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CHAP Education for Orientation
Revised 7/19/12
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Topics Covered in this Inservice
a)
b)
c)
d)
e)
f)
g)
h)
Overall Responsibilities and
Limitations
Communication Techniques
Client Rights
Observation of Client Status and
Changes in Client Condition
Basic elements of body functions
and changes in body functions
Standard precautions
Procedures for maintaining a
clean, safe and healthful
environment
Recognizing emergencies and
appropriate response to an
emergency
i)
Care of clients served including
the physical, emotional and
developmental needs
j) Bathing and personal care
techniques
k) Basic nutrition, meal preparation
and fluid intake
l) Assisting clients to achieve
maximum self reliance
m) The care of aged clients
n) Standards of supervision
o) Documentation of appropriate
record
p) Advance directives rationale and
implications
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Additional Local Policies and Topics
• Medical Device Reporting Act
• Performance Improvement Policy
• Infection Control Local Policies/ Procedures
– Blood borne Pathogens, HIV/AIDs
• TB Exposure Plan
• Recognizing Signs of Abuse
• Comprehensive Emergency Management Plan
• Personal Care Competency Evaluation
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A. Overall Responsibilities and Limitations
What You Can Do as an HHA
What you Can’t Do as an HHA
•
•
•
•
•
•
•
• Wound Treatment or First
Aid
• Pick up Client if fallen
• Administration of
Medication
• Climb ladders or tools
• Heavy Yard Work
• Cut fingernails, toenails, or
hair
Bathing
Dressing
Grooming
Transferring
Toileting
Feeding
Companion Services
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B. Communication Techniques
• When communicating with office, clients, and
coworkers, it is important to be:
– Respectful
– Professional
– Timely
• Much of the communication between office staff
and field staff is via phone and/or through email
using ersp messaging. Please check email daily,
and respond as appropriate. Please return all
phone calls based on voicemail message.
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C. Client’s Rights / HIPAA
Every client has the right to:
• Know the name and contact information of the
Comfort Keeper’s supervisor.
• Be able to complain without fear.
• Participate in developing plan of care.
• Be treated with courtesy and respect.
• Refuse services and be informed of consequences.
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C. What is the Health Insurance Portability and
Accountability Act of 1996 ?
• Grants everyone in the United States a federal right
to privacy.
• Created a national standard for the privacy of health
information.
• Gave the federal government a way to regulate and
enforce this right to privacy.
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C. Definitions
• A covered entity is any agency, facility, or business
that provides care to the public. Our home health
agency is a covered entity.
• Health information is information the agency creates
or receives that relates to a client’s past, present, or
future health. This includes healthcare history and
payment for that healthcare.
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C. Definitions
• Protected health information (PHI) is any
information about a client’s health that our agency
transmits or maintains. This includes information
kept on paper or in computer databases. It also
includes conversations about clients.
• Identifiable health information is information that
can be linked to a client through things such as a
name, address, social security number, medical
record number, or telephone number.
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C. HIPAA Violations
• Discussing client’s health information with your
family/ friends;
• Leaving papers or computerized medical records
open at your desk, in a client’s home, or in your
home;
• Talking about the client’s health information in the
presence of unauthorized family members or visitors
• If you knowingly violate HIPAA, you could be subject
to disciplinary action, including termination. Severe
offenses could lead to large federal fines and prison
sentences.
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Complaints and Grievance
Policy Purpose
To ensure that an appropriate method is in place to
provide clients, family members, staff, and all other
parties associated with Comfort Keepers an
opportunity to file a complaint on behalf of a client or
client representative/ family member and ensure that
complaints are properly investigated and appropriate
actions are implemented to provide a prompt and
equitable resolution.
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Complaints and Grievance Policy
Procedure - Intake
Complaints will be made in writing and will contain the
following:
• Name and address of individual filing;
• Relationship of that person to client, if applicable;
• Client’s name, if applicable, with medical record number;
• Date and time the complaint was filed (must be filed within 15
days of alleged incident;
• Detailed description of the alleged incident.
• Administrative, discrimination, and employee issues will be
handled by the Administrator or Alternate Administrator.
• Direct care issues will be handled by RN or Administrator.
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Complaints and Grievance Policy
Procedure - Intake
Complaint Grievance Form
Complaints Grievance Log
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Complaints and Grievance Policy
Procedure - Investigation
• The appropriate supervisor or designee will conduct a thorough but
informal investigation allowing interested persons and
representatives to present evidence relevant to the complaint.
• The investigating individual shall issue a written decision to all
concerned parties determining the findings, and the validity and
resolution of the complaint no later than 15 days after its filing.
• Reports of all complaints, including the investigative findings and
the resolution, will be maintained by the Administrator for 7 years.
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Complaints and Grievance Policy
Corrective Action / Complaint Resolution
• Data collected from the complaints will be compiled and integrated into
the Process Improvement process and reported to the governing body.
• The Administrator will communicate to the complainant the findings and
actions to be taken to resolve the complaint.
• Reports will be produced as requested and trending will be identified.
• Appropriate arrangements will be made to ensure that disabled persons
are provided accommodations, if needed, to participate in this process.
• For any grievance/complaint, the person reporting the issue may contact
the office at any time, including during off hours.
• In the event of a serious complaint/grievance, the on call person should
contact the RN or Administrator to address the issue.
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D. Observation of Client Status and Changes in
Client Condition
Status Area
Condition Changes
Cognitive
Memory issues
Physical
Balance
Appetite
Stamina
ADLs (see next slide)
Sleep Patterns
General well-being
Emotional
Enthusiasm/ Outlook
Mood/ Depression
Report these changes to your Care Coordinator and possibly the emergency
contact depending on level of severity.
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E. Basic elements of body functions and
changes in body functions
Body Function
Observable Changes
Mobility/ Ambulation
Decline in ability to walk or stand
Eating/ Drinking
Decline in ability feed self unassisted
Continence
Decline in ability to control bowel and bladder functions
completely by self
Toileting
Decline in ability to use toilet unassisted
Dressing
Decline in ability to properly put clothing on unassisted
Communicating
Decline in ability to verbally express oneself
Report these changes to your Care Coordinator and possibly the emergency contact
depending on level of severity.
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F. Standard Precautions
• Infection prevention practices that apply to all clients
regardless of suspected or confirmed diagnosis or
presumed infection status.
– Must be used every time you think you will come
in contact with a client’s blood, body fluids (except
sweat), non-intact skin, or mucous membranes.
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F. Standard Precautions
• Follow proper hand hygiene practices
• Use personal protective equipment
– Gloves, Masks, Gowns
• Handle soiled client care equipment appropriately
• Handle laundry appropriately
• Handle sharps appropriately
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F. Standard Precautions –
Hand Hygiene
•
•
Clean hands are the single most important factor in preventing spread of infections.
Wash hands:
– Immediately upon arriving at work, and just before leaving for home;
– Before touching your mouth or eyes;
– Before eating;
– After using restroom;
– After contact with another person’s body fluids.
– Between direct contact with different people;
– Before preparing, handling, or serving food;
– Before/ after assisting client with personal care/ meals;
– Whenever hands are visibly soiled;
– Before and after using gloves;
– Before/ after touching client’s intact skin
– After wiping down surfaces, cleaning spills, or other housekeeping duties; and,
– Remind/ assist clients in following same procedures.
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F. Standard Precautions Proper Hand-washing Technique
• Wash hands with soap and water immediately, or as
soon as possible, after contact with blood or other
potentially infections materials.
• If a sink is not readily accessible, use an alcohol-based
hand rub, but wash with soap and water as soon as
possible.
• If there has been no occupational exposure to blood or
other potentially infectious materials, and your hands
are not visibly soiled, you can use an alcohol-based
hand rub for routinely decontaminating your hands.
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F. Standard Precautions –
Personal Protective Equipment - Gloves
• Wearing gloves reduces the risk of you getting an
infection from clients. It also prevents the
transmission of germs from you to the client.
• You should wear gloves …
– When you have cuts, rough skin, or scratches
on your hands.
– Whenever you think your hands will come in
contact with blood, potentially infections
materials, mucous membranes, or non-intact
skin.
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F. Standard Precautions –
Personal Protective Equipment - Gloves
• Circumstances requiring glove change:
– When they are soiled and/or torn
– When going from a dirty to clean procedure
– Between each client and/or procedure
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F. Standard Precautions – PPE
Masks, Gowns, Goggles, Face Shields
• Masks, Goggles, Face Shields
– Designed to protect mucous membranes (nose,
mouth, eyes) from splashing or spraying blood,
body fluids, secretions, or excretions.
• Gowns
– Designed to protect your clothing and to keep
contaminated fluids from soaking through to your
skin.
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F. Standard Precautions-PPE
General Rules
• Use PPE that is appropriate for the task you are performing.
• Remove PPE that is torn or punctured or has lost its ability
to function as a barrier.
• Remove PPE carefully to avoid contamination.
• If you are accidentally exposed to a patient’s blood or other
body fluids and are wearing PPE, remove the contaminated
PPE.
• Immediately wash any exposed skin with soap and water,
or flush exposed mucous membranes of the eyes, mouth
and nose.
• Immediately contact supervisor to let her know what
happened and complete a Comfort Keeper Incident Report.
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G. Procedures for Maintaining a Clean, Safe, and
Healthful Environment
Fire Safety in client’s home
• Encourage the client or family member to purchase smoke
detectors and test them regularly. Test every 6 months.
• Be on the lookout for:
– Too many plugs in an outlet
– Oxygen too close to heat source
– Towels, curtains, other flammable materials close to
stove
• Make sure you and your client have an emergency exit plan
• Know the location of any fire extinguishers and learn how
to use them.
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G. Procedures for Maintaining a Clean, Safe, and
Healthful Environment
General Safety Tips in Client’s Home
• Keep electrical cords out of traffic area
• Encourage client’s/family members not to use throw rugs
• Make sure there is adequate lighting
• Store medical supplies (including oxygen) in a safe, dry area
• Have a backup plan in case of power failures
Bathroom Safety Tips
• Keep floor clean and dry
• Ensure tub and toilet railings are secure
• Place non-skid mats in the top
• Make sure there is adequate lighting
Bedroom Safety Tips
• Ensure that bed is at a safe height for patient to get in and out of
• Keep the client’s personal items within reach
• Keep lamps and telephones within client reach
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G. Procedures for Maintaining a Clean, Safe, and
Healthful Environment
Kitchen Safety Tips
• Label and date all food containers
• Do not use stove or oven for heating the home
• Instruct client not to use the stove if he/she is wearing oxygen
Entrance/Exit Area Safety Tips
•
•
•
•
•
Make sure there is adequate lighting
Ensure that steps have secure railings
Ensure that the walking surface is in good condition
Do not use the hall or stairway as a storage area.
You may need to ask the client/family member to remove clutter from
halls or stairs. Talk with your care coordinator first if you think this may
not be received well.
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G. Procedures for Maintaining a Clean, Safe, and
Healthful Environment
Avoiding/Preventing Workplace Violence
• Treat everyone with respect and refrain from engaging in
abusive language, intimidation, threats, assaults, or fighting
• Be alert for warning signs from a potentially violent person
– Making threats, Talking about carrying weapons
– Cursing or screaming, Pacing or restlessness
– Making violent gestures
• Report all real or suspected violence to your supervisor.
• If you find yourself in a potentially violent situation, stay calm
and remove yourself from the situation ASAP.
• Report incident from a safe location.
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H. Recognizing emergencies and appropriate
response in an emergency
Emergency
Appropriate Response
Client falls
911 if unable to get up unassisted
Client is found unconscious
911
Client is bleeding uncontrollably
911
Client takes wrong medication
Call Care Coordinator first, then possibly
911
Client chokes and has no airway
911
Client is having chest pains
911
Client is unresponsive
911
Client does not come to the door
Call client, call office, last resort - 911
Each situation has its own unique circumstances. If client is in a facility, the facility staff must
be notified as first step. A call to the Care Coordinator (either before or after 911, as
appropriate) is always required in all of these situations.
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I. Care of Clients served including physical, emotional, and
developmental needs, L. Assisting Clients to Achieve
Maximum Self Reliance, and M. The Care of Aged Clients
• Instead of “doing for” the client, we provide care by
“doing with” the client, engaging their participation
at their level of function.
• Focus is on the mind, body, safety, and nutrition
• Process includes communicating, interacting, and
engaging with the client on a number of different
services, from light housekeeping, to cooking, to
personal care needs.
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K. Basic Nutrition, Meal Preparation, and Fluid
Intake
A healthy diet helps to:
• Build, repair, and maintain body tissues
• Provide energy
• Regulate body processes
• Food gives us energy to carry out the day’s activities
and is necessary to rebuild body tissue
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K. Basic Nutrition, Meal Preparation, and Fluid
Intake
The process of aging effects dietary habits and
patterns in several ways. Seniors have:
• An increased incidence of protein-calorie
malnutrition.
• An increased need for nutrient-rich foods.
• An increased need for fiber.
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K. Basic Nutrition, Meal Preparation, and Fluid
Intake
The process of aging effects dietary habits and patterns
in several ways. Seniors have:
• A decrease in appetite without significant weight loss.
• A decrease in metabolism and muscle mass;
• A decrease in the need for as many calories, so their
appetite decreases to compensate.
• A decrease in the ability to digest fats with age.
• A decrease in their ability to smell or taste food because
of normal aging, medications, and disease. Ill-fitting or
painful dentures that can make eating difficult.
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K. Basic Nutrition, Meal Preparation, and Fluid
Intake
Diseases such as Alzheimer’s or dementia, anorexia,
depression, social isolation and failure to thrive which
have a direct affect eating and nutrition.
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K. Basic Nutrition, Meal Preparation, and Fluid
Intake – Senior Food Pyramid
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K. Basic Nutrition, Meal Preparation, and Fluid
Intake
• The best diet, one high in grain products, fruits and
vegetables, and low in saturated fats and cholesterol,
is based on the senior food pyramid. Limit foods that
contain no nutrient value such as refined sugar,
caffeine, and alcohol.
• Water is vital to health and well being. It is necessary
to drink 6-8 cups of water daily. The body needs
water to digest, to flush and eliminate toxins, to
maintain body temperature, and to prevent
dehydration.
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K. Basic Nutrition, Meal Preparation, and Fluid
Intake
When developing a menu of foods to be prepared, consider these
key aspects:
• Recommended servings from the food pyramid
• Variety – A well-balanced diet consists of nutrients from many different
kinds of food. No one food is perfect.
• Texture – Combining crispy foods with smooth soft foods makes each
texture seem more interesting. Unless the client is on a special diet and
the texture of the food is controlled, try to choose different types of
texture within each meal served.
• Flavors – If all foods in the meal have a strong distinctive taste, they will
compete with one another and overwhelm the client’s taste buds. Keep
the strong-flavored foods as the spotlight and milder-tasting foods as the
background in a meal. Season the food as the client prefers and their diet
permits.
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K. Basic Nutrition, Meal Preparation, and Fluid
Intake
When developing a menu of foods to be prepared, consider these key
aspects:
•
Temperature – Cook the food at the correct temperature. Ask the client at what
temperature they prefer their food. Not everyone enjoys food very hot or very cold. Some
people like ice. Some do not.
•
Taste – Cook the meal to the taste of the client. Discuss with the client or family the spices
they like and how they usually season their food.
•
Shape – Prepare the food with familiar shapes. Some families always slice their tomatoes,
some cut them into chunks.
•
Color – Give each meal eye appeal by keeping the colors compatible. A sprig of parsley, radish
roses, olives, or carrot curls may make an interesting dash of color to an otherwise drablooking meal.
•
Cost – Most clients are not free to spend an unlimited amount of money on their food, so
plan meals that are within their budgets and do not cause waste.
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N. Standards of Supervision
• All Comfort Keepers receive a performance evaluation on or around their
90th day, on the anniversary of their start date, and annually thereafter.
• Care Coordinators/ Supervisors perform periodic onsite visits to client
locations and observe Comfort Keepers on-the-job performance.
– Visit purpose is to ensure Comfort Keeper is following plan of care
• Care Coordinators/ Supervisors conduct 1:1 discussions as necessary, or
upon request of the Comfort Keeper.
• Periodic surveys to rate Comfort Keeper performance, Comfort Keeper
satisfaction, and Client satisfaction are performed on regular basis. The
results of these surveys are shared with the appropriate parties.
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O. Documentation on Appropriate Record
• Care Notes are required for all clients who receive
personal care services, and for homemaker
companion clients where long term care insurance is
involved.
– One Care Note per client, per Comfort Keeper, per
week
– Care Notes are due in the office no later than
10am Monday morning for the prior week’s work.
• Additional detailed instructions on how to complete
a care note are contained in the New Employee
manual.
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P. Advance Directives Rationale and
Implications
• Advance Directives are instructions written to healthcare providers
before, or in advance of, the need for medical treatment.
• The Patient Self-Determination Act (PSDA) requires home health
agencies and other institutions receiving Medicare and Medicaid
funds to do the following:
– Have written policies and follow procedures regarding advance
directives
– Document in the medical record if a patient has an advance
directive in place
– Comply with state laws on Advance Directives
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P. Advance Directives Rationale and
Implications
Advance directives include the following:
• Living wills
• Durable powers of attorney for healthcare,
also called healthcare proxies
• Do-not-resuscitate (DNR) orders
• Anatomical gifts, such as organ or tissue
donations
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P. Advance Directives Rationale and
Implications
• A living will is a legal document that a person uses to
make her wishes known regarding life-prolonging
medical treatments.
• A healthcare proxy enables a patient to appoint
someone he trusts to make decisions about medical
care if he cannot make those decisions himself.
• A DNR is a legal order written either in the hospital or
on a legal form to respect the wishes of a patient to
not undergo CPR or advanced cardiac life support
(ACLS) if their heart were to stop or they were to stop
breathing.
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P. Advance Directives Rationale and
Implications
• Advanced care planning helps ensure that family
members, friends, and caregivers are all familiar with
a patient’s wishes about the care he wants to
receive, especially at the end of life.
• It is important to honor and respect any advance
directives and to not discriminate against patients
who do not have advance directives. Home health
agencies also cannot require a patient to have an
advance directive.
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Local Policies
Medical Device Reporting Policy
Objectives
• After attending this training, attendees will …
– Be knowledgeable of the Medical Device reporting
regulation and purpose;
– Be able to list the events that Comfort Keepers is
required to report; and,
– Be able to verbalize Comfort Keepers policy with
regard to documentation and reporting of adverse
events involving medical devices.
What is the Medical Device Reporting Act?
• The Medical Device Reporting Act requires user
facilities (including a private residence) to report the
following:
– Device-related deaths to the FDA and to the
device manufacturer;
– Device-related serious injuries to the
manufacturer, or to FDA if the manufacturer is not
known; and,
– Submit a summary of all reports during this period
to the FDA.
What is considered a Medical Device?
• Examples of medical devices that are typically
found in the home or facility where we are caring
for a client include: hospital beds, patient
restraints, ventilator, trapeze bars, defibrillators,
wheelchairs, bedside commodes, shower chairs,
walkers, oxygen concentrator, and bandages.
• Generally, if it is used in medical practice and it is
not a drug or biologic, it is a device.
Reporting Requirements
Reporter
What to Report
Report Form
Submit to
When
User Facility
Death
FDA 3500A
FDA & Mfg
Within 10 work
days
User Facility
Serious Injury
FDA 3500A
FDA & Mfg
Within 10 work
days
User Facility
Adverse Events
FDA 3500
Product Problems
Product Errors
FDA & Mfg
Voluntary
User Facility
Annual Reports of FDA 3419
death and serious
injury
FDA & Mfg
January 1
Who Prepares the Reports?
• The supervisor or
reporting professional
will complete the
Unusual Occurrence /
Incident Report Form
and submit to
supervisor within 24
hours of the date
identified.
Additional Information to be
Reported by Care Coordinator
• Lot, batch, or serial number (or other identifier) of the device;
• Name, address, telephone number and social security number (if
available) of the client using the device;
• Location of the device;
• Date service was provided to the client using the device;
• Name, address and telephone number of prescribing physician;
• Name, address, and telephone number of the physician who regularly
follows the client;
• Name, address (if available) and telephone number of manufacturer or
supplier of the device; and,
• The date the device was:
– Returned to the manufacturer; or
– Permanently retired from use or otherwise disposed of permanently, if and
when applicable.
Performance Improvement Program
Performance Improvement Policy
• Purpose of policy – to define our process for identifying areas
needing improvement.
• The Policy –
– Is guided by a Vision statement;
– Has defined quality objectives described in terms of client/service
outcomes;
– Has identified “Key Functions Measured” to be subject to the
program;
– Has identified staff responsibilities for the program;
– Has described and defined how priorities will be determined and how
performance will be measured;
– Includes education; and,
– Provides for multiple inputs into the process.
Topic Areas (Key Functions)
to be Measured
• Rights and Ethics
Violations
• Assessments
• Care, Treatment and
Services Provided
• Education
• Continuum of Care
• Organizational
Performance
• Leadership
• Environmental Safety and
Equipment Management
• Management of HR
• Management of
Information
• Surveillance, prevention,
and control of infection.
Staff Responsibilities
• Administrator is responsible for overall program.
• Designated staff members assist in data collection,
evaluation, and interpretation of data.
• Administrator and designated staff evaluate results
and development/implementation of actions to solve
identified problems.
Forms
Request for Problem Resolution
Performance Improvement Guide
Forms
Performance Improvement Program Worksheet
Client Service Indicators
Forms
Performance Improvement Framework
PDCA
• Plan – Design improvement plan, set goals
• Do – Collect data and analyze
• Check - Determine the value of the results
• Act – What needs to be done and do it
Findings of the performance improvement efforts are
reported to the organization.
Infection Control
Overview
Bloodborne Pathogens
HIV/AIDs
Local policies
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Overview: What is Infection Control and
Why is it important?
• Infections can harm you and your clients, so it is
important that you know how to protect yourself and
your clients from those infections that are avoidable.
• Elderly persons are more susceptible to infections
due to suppressed immune systems (disease,
medications), thin skin, and multiple health
problems.
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Overview: Transmission of Infection
• Direct transmission – when any part of your body comes
in contact with a client’s body (example: your hands
touch a client’s skin).
– Methicillin-resistant Staphylococcus aureus (MRSA),
Vancomycin-resistant Enterococcus (VRE), Influenza
• Indirect transmission- contact with objects that an
infected person has touched (examples: thermometers,
telephones, toilets, bedpans).
– MRSA, VRE, Clostridium difficile (C. Diff), Salmonella,
Shigella, E. Coli
• Use of Standard Precautions (covered previously) is
EXTREMELY IMPORTANT to prevent direct or indirect
transmission.
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Bloodborne Pathogens
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Definition
• Bloodborne pathogens (BBPs) are microorganisms
such as viruses or bacteria that are carried in human
blood and can cause disease in people.
• Include but are not limited to:
– Hepatitis B virus (HBV)
– Hepatitis C virus (HCV)
– Human immunodeficiency virus (HCV)
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Transmission
• BBPs are transmitted through contact with
infected human blood and any body fluid that
is visibly contaminated with blood.
• Can also be transmitted through semen,
vaginal secretions, cerebrospinal fluid,
synovial fluid, pleural fluid, peritoneal fluid.
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Hepatitis B (HBV)
• Most frequently encountered infectious bloodborne
hazard faced on the job.
• Very durable – can survive in dried blood up to 7
days.
• Initial symptoms are much like the flu.
• Jaundice follows as disease progresses. Can take up
to 1 to 9 months before symptoms become
noticeable.
• No cure or specific treatment, but some people
develop antibodies.
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Hepatitis B Vaccine
• Available at no cost to employees
• 3 shot series over 6 month period of time
• Booster shots may be recommended for those who
have already received the vaccine.
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Hepatitis C (HCV)
• Incidence has been declining in US since 1990s.
• Typically mild in early stages and rarely recognized
until it has caused significant liver damage.
• Most common symptom is fatigue, with other
symptoms including mild fever, muscle/joint aches,
nausea, vomiting, diarrhea, loss of appetite,
abdominal pain
• No cure, but some medications can suppress virus
for long periods of time.
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Human Immunodeficiency Virus (HIV)
•
•
•
•
Attacks the body’s immune system
Causes the disease known as AIDS
No known vaccine, no known cure
Symptoms include weakness, fever, sore throat,
nausea, headaches, diarrhea, weight loss, swollen
lymph glands
• Most commonly transmitted through sexual contact,
sharing of hypodermic needles, accidental puncture
from contaminated needles/ sharps, and from
mothers to their babies at or before birth.
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Reduce possibility of sharps exposure
• Use dustpan and brush, tongs, or forceps to clean up
broken items;
• Avoid touching any found needles … or handle with
extreme caution if you must touch it.
• Dispose of contaminated sharps in a biohazardlabeled, puncture-resistant, leak proof container
immediately after use.
• Treat every trash bag as though there could be a
needle in it – don’t carry it against your body.
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HIV/ AIDs
• Video – Required by State
of FL
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Local Infection Control Policies
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Local Infection Control Policies Encompass
…
•
•
•
•
•
•
•
•
Guidelines Regarding Accidental
Exposure
Wound and Skin Precautions Policy
Respiratory Precautions Policy
Enteric Precautions Policy
Disease Reporting Policy
Client Infection Surveillance Policy
Employee Infection Surveillance
Policy
Contaminated Linens and Clothing
Policy
• Decontamination of Contaminate
Surface Policy
• Disinfection of Non-Critical
Instruments Policy
• Disinfection of Semi-Critical Items
Policy
• Critical Equipment Usage Policy
• Bag Technique Policy
• Needle and Sharp Stick Policy
• TB exposure Plan
• Biomedical Waste Plan
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Accidental Exposure
• In accordance with the CDC recommendations
and in compliance with OSHA, Comfort
Keepers shall provide treatment, follow-up
testing, and referral for documented
occupational exposure to communicable
diseases from blood and/ or body fluids.
– All employees given opportunity to be immunized
for HBV
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In the event of an accidental exposure
• Various lab tests may be ordered on employee and
source individual
• Follow-up will be provided by licensed physician
• Confidential medical evaluation/ follow up care will be
offered to employees who experience an exposure to
HIV/HBV
• Documentation will be provided per state and federal
regulations
• Employee must complete an Unusual Occurrence
Report to document exposure
• Medical records will be kept confidential
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Wound and Skin Precautions Policy
• Field staff will follow STANDARD
PRECAUTIONS with emphasis on wound and
skin guidelines to control the spread of
communicable diseases when working with
clients who have wound and/or skin
infections.
• NOTE: Reminder – Comfort Keepers don’t
treat wounds.
79
Respiratory Precautions Policy
• Field staff will follow STANDARD
PRECAUTIONS with emphasis on respiratory
guidelines (contained on next slide) to control
the spread of communicable airborne
diseases.
80
Respiratory Precautions Procedures
• Door to client’s room should remain closed, if possible.
• Wash hands before and after client contact and between client care
procedures.
• Gowns should be worn if soiling by infective material likely.
• Masks should be worn by anyone entering room with the client.
• Protective eyewear should be worn if client is coughing or sneezing.
• Persons and family members of clients who are susceptible to the
disease should be excluded from client’s room unless contact is
necessary.
• Disposable articles contaminated by secretions should be bagged
prior to leaving the room and appropriately disposed of.
• Non-disposable articles, linens, and surfaces contaminated by
secretions should be disinfected according to Decontamination
Guidelines (See: Decontamination of Contaminated Surfaces).
81
Enteric Precautions Policy
• Field staff will follow STANDARD
PRECAUTIONS with emphasis on enteric
guidelines (contained on next slide) to control
the spread of enteric communicable diseases.
• Note: Enteric means “of the intestine.”
82
Enteric Precautions Procedure
•
•
•
•
•
•
•
Incontinent clients should be diapered to prevent soiling of other materials.
Wash hands before and after client contact and in between procedures.
Persons likely to have direct contact with the client’s feces or articles contaminated
with feces will wear gloves.
Gowns will be worn if there is likelihood of clothing being contaminated by
infective material.
Protective eyewear will be worn if splashing of infected material is likely (i.e. loose
stools, colostomy procedures, etc.)
Contaminated, disposable articles will be bagged and disposed of according to
state and local infection control guidelines. Follow facility guidelines, as required.
In the home, please follow instructions of the family.
Contaminated linens and clothing will be handled carefully with gloves and will be
washed separately from other wash. The laundry will be washed in hot (160° F),
soapy water for 25 minutes. Chlorine bleach will be added to wash cycle to
provide extra microbiocidal activity.
83
Disease Reporting Policy
The Policy
• The occurrence of diseases listed
in state regulation shall be
reported by telephone to the
County Public Health Department
within 40 hours of recognition.
List of Diseases to Report
84
Disease Reporting Procedure
• In the event a staff member learns of a confirmed diagnosis
of one of these diseases by a qualified professional, he/she
will ensure the reporting of the condition to the RN, who
will the report it to the appropriate agency.
• The RN will report:
–
–
–
–
–
Name
Age
Sex
Date of Onset
Criteria for Diagnosis
85
Client Infection Surveillance Policy
• To provide an infection control system that
identifies, reports, evaluates, and maintains
records of infection among clients.
86
Client Infection Surveillance Procedure
•
Specific infection conditions will be documented on the Client Infection
Surveillance Form:
–
–
–
–
–
–
–
–
Adult clients with fever above 101°F.
Acute diarrhea (may be accompanied by fever, cramps, and bloody stools).
Skin lesions, eruptions, or dermatitis.
Persistent cough (with or without sputum)
TB
Viral Respiratory infection
Catheter infections
Other symptomology that may indicate a communicable disease.
•
Identified infections will be documented on the Infection Control Log
•
Follow up of clients will take place via Client Care Conference, with the date of
infection resolution recorded in Infection Control Log by Registered Nurse.
87
Client Infection Surveillance Forms
Client Infection
Surveillance Form
Client Infection Control Log
88
Prevention and Control of Infections
Procedure
• The total numbers of infections
per month are recorded on the
Infection Control Summary
Sheets.
• Infections are discussed at least
monthly during Client Care
Conferences
Client Infection Control
Summary Sheets
89
Employee Infection
Surveillance Policy
• To provide an Infection Control System that
identifies, reports, evaluates and maintains
records of infections among Comfort Keepers
employees.
90
Employee Infection
Surveillance Procedure
• Field staff will report any personal symptoms of infectious process
to the appropriate supervisor. Pertinent information will be
documented on the Employee Infection Control Log by
administrative staff.
• Appropriate follow-up will be done/ documented by employee’s
supervisor. Note that this is for tracking purposes only, and not for
medical advice.
• Staff member will not be assigned to provide care until symptoms
have been resolved. In some situations, a note from the
employee’s doctor many be required to certify that the employee is
cleared to return to work.
91
List of Infections to be Documented
List of Infections
• Employee temperatures above
101°F
• Acute diarrhea
• Skin lesions, eruptions, dermatitis
• Upper respiratory infections with
temps above 101°F
• GI disturbances
• Other symptomology that may
indicate a communicable disease
Employee Infection Control Log
92
Contaminated Linens and
Clothing Policy
• Good hygienic measures shall be implemented
when handling and/or cleaning contaminated
laundry.
93
Contaminated Linens and
Clothing Procedure
• Contaminated (visibly soiled) linens will be handled carefully with
gloves and protective clothing, if necessary.
– Wash separately from other household wash, if possible.
– If not able to wash immediately, place in plastic bag to avoid leakage.
• The laundry will be washed in hot (160°F) soapy water for 25
minutes, if possible.
• At low temps, chemical disinfectant-detergents suitable for low
temp wash may be used at recommended dilutions.
• Laundry will be thoroughly dried on a high setting in the dryer, or
dried in the sun.
• Laundry may be washed in a Laundromat if the above
recommendations are followed.
94
Decontamination of a
Contaminated Surface Policy
• All staff shall be knowledgeable in the
decontamination of surfaces so that areas
soiled during client care procedures may be
effectively cleaned. Also, that the client
and/or their primary caregivers may be
instructed in the appropriate method of
surface decontamination.
95
Decontamination of a
Contaminated Surface Procedure
• To decontaminate generally soiled floors, counters and equipment
surfaces, wipe them down with most any disinfectant-detergent
registered by EPA (check labels). Cleaning these surfaces should be
done immediately if spills occur.
• For large spills:
– Wearing gloves, remove visible contamination with absorbent towels and
dispose of them in closed waste bag. Dispose of needles in sharps container.
– Flood the contaminated surface with disinfected that is registered as a
tuberculocidal with EPA, or a 1:10 dilution of bleach.
– Allow disinfectant to stand for 10 mins.
– Wearing gloves, either mop or wipe up spill.
– Wash hands after removing gloves.
96
Disinfection of NonCritical Instruments Policy
• All “non-critical” client care items shall be
disinfected on a regular basis, or as needed when
visibly soiled.
– The CDC defines non-critical items as those that will
not touch mucous membranes, tissue or the blood
system (i.e. blood pressure cuffs, bed pans,
stethoscope, scissors, crutches, etc.). These items
rarely, if ever, transmit disease since intact skin is a
very efficient barrier to bacteria and viruses.
97
Disinfection of NonCritical Instruments Procedure
• Using gloved hands, pre-clean the object using
hot, soapy water.
• Soak object for 10 minutes or thoroughly wipe
down the object with a disinfectant detergent
suitable for low level disinfection (such as ethyl/isopropyl
alcohol, 5.25% household bleach, other germicidal detergent solutions,
as followed per instructions on label)
• Rinse object thoroughly with fresh water.
• Air dry on a clean surface or towel.
• Store in a protective wrapper or in a clean
covered area (drawer, bag, etc.)
98
Disinfection of
“Semi-Critical” Items Policy
• All “semi-critical” client care equipment shall
undergo at least a high level of disinfection
prior to client use.
– The CDC defines “semi-critical” equipment as that
which will come in contact with the mucous
membranes but not enter the tissue or blood
system (i.e. respiratory therapy equipment, urine
bags, thermometers, electric razors)
99
Disinfection of
“Semi-Critical” Items Procedure
• Wash hands and put on gloves.
• Remove item for client care and put in a closed
impervious container or bag.
• Pre-clean semi-critical equipment using hot,
soapy water and “elbow grease.”
• Soak semi-critical items in a disinfectant suitable
for high level disinfection for the time
recommended by the manufacturer (20-30 mins).
• Store in a clean, covered area (drawer or cabinet).
100
Bag Technique Policy
• Comfort Keepers staff will consistently implement the
principles to maximize the efficient use of the client
care supply bag when used in caring for clients.
• Due to the nature of the non-medical care provided by
our staff, the need for a supply bag and bag technique
procedures is greatly reduced. The only bag you would
be bringing in would be your CK bag with your
binder/notes, and possibly gloves. This policy is in
place as a guide for employees of Comfort Keepers who
might come in contact with others who provide services
for our clients.
101
Bag Technique Procedure
The bag may have the following contents:
•
•
•
•
Hand washing equipment – alcohol-based hand rub and skin cleanser, soap, and
paper towels.
Assessment equipment (as appropriate to the level of care being provided) –
thermometers, stethoscopes, etc.
Disposable supplies (as appropriate to the level of care being provided) –sterile
and non-sterile gloves, plastic aprons, dressings, adhesive tape, alcohol swabs,
scissors, bandages, skin cleanser, paper towels, etc.
Paper supplies – printed forms and materials necessary to teach clients/families
and document client care.
Staff must regularly check the expiration date of any disposable supplies kept in the
nursing bag. Expired supplies will be retuned for disposal. The bag will be cleaned as
soon as feasible when it is contaminated or dirty. Soap and water, alcohol, or other
approved cleaning agent will be used.
102
Bag Technique Procedure
•
•
•
•
•
•
•
The bag will be placed on a clean surface in the car and/or in the home.
Prior to administering care, alcohol-based hand rubs or soap and paper towels
will be removed, and hands will be washed. These supplies will be left at the
sink for hand washing at the end of the visit.
After hand washing, supplies and/or equipment needed for the visit will be
removed from the bag.
The bag will contain a designated clean and dirty area. The clean area carries
unused or clean supplies/ equipment, and the dirty area is designated for
contaminated materials (i.e., lab specimens which require transport, used
equipment)
When visit is complete, reusable equipment will be cleaned using alcohol,
soap and water, or other appropriate solution, hands will be washed, and
equipment and supplies will be returned to the bag.
Hands will be washed prior to returning clean equipment to bag.
If paper towels or newspapers have been used as a protective barrier for bag
placement in the client’s home, they will be discarded.
103
Needle and Sharp
Stick Policy
• As a non-medical provider of care, it is the
policy of Comfort Keepers to never engage in
the use of syringes for the purposes of
providing care. As such, this policy is for the
occasion where due to the condition of the
client or those sharing domicile with the
client, an employee comes in contact with a
syringe or other sharp instrument.
104
Needle and Sharp
Stick Procedure
In the event of a caregiver being stuck by a needle or
other sharp medical instrument:
• Clean the area with soap and water, or flush mucous
membranes with water or saline.
• Report needle stick immediately.
• Determine if the needle was clean or dirty (a clean
needle is one that has not come in contact with client
or attachments (piggy-back needle, tubing, IM
injection, lancet).
• Complete Unusual Occurrence Report within 24 hours
of incident.
105
Needle and Sharp
Stick Procedure
• Treatment for clean needle stick:
– Tetanus booster if you haven’t had one in 10 years
– Cleanse wound with antiseptic
– Apply dressing if needed.
• Treatment for dirty needle stick:
– Client should be tested for HIV and HBV
– Employee will be tested for HIV and Hepatitis B as soon as possible to obtain
“baseline” values
– Begin counseling and drug treatment as prescribed
– For normal baseline HIV testing, retest per guidelines for HIV exposure.
– Follow up testing for Hepatitis B should occur 30-60 days after the needle
stick. The employee will be observed for symptoms for one year.
106
Mycobacterium Tuberculosis (TB)
Exposure Control Plan
• Comfort Keepers will follow the requirements
of the County Health Department in dealing
with the testing and incidence of TB. The Plan
will be kept in compliance with the most
current CDC recommendations via the
application at the County Health Department
level.
107
Mycobacterium Tuberculosis (TB)
Exposure Control Procedure
• Administrator is responsible for agency-wide management of the
plan.
• The written plan is a part of Comfort Keeper’s Infection Control
Manual and will be available for review by all staff.
• Plan will be revised as needed and formally reviewed / approved by
Governing Body or their designee annually and whenever changes
take place.
• Infection Control Committee will also participate in risk
assessments, problem evaluations and other areas of program
administration.
108
TB Exposure Control Plan –
Administrative Controls
The Comfort Keeper TB Exposure Control plan has the following
administrative controls:
• Written policies and protocols to ensure rapid detection, isolation,
diagnostic evaluation, effective work practices and treatment of
persons likely to have TB.
• A comprehensive, mandatory skin testing program.
• Personal respiratory protection (masks).
• Supervisory oversight visits to the residence that will include
assessment of environment (in the event of the occurrence of TB)
and employee work practices in an effort to minimize exposure risk.
109
TB Exposure Control Plan –
Risk Assessment
• An initial risk assessment will be conducted by
administrator to determine the risk of TB
transmission in specific areas and groups of
employees.
• Based on 3 factors:
1. # of TB patients in area per county health dept
2. Drug susceptibility patterns of TB patients
3. Health care worker PPD skin test data
110
•
TB Exposure Control Plan –
Occupational Exposure Determination
Guideline of positions which pose a risk of occupational exposure to TB:
–
–
–
–
–
•
Nurse (supervisor in non-medical providers)
Home Health Aides
CNAs
Supervisors
Administrator (nurse)
Some exposure
–
–
Clerical
Administrator (non-nurse)
•
Comfort Keepers may determine that some job classifications have no risk of occupational
exposure.
•
In the event that individuals with TB become clients of Comfort Keepers, or a current client of
Comfort Keepers becomes infected with TB, a review of medical records of a sample of
clients admitted will be conducted to evaluate infection control parameters and to determine
if any changes are necessary.
111
Early Detection of Clients with TB
• TB may be suspected in a client if:
–
–
–
–
–
–
Persistent cough of more than 2 week’s duration
Bloody sputum
Night sweats
Weight loss
Anorexia
Fever
• Suspicion should be higher in following groups:
–
–
–
–
Asian immigrants
Persons with previous history of TB
Persons who are HIV positive
Immunosuppressed clients with pulmonary signs or symptoms
112
Management of exposure
to employees from clients with TB
• Anti-tuberculosis drugs shall be administered to clients with
active TB (or who considered highly likely to have active TB)
by a medical HHA, not a Comfort Keeper.
• Initiation of TB isolation shall follow the diagnosis
• All persons entering a home where there is a risk of
contracting TB will wear appropriate respiratory protection.
– Will be available in appropriate styles and sizes at the Comfort
Keepers’ office
113
Employee Screening for TB
•
Upon hire, all employees will undergo a standard PPD test with interpretation by a
qualified individual other than oneself.
•
Employees who can produce a report of negative PPD test results within the
previous twelve (12) months do not require an additional PPD test.
•
Employees with a history of positive PPD skin testing are required to have a
baseline chest x-ray at hire or provide written documentation of a normal chest xray within the previous 12 months.
– Chest x-rays will be repeated with the development of any signs or symptoms
or when additional x-rays are required by the physician.
•
Annually, employees will complete a symptoms health questionnaire, and if
symptoms are present, PPD testing will be completed immediately.
114
TB Symptoms Health
Questionnaire
115
TB Education
•
Upon hire and annually thereafter, employees will participate in training on the
topic of Tuberculosis.
•
In the event of a client or caregiver diagnosis of TB:
– The client and caregiver will be provided with appropriate educational
materials according to their level of understanding.
– The client and caregiver shall be instructed on the need to maintain the home
in a clean fashion, and the importance of ventilation shall be stressed.
– The client and caregiver will be provided appropriate respiratory protection
and will be instructed on its application.
– The client and caregiver will be instructed on the need to continue the antituberculosis drug therapy as outlined by the physician and/or the Public
Health Unit.
– The client and caregiver will be instructed on the need for good nutrition.
– The client and caregiver education shall be documented in the client medical
record and maintained as confidential.
116
TB Education Documentation
Mycobacterium Exposure Plan
TB Training Program
117
Employee Counseling,
Screening, Evaluation
• Any employee exhibiting signs and symptoms compatible with TB
shall be promptly referred to the County TB Control Unit and/or
Comfort Keepers Medical Director to be evaluated for TB.
– The employee shall not return to work until TB is excluded or the
employee is on therapy and documented as non-infectious.
• Employees should know if they have a condition or treatment that
may suppress their immunity, as they have a greater risk for rapid
progression in the event of a TB exposure.
– Options for changes in job setting shall be discussed with employees
who are severely immuno-compromised.
– All medical information, including employee immune status, will be
treated confidentially.
118
Biomedical Waste
• Non-skilled agencies are exempt from the
requirement for Biomedical Waste
Regulations.
119
What is Considered Abuse?
• Verbal abuse is defined as any oral, written, or gestured
communication that is disparaging or derogatory, meaning
words or gestures that could offend clients or hurt their
feelings.
• Sexual abuse includes sexual harassment or inappropriate
sexual contact with a client.
• Physical abuse is willful physical contact with a client that
harms or is likely to harm a client. The physical contact can
occur either directly with the client or through the use of
some object or substance.
120
What is Considered Abuse?
• Mental abuse is also known as psychological abuse. It can cause a
high level of fear, anxiety, agitation, withdrawal, or other emotional
distress that is not otherwise explainable.
• Corporal punishment is physical punishment of clients for
something they have or haven’t done or said. Some examples of
corporal punishment are: Slapping a client’s hands, Spanking a
client for not taking medicine, Restraining a client because he or
she isn’t doing what a Comfort Keeper wants.
• Involuntary seclusion or isolation occurs when clients are
separated from other people or confined to their rooms against
their will, when it is not being done for a temporary, therapeutic
intervention consistent with a client’s plan of care.
121
What is Considered Abuse?
•
Abandonment is when clients are left alone in an unfamiliar location where they
may become disoriented and lost. Because they are in need of physical care, the
abandoned elderly become even more helpless and in need of protection.
•
Physical mistreatment occurs when medication, restraints, or isolation techniques
are used for punishment instead of therapy.
•
Neglect can be defined as failure of an office or Comfort Keeper to provide
treatment or services that are necessary to maintain the health, safety, or comfort
of a client.
•
Misappropriation of a client's property means taking a client’s property without
permission or deliberately misplacing it.
122
What to do if You Suspect Abuse
• Report it to your immediate supervisor.
• Try to remember information that will be helpful in
investigating the alleged abuse, such as:
– What did you see or hear that made you suspicious? Who was
nearby when it occurred? What time of day did you see or hear
it?
• If you are aware that someone is abusing a client, you, too,
may be prosecuted for not reporting it and allowing it to
continue.
123
J. Personal Care Techniques
•
•
•
•
Bathing
Skin Care
Oral Hygiene
Toileting
124
J. Bed Bath
•
•
•
•
•
•
Assemble Equipment
Wash hands
Check that room temp is appropriate
Maintain client privacy
Communicate your intentions to client
Remove top bedding to top of legs and cover
with towel or bath blanket
• Verbalize importance of making client feel
comfortable and not embarrassed
125
J. Bed Bath
• Discuss desired water temp, test water temp, have client test water
temp
• Assist client with getting undressed
• Ask client to participate in washing
• Uncover, wash, rinse, dry one part at a time, beginning at head and
working down, washing front of body, then back.
– Put gloves on to clean peri and buttocks
• Remove gloves and apply lotion/ rub back at client’s request
• Assist client with dressing in clean, dry clothing and reposition
• Clean bathing area and remove wet/dirty linen/ wash hands
126
J. Sponge Bath
• Note that a Sponge Bath follows the same
basic steps as a bed bath, however a Sponge
Bath may be performed in the bathroom, or
someplace other than in the bed.
• Typically, the person being bathed is more
participative in a sponge bath than a bed bath,
and may only need help washing those areas
that he/ she is unable to reach.
127
J. Skin Care
•
•
•
•
•
•
•
•
•
•
•
•
•
Inspect skin for dryness, redness, abrasions, bruising and report changes to
supervisor
Gently apply lotion to skin and reddened areas, such as elbows, knees, and heels
as directed by client
Place pillows/cushions to protect bony prominences as directed by client
Assemble equipment for back rub/explain procedure to client
Wash hands and position client on side
Expose back area and lubricate hands with lotion
Rub back gently with lotion, as directed by client
Add lubrication as needed
Apply slight pressure with palms of both hands
Begin at lower back and work upward toward shoulders
Use gentle, long, rhythmic strokes, up and down back
Massage gently around bony areas and observe skin, continuing procedure for 5 to
10 minutes at client’s request and preference
Remove excess lotion, assist client in dressing, and wash hands following
procedure.
128
J. Oral Hygiene
• Wash hands
• Collect all necessary equipment: Toothbrush,
toothpaste, mouth wash, water glass, basin (if
needed), and towel
• Place equipment within client’s reach on table
• Provide chair for client (if needed)
• Encourage client to brush teeth/ gums and rinse
mouth, and assist if necessary, using gloves.
• Assist client to wipe face, remove and dispose of
gloves, and wash hands.
129
J. Oral Hygiene – Denture care
• Wash hands
• Collect all necessary equipment: Toothbrush, toothpaste, mouth
wash, water glass, basin (if needed), denture container and towel
• Place equipment within client’s reach on table
• Provide chair for client (if needed)
• Using gloves, remove or help client remove dentures.
• Brush, or assist client with brushing, dentures with cool water.
• Soak dentures in liquid overnight, and clean oral cavity with swab or
gentle brushing.
• Assist client to wipe face, remove and dispose of gloves, and wash
hands.
130
J. Toileting – Assistance with Bedpan
• Wash hands and put on gloves.
• Discuss with client what you are going to do and always allow client
response.
• Have client bend knees and raise hips and position bedpan under
the buttocks.
• Raise the head of the bed, if possible.
• If necessary, roll client to side to position bedpan and roll client
back.
• Maintain client’s privacy, cover client.
• Have client bend knees, raise hips to remove pan.
• Cleanse area if client unable to do so for self.
• Empty and clean bedpan.
• Remove gloves, put in trash and wash hands.
131
J. Toileting – Assistance with Urinal
• Wash hands and put on gloves.
• Discuss with client what you are going to do and always allow
client response.
• Assist client as necessary in placing penis in urinal.
• Hold urinal for client, if necessary.
• Maintain client’s privacy.
• Remove urinal and wash penis, if needed and if client is
unable to do so for self.
• Empty and clean urinal right after each use.
• Remove gloves, put in trash and wash hands.
132
J. Toileting – Assistance with Commode/ Toilet
• Wash hands and put on gloves.
• Discuss with client what you are going to do and always allow
client response.
• Assist client to commode or toilet and position correctly.
• Maintain client’s privacy.
• Cleanse client if unable to do so for self.
• Transfer off commode or toilet, as necessary.
• Empty and clean commode/toilet right after use.
• Remove gloves, put in trash and wash hands.
133
J. Competency Evaluation Stations
• Bathing –
– Demonstrate Bed Bath
• Skin Care
– Test to describe effective skin care
• Oral Hygiene- toothbrush, toothpaste, denture cup,
dentures, basin, gloves
– Demonstrate cleaning of dentures or helping client with
brushing teeth
• Toileting – standard bedpan, fracture bedpan, bedside
commode, urinal, wheelchair, gloves
– Demonstrate transferring from wheelchair to commode and/or
placing and removing bedpan for bedbound client