Respiratory and Cardiac Arrest: If a staff member witnesses a patient has a cardiac event, they will initiate a call to 911. If the patient is unresponsive without a pulse, the staff member will initiate CPR. Journey Nursing Services will continue CPR until relieved by 911 or the situation becomes unsafe.

Chocking: If a staff member witnesses a patient choking, the staff member will ask them if they can assess the airway. If the patient is unable to speak, they will attempt abdominal thrusts. They will initiate a call to 911. If the object is visible, they can try to remove it. They are never to do a blind finger sweep. If the patient becomes unresponsive, the staff member will lay the patient on the floor and will attempt rounds of rescue breaths and abdominal thrusts. If the member is no longer able to locate a carotid pulse, the staff member will initiate CPR.

Seizure: If a staff member witnesses a patient having a seizure, they will protect the patient from hitting their head while lowering them to the ground and initiating a call to 911. If the patient has a history of seizures and is prescribed rescue medication, a nurse may administer those or if a caregiver is delegated. If the patient is unresponsive without a pulse, the staff member will initiate CPR.

Bruises and cuts: Basic first aid will be provided if a cut or bruise is observed. The nurse will attempt to stop the bleeding, clean the wound, apply ice, and cover the wound. RN will assess the situation for further medical intervention if cuts are self-inflicted. The nurse will activate a response to self-harm and suicidal ideation. If the nurse is unable to stop the bleeding or the event was caused by self-harm, they will initiate a call to 911.

Opiate Overdose: If the nurse suspects opiate overdose, they will turn the patient to their side into the recovery position as a precaution in case vomiting occurs and try to keep the patient awake; they will initiate a call to 911 if the patient has a prescription and orders for Narcan medication may be administered by a nurse or delegated caregiver. If the patient is unresponsive without a pulse, the staff member will initiate CPR.

Anaphylaxis allergic reaction: If a patient with a known anaphylactic reaction is triggered by an allergen initiate emergency response immediately. If a patient has a history of anaphylaxis and is exhibiting signs of an anaphylactic response, treat it as such. Signs include wheezing, labored or absent breathing, weak and rapid pulse, pale in color or cyanotic, skin cool, moist, and clammy.  If the patient has a history of anaphylactic reactions and is prescribed rescue medication, a nurse may administer those or a caregiver is delegated. If the patient is unresponsive without a pulse, the staff member will initiate CPR.

Psychiatric mental health emergency: Staff will ensure the patient is free of distractions and items that may be used for self-harm. A staff member will remain with the patient. The patient will be transported to the hospital via 911. If a patient is self-harming or having suicidal ideation, they are required to be transported to the hospital via 911. They should not be transported by private vehicle because this would be high-risk.

Preparedness occurs through training and anticipating the response to events during and after an emergency or disaster. Journey Nursing Services employees will understand their roles and responsibilities so that when, not if these events occur, they will be prepared with the knowledge and training to respond accordingly.

NO SHIFT RELIEF

Unfortunately, this is the most common urgent staffing situation that we encounter and can be alleviated with improved commitment and following the call-off policy. If a staff member is on shift and a relief fails to arrive, the staff member must ensure that the patient's safety needs are met based on their plan of care. There may be some clients who can stay home alone; however, for other clients requiring 24-hour care, we'll need relief to arrive before they can depart. The steps will be to contact the office immediately if your relief has not arrived, we will Activate the patients backup care plan and work on getting the staff member relieved as quickly as possible.

Back-up Care Plan:

All Clients will have a standard back up care plan listed in their care plan. This may be altered to included additional patient specifics. 

Back Up Care Plan: Patient has a care team that consists of multiple caregivers. He will also have additional caregivers and the Clinical Care Managers Oriented and delegated for his care. In the event of a call out Journey Nursing Services will make all attempts to fill his shift. (1) Contact all oriented staff (2) Contact other agency that provides care to request assistance. (3) Journey Nursing Services will Request a qualified friend or family member to provide care (4) On-Call Caregiver will cover shift (5) Patient would be transported to a higher level of care to have needs met.

WEATHER CONDITIONS

Weather emergencies may give us some time to implement precautionary care before they occur. The administrative team subscribes to the state weather alert system at www.isaws.org, and all staff members are encouraged to do so. 

When there is a notification of a significant weather alert, the administration sends a notification to Journey Nursing Services staff. Weather emergencies may include, but are not limited to, floods, snowstorms, windstorms, power outages, tornados, or hurricanes. The most common in the Seattle area are windstorms, power outages, and snowstorms. The number one priority of Journey Nursing Services is ALWAYS the protection and preservation of the lives of both its patients and staff members. In a weather emergency, this may mean keeping your patient, self, and environment warm and with essential requirements for life, such as food. It is important to know how to activate emergency protocols in each home that a care provider works in.

Definitions 

• Advance Directive: Living wills and other advance directives are empowering, written, legal instructions regarding your preferences for medical care if you are unable to make decisions for yourself. They give patients the control and confidence that their wishes will be respected.
• Advance care Planning refers to a whole process, including reflection on what's important to a patient in terms of quality of life, learning about options, such as palliative and hospice care, honest discussions with others, and creating an advance care directive.
• Cardiopulmonary resuscitation (CPR): The process of attempting to restart the heart when it has stopped beating includes supportive breathing, compressions, and possibly electric shock.
• DNR: Includes any number of interventions that may be used to maintain patient comfort and provide pain management, if that patient life expectancy is under 6 months through end-of-life care.
• POLST form: Physician orders for Life-Sustaining Treatment. This form is used in a home-based setting to indicate a patient's preference for life-saving measures.
• Medical DPOA: Durable power of authority. This person may make medical decisions on behalf of the patient if the patient is unable to make them themselves.

EXPECTED DEATH PROCEDURE

1. If the patient is on hospice services, the hospice provider will be notified at the time of death and will handle the coordination of services after the death. 
2. If the patient is on palliative care services, if pre-arranged with the provider and family, Journey Nursing Services may coordinate services at the time of death. 
3. Even in an expected death, occasionally emergency medical services are called. If this happens- Journey Nursing Services staff will meet emergency services at the door and present them with the signed POLST form. 
4. In the home, the nurse and the hospice nurse work together to determine who is most comfortable calling the family. While hospice provides this service, the nurse's familiarity with the family can also make them the best person to make that call. 
5. The nurse will stay in the home until the funeral home arrives to transport the body unless the family arrives or is present and determines the nurse is no longer needed. 
6. If the patient is in hospice, the nurse may be asked to dispose of medications in the home, which must be documented in the chart. 
7. The patient's care plan will be closed; document if goals were met. 
8. A comprehensive final progress note will be completed, detailing the time of death, interventions at the time of death, and who the patient's death was reported to, ensuring a thorough record of the patient's journey.

UNEXPECTED DEATH PROCEDURE

1. Journey Nursing Services staff will call emergency services via 911 if an unexpected death occurs. 
2. If the patient does not have a POLST form, CPR must be initiated and will continue until emergency services take over. 
3. If the patient has an active and signed POLST, the nurse will meet emergency services at the door and present them with the signed POLST form.
4. The patient will either be transported to the hospital, or the medical examiner will be called; emergency services will determine this.
5. If the medical examiner is called, the nurse will stay in the home until the funeral home arrives to transport the body unless the family arrives or is present and determines the nurse is no longer needed. 
6. If the patient is in hospice, the nurse may be asked to dispose of medications in the home. It is crucial that this action is documented in the chart, as it is a significant part of the patient's care. 
7. The patient's care plan will be closed; document if goals were met. 
8. A comprehensive final progress note will be completed, detailing the time of death, interventions at the time of death, and who the patient's death was reported to, ensuring a thorough record of the patient's journey.