State Nurses Meeting

Chamberlain, SD

October 18, 2017

  1. Introductions and agenda overview
  2. Meet new DD nurse Libby Sherer- WELCOME! Libby’s email address is:
  1. Shared Living-Charlene with RHD
  2. A new form of supported living arrangement in which an individual shares a home and life experiences with a person with an intellectual disability (See attached document).
  3. Companion Care
  4. An individual moves into the persons home to care for them
  5. Host Home
  6. The person moves into a community members home and lives with them
  7. Required to provide transportation, housing, medication administration, financial assistance, community involvement, care plan, and assist with ADL’s. Same requirements as the Choices waiver for medical
  8. Must be 21 years old or older, have a reliable form of transportation, active driver’s license, and receive all DSP training and med certification to be a provider
  9. Training is provided initially and annually. Provider receives $38,000 annually, $500 monthly for room/board, and $2,000 annually for respite care, additional costs reimbursed if the Host Home Provider chooses to provide day services as well.
  10. 9-3 M-F is “off” hours where person can attend day services in SF
  11. 24/7 telephone support access to director, supervisors, and a nurse
  12. Goal is to transition 12 individuals from SDDC/HSC into a host home within one year.
  13. Program is for adults 21yo and older and from an institution setting such as SDDC or HSC.
  14. Individual served will move into a transition home for a period of 30-90 until they are matched with a companion or host home.
  15. ?’s asked
  16. What type of persons can be served?
  17. Ambulatory, currently not physically disabled as transition home is not handicap accessible or set up for lifts.
  18. Is there a restriction on money earned if person served is employed?
  19. Same restrictions with SS and benefits as everyone else
  20. Can family members receive money and be a host home?
  21. Not currently, but this is up for discussion
  1. Contingency plans for agencies if an RN is absent for a long period of time
  2. Dakotabilities- large agency with multiple nurses on staff- not a concern
  3. LIVE-contracting with an RN for oversight
  4. NHTC – contacts urgent care or ER if RN out for longer period of time
  5. **Requests an email of RN job description- please email yours to Cassie to send out.**
  6. Remote monitoring
  7. Division Requirements:
  8. RN must be on staff, but no stipulations on hours worked or physically at agency
  9. RN must oversee med training, med errors, and other nurse oversight
  1. Misc. Questions
  2. How do agencies complete med class with previously certified staff using core curriculum or BON certified?
  3. Mixed review- most agencies will have person run through the full med course regardless
  4. Review agency specific items, test out and complete supervised med passes
  5. What do agencies do with a staff that leaves and comes back within a year of certification?
  6. Cassie will bring this back to DDD staff to have internal discussion; Cassie will update nurses via email when information is received.
  1. Self-Administration Assessments **handouts provided (please see attached)
  2. Discussion on Dr.’s order to self-administer
  3. Team decision- if provider states on annual physical form that person cannot self-administer, a self-administration assessment should still be completed and a team meeting should be completed to ensure this is accurate
  4. Allow self-administration of “low level” meds such as MV, etc
  5. Recommend removing question for physician to fill out on physical form if appropriate to self-administer; physicians can make recommendations on medication administration, however, it is still CSP responsibility to complete assessment and review as a team to deem appropriateness
  6. ? on how to monitor topical medications- Shirley
  7. Place ointment into a small med cup and have cup returned empty after use
  8. Monitor refill date of cream with weekly checks
  9. ? on controlled medications if self-administer- Shirley
  10. No rules on home monitoring if living independently
  11. Does not require daily documentation
  12. Agencies vary on how often controlled meds are counted from each administration pass to each shift, daily, etc
  13. ? On bulk bottles of pills or liquid- Lauri and Shirley
  14. Suggest to pre-fill syringes and only give out 1-2 syringes to have on hand
  15. Document count by mls.
  16. Ok to have staff remove dose from bulk container
  17. CPR Training increased fees for card through American Heart Association ($20)- Angela
  18. ARSD rule does not specifically state that a card is required, only training provided by each CSP.
  19. Some are using online or E-cards ($8 per card)
  20. Some do not provide a card, but staff can purchase on their own if they’d like one
  21. ? on CPR required before passing meds
  22. CPR is not required prior to med training, however, is recommended to provide CPR training before directly working with participants
  23. Each agency should have a policy on this and follow that policy
  24. ? on using Relias Learning for Med Course
  25. Mixed reviews due to test scores dropping without class time
  26. Some are using this and providing hands on class time- improved scores noticed
  27. Telemedicine Use
  28. SDDC utilizes with local hospital or Aberdeen
  29. Julie/Lifequest utilizes it at their agency
  30. Angela/Chamberlain uses a free services of VSEE- however both providers must have this downloaded.
  31. Free and secure
  32. Must have RN on agency side to complete vitals, billing, etc
  1. Advance Directives
  2. Almost all agencies are full code, until leave facility
  3. All honor Hospice DNR’s with staff training
  4. A few honor DNR’s with staff training
  5. Comfort One- bracelet, has ID # to use through EMS system
  1. Core Curriculum
  2. All agencies use basic core program and add agency specifics
  3. **SEND OUT Core curriculum again**
  1. Med Destruction
  2. DD reviews on site at policy implementation
  3. Reviews injures, med errors, destruction
  4. Keep minimally 2 years per Cassie
  5. MARS- Keep for 6 years
  6. Medical records- on file for 6 years after last claim date
  7. ? on ARSD rule as states must be completed ‘ON SITE’- agencies requesting this be reviewed and removed.
  8. Cassie will discuss internally with DDD staff to see if this can be changed or receive clarification as to why this is required.
  1. Technology Use
  2. Winner- uses remote monitoring, electronic med minders, sensors on bed, stove, and doors, etc- staff are called by monitoring company if concerns
  3. Syngistics Company- electronic med minders
  4. MedReady
  5. Aberdeen- Skype to monitor med passes
  6. ? on video use being restrictive- Per Division/Cassie it is not a restriction because we are not taking anything away, but should be reviewed through a committee and have signed consent forms from participants.
  1. Recommendation/request from Angela:
  2. Centrally located area to keep all discussions and Division responses/stance on issues or questions discussed.
  3. Area for questions and DD answers
  4. Cassie will follow up with other DD staff to brainstorm ideas of where to centrally keep nurse’s meeting notes and other spreadsheets for questions
  1. ? on how often agencies are checking quality controls on glucometers
  2. Machine specific, newer models do not require
  3. Some control test on each new box of strips opened
  4. Only if readings seem “off” due to limited # of strips/cost
  5. Glucometers can be replaced every 2 years
  6. Battery concerns- Contour is rechargeable with USB cord
  7. Others use OTC OneTouch Ultra mini @ $20 as a back up
  1. New standard from Sanford for a HIV/Hep screen
  2. Born between 1945-1965
  3. Charging/billing for this test- watch bills closely
  1. Colonoscopy vs. Cologuard
  2. Cologuard- sensitive DNA test on fecal sample, if positive then colonoscopy recommended
  3. Dr. /family refusals for preventative tests- must be clearly documented in file for DD to review
  1. TB Screening
  2. No requirement from DD on TB testing- agency specific
  3. Recommendations for a TB risk assessment
  4. ARSD does not require TB testing – each agency should have a policy in place to address this and follow that policy. See previous nurse’s meeting minutes for TB contact Kristin Rounds for further questions.
  1. ? on mandatory staff flu vaccinations
  2. Redfield- YES
  3. All other agencies- No
  1. DD Updates
  2. Handout given with staff assignments
  3. Libby- new DD nurse

**Requests for copies**

  • SDDC Admissions/Discharge checklist
  • Core Curriculum
  • Agencies RN job descriptions
  • ARSD Rule checks

Next Meeting to be announced (Spring 2018)