Licensed Practical Nurse (Day, Evening, & Night Shift)-Inpatient Services

GENERAL JOB DESCRIPTION

The Licensed Practical Nurse works with agency clients in the Adult Residential Program (both STC and LTH/IOP). The Licensed Practical Nurse orients clients to the agency and the expectations of services which are to be received through the Medical Staff and managing the agency clients’ medical care. The Licensed Practical Nurse facilitates health care services as a support to the clients’ own self-management. All residents are responsible for their own health care services and management of their medication administration and supply of that medication. It is not the policy of the agency to provide all medical services to agency residents.

DUTIES & RESPONSIBILITES

It is the duty and responsibility of the Licensed Practical Nurse to:

·       assess potential residents for appropriateness for the treatment program;

·       complete an updated assessment on each client after admissions;

·       complete a medical treatment/discharge plan based on updated assessment;

·       communicate the treatment plan with the treatment team upon admission and on a monthly basis;

·       provide on-going health education to all residents as outlined in the Residential Program Manual;

·       provide on-going assessment of acute medical/nursing needs of all residents and refers residents to appropriate treatment centers;

·       monitor prescribed medication consumption and treatments that includes assessing resident knowledge and understanding of medication and treatment regimens, as well as, accuracy of administration;

·       coordinate the management of patient’s medication stock including pharmacy pick-up and drop-off of meds, calling in refills for clients, and upkeep of how medication is stored;

·       conduct urine drug screens on all residents as directed to do so;

·        conduct weekly psycho education classes;

·       follow treatment care plans set forth by the medical staff;

·       document all pertinent health related information about residents on the resident chart that is done routinely and according to nursing standards of practice;

·       complete Incident Report form before the end of a shift if applicable; and

·       maintain HIPAA guidelines; and

·       perform other duties as assigned.

Client Induction duties include the following:

·       Nurse will review all admissions packets to determine if potential client is eligible for program and if they need PPD, medical records requested, H & P, Psych evaluation. On review of the candidate’s drug of choice, last use and consumption level, a determination of need for medical detox may be necessary as well.

·       At time of admission, ALL new admits will meet with a staff nurse. At that time, MARs form, determination of med call schedule for patient, education on med refill process, med slips, and general health conduct will be explained and documented by the nurse and placed into a medical chart.

·       Nurse will place PPD within 72 hours of admission to the program and read within 72 hours of placement. Any clients with a positive PPD or showing signs of possible TB infection will be referred to the Wetmore Clinic for further follow up.

·       Photocopy any insurance or Medicaid card for chart. Document emergency contact and relationship in the event client goes to ER or needs financial assistance for medical.

·       Review of chart will be determine if patient will go onto the psychiatry schedule based on initial determination to enter program. (i.e. follow-up, first visit within 30 days, or prn).

Psychiatry duties include the following:

·       Work with Community Health Center (CHC) staff to ensure that clients who are in need of a psych evaluation as indicated by their initial screen or at the Chief Medical Officer’s request are scheduled for an appointment.

·       Work with treatment staff to report appointments and assist in scheduling if needed.

·       Print out notes/visits from the EHR for client charts and submit for filing.

·       Receive any verbal orders by providers, document, and facilitate them.

Medical duties include the following:

·       Medical slips will be picked up twice daily from the treatment team office.

·       Nurse will take vital signs on patients that have medical complaints that require triage and present them to the CHC with that patient’s chart ready for review.

·       All HIV screening will be offered to OHL clients by the CHC. The Nurse will coordinate with the CHC as needed.

·       Nurse will call and coordinate clients to CHC as needed.

·       Nurse will review all charts seen by the CHC and or arrive by medical feedback sheet and follow instructions as directed. It may be necessary to educate client on diagnosis and treatment plan with goals.

·       Print out notes/visits from electronic health records for client charts and submit them for filing.

Treatment Team Meetings duties include the following:

·       Nurse will attend the weekly treatment team meeting and bring any concerns to the Counselors regarding clients and listen to concerns of the Counselors and assist if it is a Medical Staff issue.

·       Nurse will bring and present the MAR book in the weekly treatment team meetings.

Discharge duties include the following:

·       All clients discharged or graduated from OHL, will obtain their personal medication from the front desk and sign an acknowledgement receipt of the medications that they receive. This receipt is to be scanned into the client’s chart.

·       Medical Staff Daily Inquiries – Report with night staff for shift change.

·       Check in with the Front Desk to know if any clients went to the ER after hours and attain paperwork. Medical visits must be accompanies with a medical feedback sheet, any pertinent labs, and notes for the visit. All clients going out of the house for medical appointments will be obligated to stop at the nurse’s office to report what occurred in the visit and submit any paperwork before going back on the floor.

·       Pharmacy Coordination – Occurs as needed. Pharmacy coordination may include but is not limited to MHSD, Avita, St. Vincent DePaul’s, and local community pharmacies.

·       Facilitate medication refills by instructing clients how to fill out a medication refill request, attain refills, and arrange for payment.

·       Call medications in to pharmacy prior to departure, patient must fill out sheet with financial request.

·       Document on a pharmacy log which clients have pending medications.

·       On arrival of medications, document all arrivals into each client’s chart.

·       Insert any medication information sheets into patient’s chart.

·       Any clients that have stat prescriptions send and fill ASAP if they are antibiotics, anti-inflammatory medication, etc…

·       Clients who do not request medications prior to running out will have this reported to the client’s individual Counselor.

Protocol includes the following:

·       All new admits will have a medical record in the EHR. These records will hold clients’ recent PPD, intake packet from admissions, a medical reconciliation form of all meds, and any medical records that arrived for the client such as History and Physical, Psych Evaluations, Hospital Records, Labs. This chart will be made when the nurse meets the client and is assembled by the Medical Staff.

·       The Medical Staff will establish appropriate medications which can be used at OHL. Narcotics may not be used in the Adult Residential Program (there may be exceptions in a very few cases to this policy but approval for the use of any narcotic must come from the Program Manager prior to administration of such medication.) Certain pain relievers are acceptable on a case by case basis with documentation from the medical provider who provided the pain reliever. The Nurse may be instructed to give clients comfort medications as outline in the policy and instructed by Community Health Center Staff or the Chief Medical Officer.

·       The Medical Staff will establish what medication calls the client will use for their medication regiment. There are four medication calls per day. As needed medications will be used on a case by case basis. This schedule will be written down for the client to have as a reference and present to their Counselor.

·       The clients’ schedule will be documented into a log for medication calls. This log will allow nursing staff to know when a client has been missing medication calls or not taking them correctly.

·       Medication stock will be stored under lock and key in the Nursing Office Medication Room. Clients will only be allowed access to their medication during medication calls and in special circumstances based on the situation and nurses’ clinical judgment.

·       All staff will observe the taking of medication at each medication call. Observing the bottle instructions, the amount of pills client takes, and how low the medication appears in the bottle. Encouraging patients to be aware of their stock of medication is part of the Medical Staff’s duties.

·       Missed medication calls will results in client missing medication if it is too close to the next medication call based on clinical judgment. There will only be three grace opportunities to take late or missed medications. At that time the nurse will notify that client’s Counselor of the behavior to have it addressed as part of their treatment. These cases should be logged into nurse’s log to be presented in treatment team meetings.

·       Ideally, all medication refills must be paid by the client. Patient must be instructed at time of orientation as to how medications are filled and how frequently.

·       All medication refills need to be written onto a medication refill slip and submitted to the Medical Staff. Depending on level in the program, client’s role in refilling their medications will change to allow them to participate more independently.

·       Patients will be oriented to the process of filling out a medical slip when they are sick.

·       Patient will be informed that all sick visits are triaged and addressed in order or urgency. Clients will not be allowed to go to EH for primary care issues unless indicated.

·       If a client repeatedly complains of issues that are impeding their capacity to participate in a residential program, they may be considered inappropriate for the program and discharged if indicated.

·       All suicidal attempts will result in immediate discharge. Suicidal ideation is to be addressed directly with OHL Staff and the client’s safety will be managed accordingly.

Discharge Planning duties include the following:

·       All clients are to be told their obligation to stop by the Nursing Office prior to discharge or graduation to receive their medications. Clients are to be made aware that if they leave OHL at night or on a weekend, they may return to the nurses’ office in 72 hours, medications will be discarded and a note in chart will indicate last day at OHL noting they did not participate in a discharge plan as contracted.

·       All new clients will sign in their medications and sign out their medications. All clients will be given the phone numbers to Behavioral Health and the Primary Care Clinic’s as part of their orientation in the event they leave without a discharge plan.

Daily Task List includes the following:

·       Report in with staff. Review the night log for any ER visits or medical complaints from the night. Match to Incident Reports as needed.

·       Review all needed actions for the day dealing with the CHC as needed: medication orders, lab draws, chart reviews of or any pending documents to file.

·       Review the intake schedule for admissions and prepare appropriately.

·       Review medical slips submitted by clients of OHL. Triage slips to determine urgency of CHC visit. Number of clients seen is variable. Report client needs to the CHC if warranted.

·       Respond to emails in timely fashion and carbon copy appropriate parties.

·       Coordinate new admits into the CHC for an initial H&P and placement of PPD. Range of clients is determined on activity of admissions.

·       Conduct medication calls.

·       Review Admissions packets on all candidates for the Residential Program and advise on eligibility and needed documentation for any medications.

·       Receive charts at admit and review for all necessary components using chart content checklist. Send Residential Program staff all needed documents: H&Ps, TB skin tests, Psych evaluations.

·       Orient any new admits to the medical side of the Residential Program: medication calls and refills, sick slips etc…

·       Coordinate all received medications at arrival to be available to client by first available medication call.

·       Review any outside facility medical records for residential clients and determine follow-ups as needed.

·       Email Counselors promptly regarding any clients off the floor with new medical orders that would affect their treatment and of any pending offsite medical visits.

·       Review Discharge Summary and/or be aware of any clients leaving. List medication stock on form and have client sign for it. Photocopy and scan into client chart.

Weekly duties include the following:

·       Attend Multi-disciplinary Team Meeting. Participate in the medical components of clients cases as needed.

·       Coordinate patient referrals with the Psychiatrist and Nutritionist Follow-up on providers’ instructions.

·       Meet weekly with the Community Health Center as needed.

·       Pull discharged clients and note discharge date on a progress note and file.

·       Manage the MAR daily, weekly, and monthly as needed and file all MAR into client’s charts.

·       Review MAR for patterns of missed medications by clients, inquire with client as to why, report to Counselor, and Behavioral Health contract as needed.

·       Manage the medications refrigerator and discard old medications.

PHYSICAL DEMANDS

The employee may sit comfortably to do paperwork approximately 30-40% of the time. Walking, standing, bending, and carrying of light items such as papers, books, or small parts approximately 60-70% of the time. Employee must be able to walk about the facility and climb stairs. Local travel is required no more than 10% of the time.

WORK ENVIRONMENT

Work is normally performed inside a temperature controlled office setting.

MINIMUM QUALIFICATIONS

Minimum qualifications include the following:

·       LPN license

·       Healthcare CPR

·       Must be able to work independently with limited supervision

·       Must be able to handle a large caseload of medication management for clients

PREFERRED QUALIFICATIONS

Preferred qualifications include the following:

·       Substance Abuse treatment experience

Residential substance abuse program experience.