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Lifewayscmh.orgLifeWays Operating Procedures
5-05.07 ON-CALL NURSING DUTIES
Telephone Calls: The on call nurse shall handle phone calls from consumers who are calling pertaining to psychiatric or medication issues. The nurse shall inform the primary physician, therapist or case Crisis Calls: If the nurse receives a call from a consumer in crisis, the call should be referred to consumer's Case Manager/Therapist or On Call Case Manager/Therapist, or Community Connections Crisis Worker, unless it is a medical issue. Al telephone contacts must be documented on Telephone Cal Form LW/#1214. Face To Face Contacts: The on cal nurse sees consumers who are brought to the nurses office from physician’s, therapist, or case managers, or who walk in to clinic and ask to be seen by a nurse. These may be consumers who have medication issues, or are in danger of decompensating. The nurse will assess and seek appropriate consultation. All face-to-face contacts must have a Nursing Progress Note written using Form LW/#1033. On Cal should not be routinely used because a consumer has not kept routine appointments. Injection Clinic: On Wednesdays and Thursdays an Injection Clinic is offered for those consumers who are on Haldol Deconate, Prolixin Deconate or Risperdal Consta. There are no set appointment times. Consumers can come between the hours of 8:00 a.m. and 5:00 p.m. The on call nurse is responsible for helping to maintain Haldol, Prolixin or Risperdal Consta Injection Log. Each week a new list is made; a copy of the list goes to the Receptionists and the File Room where the charts are pulled. Make sure there are a Current Treatment Consent and Medication Consent before Al injections shal be documented on Injection Clinic Form LW/#1250 and placed in consumer’s chart under the Treatment Section. The Injection Medication Record/ Inventory Form LW/#1002-1 shall be fil ed out. This is found under the Medication Section of the chart. Haldol and Prolixin must be reordered by physician every three months or sooner if prescription states. Missed Injections: Designated Physician's Unit staff shall call the consumer(s) to remind of missed injection and if unable to reach, inform the consumer’s case manager/therapist of consumer missing injection. If the consumer does not have a case manager/therapist then the consumer shal be sent a letter to remind them of missed injection. If consumer misses his/her next injection, the physician LifeWays Operating Procedures
should be notified. If a consumer presents for injection after missing several injection dates, the nurse must check with the physician before giving an injection.
Destroyed Medication: On occasion, the on cal nurse may be asked to dispose of a consumer's
medication. Form LW/#611 must be fil ed out and placed in the consumer's chart under Medication Section. The medications are to be counted by two nurses. Both nurses shal witness the disposal of the medication before signing the form. The medications are to be flushed down the sewer system.
Emergency Medications: On occasion, a consumer will need emergency medication. Emergency
medications are in a locked cabinet in the Injection Room and must be signed out on the Emergency Drug Inventory Log LW1002-2: Emergency Drugs are inventoried and expiration dates checked monthly. All Emergency Medications shall be charted on Nursing Progress Note Form LW/#1033A and Placed in the Treatment Section of Chart and the Medication Record/Inventory Form LW/#1002-1 is to be made out and placed under Medication Section of the chart. The prescription shall be noted with time given, and signed by the clinician giving the injection. Storing medication: All medication shall be stored in a locked cabinet, and the door to that room locked when not occupied. Al medication that is being stored for the consumer must be labeled with that persons name, directions, dosage, and expiration date. Injectible Ativan is to be stored in a locked refrigerator. Medication samples from drug representatives for our indigent population are delivered directly to Browns Option Care. Medications that arrive by mail from patient assistance programs shall be sent to Browns Option care for dispensing. A prescription must be on file, and a copy sent to Browns Making Appointments: On occasion, the physician wil ask the nurse to set up appointments with other providers or physicians in the community. The nurse shall coordinate with other Physician's Unit staff to assure appropriate referral and documentation of appointments has been completed. Drug Reps: The nurse or the Physician’s Unit Office Manager will assist the Drug Company Representatives in being able to see the physician. They will leave, or mail, sample medications after
Ordering Medications: A nurse wil be assigned the task of inventorying and ordering medications on at
least a monthly basis. A second nurse wil be designated as a back up in the event that the assigned nurse in not available. Requisitions will be filled out and forwarded to the Physician Services/Access Director for signature. Signed requisitions will be forwarded to Brown’s Advanced Care Pharmacy. Laboratory Tests: Lab reports are received via printer, fax and mail. All labs are reviewed by the nurse and routed to appropriate physician daily. The physician will return labs that they want followed up on with a note as to what they want done, to the nurse. These labs should have documentation noted on the lab slip as to what was done in fol ow up with the date and by whom, before they are sent to file room. All other routine labs shall be referred to filing, following physician review. LifeWays Operating Procedures
No labs should be filed without a physician’s signature. Code M: If a code M is called, the on-call nurse shall respond. Take BP, Stethoscope, Oxygen, Dressing Kit and Nurses bag to site. All physicians are to respond also. Code M will not be called for medical emergencies occurring within the Physician's Unit area unless there is not a doctor on the unit. Issues not resolved by end of shift: If an issue needs to be resolved before leaving, contact the Nurse or Physician Unit Support Staff. It may be necessary, in rare circumstances to ask Community Connections for assistance. Issues that can be addressed the fol owing day should be placed on the shelf in the File Billing: A Telephone Cal Documentation Form LW/#1214 must be made out for each telephone cal A Service Activity Form #1033A must be made out for each face-to-face interaction.
Fro Can Bladder Anticholinergics Be Used Long Term? Question What are the concerns related to using long-acting or extended-release anticholinergic agents over long time periods? Are other medications available that would better ameliorate urinary incontinence? Response from Karen Shapiro, PharmD, BCPS Clinical Pharmacist, Arcadian Health Plan, San Dimas, California Bladder anticho