Generally Levels of Consciousness are classified as:Severe- GCS less than 8Moderate-GCS 9-12Minor- GCS 13 or more

Shawn Pickett, BSN, RNClinical Manager/SupervisorAmerican Home Health

How often do you wash your hands? How many gloves do you use?

Scenario: Nurse Jane is taking care of a client who needs a trach change and is receiving g-tube feedings.

Before the trach change Jane, RN, elects to disconnect the g-tube 1. feeding.Jane, RN, charts the disconnection of the g-tube feedings.2. Jane, RN, completes the trach change.3. Jane, RN, charts the trach change.4. Jane, RN, restarts the g-tube feeding.5. Jane, RN, charts the tube feeding. 6.

The first 10 callers to American Home Health, please ask for Katie, to answer both the questions correctly will receive a gift card to Jewel-Osco for $10. Just for knowing when to wash and glove your hands properly.

Good Luck!

Handwashing Game

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Joint Commission has come and gone. The unannounced survey took place January 22nd and 23rd.

Pat yourself on the back and say, “UH OH!” The surveyor saw many positive things and several negative items.

“American Home Health has the sickest of the sickest children and you are doing a won-derful job with them.” stated Kathy, the Joint Commission surveyor.

She also expressed great enthusiasm for the disaster plans we have set for each home and the office. Kathy also made mention we have half the infractions we had three years ago. We are definitely going in the right direction!

On the flip side of the coin, we need to im-prove our conversion rate for hand-washing and gloving opportunities. Also, we need to pay more attention to what the DOCTOR has ordered versus doing what the parents want or what we believe is needed.

Included in the newsletter is American Home Health’s hand washing policy. Everyone should read it very carefully.

Regarding orders for the client, we MUST follow MD orders, NO EXCEPTIONS. If you are providing care outside the parameters of the MD order, then you are in violation of the Nurse Practice Act. I’m not sugar coat-ing anything. This is serious business, and,

if you can’t follow doctor’s orders, you are placing your license on the line.

Remember, what we do is GREAT but let us not be overshadowed by the negative. We provide great care to all our clients. Don’t al-low complacency to creep in. We must wash and glove our hands. It’s not only for the cli-ent’s protection but yours and your families as well.

Over the next couple of months when Nurs-ing Supervisors complete a home visit they will be evaluating you for hand washing and gloving, we expect a 90% compliancy rate. This we don’t want to happen, we have worked to long and hard to obtain and keep this status of accreditation.

As for doctor’s orders, pick up the phone, call them you have the ability and right to talk with the physician about the client -- obtain clarification of an order, provide a status up-date, etc. You are the eyes, ears, and hands of the physician however, you must follow his/her orders at all times.

Over the next couple of months there will be a lot happening, I hope each of you will work with us to make American Home Health an-other step above our competition.

Sincerely,Janelle C. Fulfs, BAVice President

JOINT COMMISSION WAS HERE!

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You’re Invited! Please Join Us for American Home Health’s

6th Annual MANDATORY COMPETENCY FAIR

Plan Ahead …. Mark Your Calendars ….

WHEN: Wednesday, April 29th, 8 am – 6 pm Thursday, April 30th, 8 am – 6 pm

Friday, May 1st, 8 am – 6 pm Saturday, May 2nd, 8 am – 6 pm

WHERE: (directions on back): Yorkfield Civic Center 15W354 Lexington Elmhurst, IL 60126

Highlights:- Free CPR Training presented by L.M. Cantone & Associates Wednesday (4/29), Friday (5/1), Saturday (5/2) at 10 AM - Private Duty Booths - Intermittent Visit Booths - Networking - Refreshments - Door Prizes

Note: Please keep in mind we are limited on how many nurses we can in-service at a time. This makes time spots limited, and we need to allocate in the order RSVPs come in. Please allocate two hours to complete the fair.

Please tear off this section and send it in.

Name: __________________________________________ Title: RN / LPN

Date Preferred: ____________ / ____________ / ____________ Time: ________

CPR Reservation Date Preferred (circle one): Wednesday (4/29) / Friday (5/1) / Saturday (5/2)

Mandatory Competency Evaluation

For General Newsletter Submissions, please contact Edward Lara or Karen Centowski at 630.236.3501 or hr@ahhc-1.com.American Home Health Corp.