First Nations and Inuit Home and Community Care Policies Template Manual
Part 8: Clinical/Service Delivery
First Nations and Inuit Home and Community Care Program
Policies Template Manual
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Part 8: Clinical/Service Delivery
Community Name
Protocol: Death in the Home
Protocol Number: PROT 8.1
Approval:
Date:
Purpose:
To respect the client's and family wishes regarding death at home, to the fullest extent possible. To ensure appropriate protocols are in place for unexpected death in the home.
Guidelines:
When a client chooses to die at home:
- An assessment of the client's condition, the family and caregiver support, and the client's wishes regarding resuscitation and dying at home is conducted by Program staff to determine if the client's wishes can be achieved.
- Following the assessment, Program staff conduct ongoing review and discussion with the client and family to identify any changes in the client's wishes, the ability of the family to manage and support death at home, and any changes in the client's condition and care requirements. In case the family is unable to support death in the home, a contingency plan that is mutually agreeable is developed.
- The relationship with the physician needs to be strong to ensure required support is provided, including pain and symptom management, on-call availability, home visits if required, and signing of the death certificate.
- At all times, the client's and family's wishes are respected; and, should these wishes change at any time, they are acted upon immediately; communicated to the rest of the care team, including the physician; and documented in the client record.
- Program staff are aware of those situations that require notification of a coroner and act accordingly and in a manner that provides the least intrusion and upset to the family.
When an unexpected death occurs:
- The Program staff notify the attending physician to pronounce death, determine cause and issue the death certificate. Program staff are aware of correct protocol, ie ensuring that the body is not moved until cause of death has been determined.
- At all times through this process, Program staff assist the family to the fullest extent possible to ensure that they experience the least intrusion and upset possible, and to help them cope with their grief and sense of loss.
Review Process:
Dates:
Suggested Procedures and Tools
- Procedure for signing of medical certificate by the attending physician, other physician or coroner to minimize the impact on the family.
First Nations and Inuit Home and Community Care Program
Policies Template Manual
Community Logo
Part 8: Clinical/Service Delivery
Community Name
Protocol: DNR (Do Not Resuscitate)
Protocol Number: PROT 8.2
Approval:
Date:
Purpose:
To ensure the client's wishes, or those of a substitute decision maker, are clearly identified and documented.
Guidelines:
- If already identified by other health providers (ie prior to referral) the client's wishes regarding resuscitation are confirmed and communicated to all Program staff and other members of the care team in the community.
- During client assessment, or as appropriate, client wishes, or those of a substitute decision maker, are identified and documented in the client record.
- These wishes are revisited periodically and as a client's condition changes.
- An informed client consent regarding resuscitation wishes is signed and included in the client record.
- Clients and caregivers are educated to ensure they understand CPR actions and the probable outcomes.
- Any request to reverse the client's original wishes, at anytime, is immediately documented and communicated to the rest of the care team.
- When there are differences in client and family wishes, the client's wishes will be followed. Program staff will help the family to understand these wishes, as appropriate.
Review Process:
Dates:
Suggested Procedures and Tools
- Procedure for documenting client wishes regarding resuscitation.
Suggested tools:
a. Incident report form
- Procedure for communicating the client wishes, and any changes in these wishes, to the rest of the care team.
First Nations and Inuit Home and Community Care Program
Policies Template Manual
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Part 8: Clinical/Service Delivery
Community Name
Protocol: First Dose Medication Administration
Protocol Number: PROT 8.3
Approval:
Date:
Purpose:
To ensure quality client care and minimize client and staff risk for administration of first dose medications in the home.
Guidelines:
- Medications considered safe for administration in the community setting for both clients and staff are clearly identified. Similarly, medications considered unsafe that should be excluded from administration in the community are clearly identified. These medications are frequently reviewed and the list revised to reflect latest best practice.
- Program orientation includes training related to first dose medications and treatment of adverse reactions.
- Registered nurses, who are Program staff or providing services on behalf of the Program, have the necessary skills and certifications to be administering first dose medications. They also have the skill, equipment and supplies to detect and manage adverse reactions.
- Prior to administration of first does medications, the client is assessed and the following client information is obtained:
- History of reactions to medications
- Any drug allergies
- Current medications
- Other pertinent client information, ie weight, vital signs
- The home environment is also assessed to determine the ease of accessing emergency services, if required (ie telephone, road access).
- Prior to administration, staff are prepared for adverse reactions and any treatment that may be required.
- Clients are monitored by Program staff during administration and for an appropriate period following administration to detect any adverse reactions.
- A family member or caregiver is available to monitor the client's condition for an appropriate period following administration and knows what to do in the event of an adverse reaction.
- Clients and caregivers understand potential adverse reactions, how to detect symptoms, and how to access Program staff and emergency services.
- Emergency services are provided in the area and available in case of an adverse reaction.
- The referring physician agrees that the client is at low risk of an adverse reaction, and is advised of any such reaction.
- Any adverse reactions and required treatment are fully documented in the client's record.
Review Process: Dates:
Suggested Procedures and Tools
- Procedure for identifying and approving medications to be administered in the community.
Suggested tools:
a. Approved medications list
b. List of medications excluded from administration in the community
- Procedure for client and environment assessment.
Suggested tools:
- Procedure for education of client and caregiver(s) regarding potential adverse reactions, symptoms, and appropriate action.
Suggested tools:
- Informed client consent form
- Procedure for identifying equipment, supplies and medications required for adverse reactions.
First Nations and Inuit Home and Community Care Program
Policies Template Manual
Community Logo
Part 8: Clinical/Service Delivery
Community Name
Protocol: General Medications Administration
Protocol Number: PROT 8.4
Approval:
Date:
Purpose:
To ensure quality client care and the safe administration of
medications in the home.
Guidelines:
- Medications considered safe for administration in the
community setting for both clients and staff are clearly
identified. Similarly, medications considered unsafe that
should be excluded from administration in the community are
clearly identified. These medications are frequently reviewed
and the list revised to reflect latest best practice.
- Program orientation includes assessment of staff knowledge
in medications and their skills in administering medications and identifying and treating adverse reactions.
- Registered nurses and registered practical nurses, who are
Program staff or providing services on behalf of the Program,
have the necessary skills and certifications to be reviewing,
administering or pre-pouring medications, in accordance
with their scope of practice. They also have the skill,
equipment and supplies to detect and manage adverse
reactions.
- Prior to administration of medications, the client is assessed
and the following client information is obtained:
- History of reactions to medications
- Any drug allergies
- Current medications
- Other pertinent client information, ie weight, vital signs
- Prior to administration, staff have a thorough understanding
of the medication, its benefits, side effects, and potential reactions with other medications the client is taking; and are
prepared for adverse reactions and any treatment that may
be required.
- Concerns that staff may have regarding medication
appropriateness and its administration are raised with
Program management, including supervisors. Attending
physicians are then consulted and the concerns are
discussed. Appropriate procedures are in place for
documenting any decisions that differ from those of the
attending physician.
- Clients are monitored by Program staff during administration
to detect any adverse reactions.
- Clients and caregivers understand all aspects of the
medication, including dose, frequency, benefits, potential
risks and adverse reactions, and how to access Program staff
and emergency services in the event of an adverse reaction.
- All medication administration, any adverse reactions and
required treatment, and any medication errors are fully documented in the client's record. Attending physicians are
advised of any irregularities, including adverse reactions and medication errors.
- Clients and caregivers are educated in self-administration,
and coaching and support are provided as required to promote self-administration.
- Clients provide informed consent to medication
administration and this consent is included in the client
record.
- Appropriate Program staff (ie registered nurses) evaluate the
outcomes achieved by the medication.
Review Process:
Dates:
Suggested Procedures and Tools
- Procedure for identifying and approving medications to be
administered in the community.
Suggested tools:
a. Approved medications list
b. List of medications excluded from administration in the community
- Procedure for client and environment assessment.
Suggested tools:
- Procedure for education of client and caregiver(s) regarding
medications, their benefits, potential adverse reactions, symptoms,
and appropriate action.
Suggested tools:
- Informed client consent form
First Nations and Inuit Home and Community Care Program
Policies Template Manual
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Part 8: Clinical/Service Delivery
Community Name
Protocol: Oxygen Management
Protocol Number: PROT 8.5
Approval:
Date:
Purpose:
To promote client, family and staff safety when oxygen and oxygen equipment is involved in client care.
Guidelines:
- Safe storage practices are followed within the Program, and clients and families are educated about safe storage practices and the risks involved if these practices are not followed.
- Safe transportation practices are followed within the Program and clients and families are educated about safe transportation practices and the risks involved if these practices are not followed.
- All risks related to the operation of oxygen in the home, including sources of heat, flame, combustion (ie aerosols), and grease, are identified, discussed with clients and families, and reduced to the fullest extent possible. Any risk situations that remain are documented and Program management is notified.
- The risks of smoking near the oxygen and equipment or while the oxygen is on are discussed with the client and family to be sure they understand the dangers of such action.
- If clients choose to smoke in an unsafe manner (ie too close to the equipment, or while the oxygen is on), Program staff should discuss the issues with clients and families to ensure they understand the dangers. If they still choose to continue to smoke, Program staff should document the client record, leave the home for their own safety, and advise Program management of the situation.
- All equipment should be carefully checked on a regular, frequent basis to ensure that it is functioning correctly and has not been altered. If it appears to have been tampered with, or is not functioning properly, the supplier should be contacted.
Review Process:
Dates:
Suggested Procedures and Tools
- Procedure for monitoring maintenance of oxygen equipment on a regular basis.
- Procedure for documenting unsafe practices, including the appropriate notification of Program management and other care team members, including the physician.
First Nations and Inuit Home and Community Care Program
Policies Template Manual
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Part 8: Clinical/Service Delivery
Community Name
Protocol: Workplace Safety
Protocol Number: PROT 8.6
Approval:
Date:
Purpose:
To minimize risk to staff while at work, whether at the Program offices, in clients' homes, or traveling.
Guidelines:
- All Program staff have the right to work in a safe environment. Potential risks in the home and community care environment are different than those in a facility environment. Program staff should be able to identify risk situations and respond as safely as possible. The Program places a high priority on workplace safety and the safety of its staff.
- Program staff should be aware of and be able to address the following risk situations:
- Physical threat, abuse or assault
- Verbal abuse
- Sexual harassment or assault
- Aggressive behaviour
- Substance abuse and related behaviour
- Physical environment risks, such as unsafe structures (ie stairs, floors), vicious or threatening animals, and exposure to smoke
- Communicable diseases
- Clients and families have a responsibility to provide a safe environment for Program staff. Although they may choose to live at risk, their choice should not put others at risk, nor should their lives be in danger.
- When traveling to and from clients, Program staff should practice the following:
- Use main roads and walkways whenever possible and avoid poorly lit, seldom traveled areas
- Check the vehicle before getting in to be sure no one is in the back seat. If the drive's seat tilted forward, it will be easier to see into the back seat area
- Do not pick up strangers
- If vehicle trouble is experienced, stay in the car and do not accept rides from strangers. Lock the doors and use the horn to signal for help
- Be alert to people who may be following the vehicle. If anything appears to be suspicious, drive to the police or community office, or to other buildings that you know are occupied so that you are not alone
- When visiting clients that may put staff at risk, the following precautions should be emphasized:
- Make the visit with another provider
- Make the visit with police or security personnel
- Schedule the visit to minimize the risk as much as possible, ie visit when other family members will be there (if there is a fear of being alone with the client)
- Stay out of the kitchen if a client or family member appears dangerous or unstable
- If it is necessary to go upstairs, follow the client instead of going up the stairs first
- Do not confront clients; instead, negotiate and suggest as a way to resolve issues. Treat all clients with respect and in a non-judgmental manner.
- Do not antagonize verbally abusive clients; speak softly, advise that other appointments are scheduled, staff are aware of the schedule and expected arrival times, and use common sense to find ways to leave as soon as possible
- Immediately leave if the client or caregiver behaves in a threatening manner, is dressed inappropriately, is under the influence of a substance, or if illegal activity is suspected
- Be sure that other Program staff know of scheduled visits and any situations that are considered risky
- Consider providing services in a safer location, such as a health centre
- If an incident occurs, once safe, be sure to document the incident with as much detail as possible. If an assault or threat has occurred, or if illegal activity is suspected, contact the police. Be sure to advise Program management and the immediate supervisor of any incidents or suspected risk to staff safety.
- When working at the office after hours or alone, be sure that appropriate safety precautions are taken, such as notifying any security, locking exit doors, and following instincts and common sense.
Review Process:
Dates:
Suggested Procedures and Tools
- Procedure for reporting incidents, including workplace risk.
- Procedure for withdrawal of services.
First Nations and Inuit Home and Community Care Program
Policies Template Manual
Community Logo
Part 8: Clinical/Service Delivery
Community Name
Protocol: Withdrawal of Services
Protocol Number: PROT 8.7
Approval:
Date:
Purpose:
To minimize risk to clients, families and staff when situations are considered to be unsafe and Program services should be withdrawn.
Guidelines:
- Unsafe situations include those circumstances that put clients and families at risk, or staff at risk. Examples include the following:
- Cognitive impairment of a client that puts the client and others at risk (ie risk of a fire)
- Physical, verbal or sexual abuse of staff
- After ensuring the client's safety to the fullest extent possible, and their own safety if they are at risk, Program staff notify Program management immediately about any unsafe situations. The attending physician and other members of the care team are also notified of the situation. It may be useful to discuss the situation as a team.
- Program staff and/or management may then contact the family to determine how the situation may best be handled. Family members may help to rectify the situation, or they may be part of the cause of the situation.
- Program management may also meet with the care team, including service providers from other programs, to identify possible solutions.
- An alternative solution will be sought in order to continue to provide care to the client whenever possible. If the client or family refuse to participate in this alternative, it may be necessary to withdraw services. If withdrawal is the only choice, clients and families will be given a period of notice so that they can make alternative arrangements. Program management will notify the client, family, physician and other care team members about the withdrawal of services.
- The withdrawal notice, rationale for the action, and any steps taken prior to withdrawing services will all be documented in the client record.
- In cases where Program staff are at risk, services will be withdrawn immediately, without notice. If the situation warrants, police will be notified and legal action may be taken.
Review Process:
Dates:
Suggested Procedures and Tools
- Procedure for reporting incidents, including unsafe situations and withdrawal of services.
- Procedure for documenting and communicating with the client and family, including the process of seeking alternative solutions and the actual withdrawal of services if this becomes necessary. Suggested tools:
- Standard letter of agreement
- Standard letter for notification of withdrawal of services, with copy to physician
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