DONs KNOW BEFORE YOU GO

• NEVER tell a patient you are new to Helms, have never given a medication before, or that you have never used a certain supply/pump.

  • Rationale:  To patients, their medications and supplies are all they know. They are not aware that there are hundreds of medications out there or that there are many different brands of supplies (i.e. IV catheters, dressing kits, and pumps). As soon as a patient hears you have never given a medication/used a supply, it can cause anxiety for the patient. We do our very best to prepare you with the knowledge you need going into the visit so that you go in confident, however homecare can throw you curve balls at times. If you do run into an issue, you can kindly tell the patient that you “need to reach out to your Supervisor for clarification”.  Send us a message through WhatsApp with your question or request someone clinical to call you if it is a clinical issue.​

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• ​DO NOT call the Pharmacy or MD unless Helms staff has asked you to. The office (Care Coordinators and Management) are the liaison between you and the Pharmacy.  Any issues you encounter while in the home (i.e. patient with concerning symptoms, missing supplies, malfunctioning equipment, etc.) should be routed through Helms first.

  • Rationale:  Our management team will be able to help you through 90% of the issues you encounter. We have many nurses completing numerous visits on any given day and as a result, we need to limit the number of phone calls to the Pharmacy or MD as we don’t want to bother them unnecessarily with things that we are capable of handling.​

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• NEVER mix meds (spike a vial/transfer med into a bag, dilute, or reconstitute) until you have established access. If the patient has a port or PICC, make sure you are getting good blood return and the access device is flushing well before touching the meds.

  • Rationale:  The medications we give are extremely expensive!  Once the vials are spiked, the meds leave the vial, or the med is mixed, it must be used within a certain period of time or it has to be wasted. With some meds this can be as little as 3 hours. It is very difficult to explain to the Pharmacy that a RN mixed meds before she/he was sure access could be obtained.​
     

• ​ALWAYS make sure you have everything you need to complete the visit from start to finish before you do anything. Please Do Not access the patient, Do Not spike/mix meds, Do Not pre-medicate the patient until you are sure you have everything you need.

  • Rationale:   We do not want to put the patient through any unnecessary trauma only to find that we do not have what we need to complete the infusion. For example, you stick the patient for an IV and then realize you do not have the required pump tubing. Or you have mixed/spiked meds and realize you don’t have any IV catheters or Huber needles to access the patient.  Another example, the patient has already premedicated and then you realize you are missing something.

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• VITALS:  You must take a minimum of one set of vitals (Temp, HR, RR, and BP) at every visit even if just a simple lab draw.  Some visits for infusions require multiple sets of vitals.  If vitals are abnormal, please document it in your note and report it to Helms so that we can determine if we should call the Pharmacy/MD right away.  Refrain from diagnosing or directing patients to take over-the-counter meds. For example, you are with a patient and you find that they have a temperature of 100.2. Do not tell the patient to take something over the counter. As the RN, your job is to assess, document and report so that the appropriate party (MD or PharmD) can advise or write an order.

  • Rationale:  We are a company that provides “skilled” nursing. A big part of it being skilled is that the appropriate assessments are taking place. Vital signs are a huge part of that. Insurance companies can refuse to pay the Pharmacy for visits that do not include the appropriate skilled assessments.  If the Pharmacy doesn’t get paid, neither do we. When you submit your visit notes, they go through a review process. This creates a several days lag time between when you submit them and when they are accessible to the Coordinator. Some things need to be reported immediately because it is our job to keep the Pharmacy/MD aware of any concerns with the patient so they can update the plan of care accordingly.​
     

• PICC lines: If you are doing a dressing change visit, you must assess, measure, and document the length from the insertion site along with all the other required assessments.

  • Rationale:  You may not be the only nurse to provide care to a patient. It is important that we are able to look back at documentation to establish baselines and assess any changes especially with how far the PICC is “out.”
     

• NEVER copy previous visit notes or document things that did not happen.

  • For example, you see a patient every week for their infusion;  DO NOT copy/paste information from previous visits. You will eventually get caught and this is not only grounds for termination, but it may have to be reported to the nursing board.

  • Another example, you have been seeing a patient for a very long time and his/her vitals are always fine. It is not appropriate to skip taking them and fabricate vitals for the visit. Again, this is grounds for immediate termination, and you are putting your hard-earned nursing license in jeopardy.