Nursing/Respiratory Specific Policy and Procedures

Live a Legacy Vent Care Home, LLC.216 NE 151st Ave.

Vancouver, WA 98684(360) 828-1873

TABLE OF CONTENTS

2

Ventilator Education; Circuit Change, etc.

The following series provides overall step by step and component bycomponent comprehensive detail. Excellent detail, explanation,definition, demonstration, and strategic mechanical advice.

Ventilator Training Part 1 - Introductionhttp://www.youtube.com/watch?v=B5eT_wJB7Ro

Ventilator Training Part 2 - Circuitryhttp://www.youtube.com/watch?v=WdyllGwFMxY

Ventilator Training Part 3 - Dry Conversionhttp://www.youtube.com/watch?v=BMFBm3YfF98

Ventilator Training Part 4 - Controlshttp://www.youtube.com/watch?v=zSu0JLv52K4

Ventilator Training Part 5 - Leak Testhttp://www.youtube.com/watch?v=AmktTNgTOtY

Ventilator Training Part 6 - Fisher Paykelhttp://www.youtube.com/watch?v=EFVPCmQp0mI

Ventilator Training Part 7 - Readingshttp://www.youtube.com/watch?v=9LcnqX2w3Og

Respiratory Circuit Exchangehttp://www.youtube.com/watch?v=uhbmDO6yirY&list=PL-DYtB7HNQvaTSFDcIc2kTm9K-ugcNrri

Ventilator Circuit Changehttp://www.youtube.com/watch?v=k1wUByg3wDo(training lab setting, no live clients)

3

TRACH Procedures: Artificial Airways; Suctioning; Using an Ambu Bag

Inline suctioninghttps://www.youtube.com/watch?v=hcrsb1hiPLc

tracheostomy suctioning lecture/demonstrationusing disposable suction catheter

https://www.youtube.com/watch?v=MlwlN5fMDns

2-person trach suction training video using ambu bag support duringsuction procedures

https://www.youtube.com/watch?v=p7F1T3WGGm0

Interactive communication with client about Trach Suctioning and TrachCare procedures preceding each procedure and demonstration;

Tracheostomy Care/Suctioning:https://www.youtube.com/watch?v=UKUk2HoI3js

Trach Tube Suction: detailed standards and special considerations;experienced trach client & caregiver; cough reflex; oral suction;

live-patient demonstration.https://www.youtube.com/watch?v=T4N_bPY94f0

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MetaNeb Respiratory System

The MetaNeb System is indicated for the mobilization of secretions, lung expansion therapy, the treatment and prevention of pulmonary atelectasis, and has the ability to provide supplemental oxygen when used with compressed oxygen.

The MetaTherapy Treatment maximizes efficiency for patients and clinicians by combining lung expansion, secretion clearance and aerosol delivery into a single integrated therapy by the MetaNeb System.

Conditions for MetaTherapy Treatment where the above conditions are met: Chronic obstructive pulmonary disease 3 (COPD) Post-operative airway management Bronchiectasis Neuromuscular disorders Cystic fibrosis Asthma Emphysema Reversal of atelectasis Chest wall trauma

In CPEP (Continuous Positive Expiratory Pressure) mode The MetaNeb System provides medicated aerosol combined with continuous positive pressure to assist in holding open and expanding the airways. In CHFO (Continuous High Frequency Oscillation) mode is a pneumatic form of chest physiotherapy that delivers medicated aerosol while oscillating the airways with continuous pulses of positive pressure.* Therapy times may differ depending on patient needs and ordered therapies.

For the complete tutorial, please visit: http://www.hill-rom.com/eLearningCourses/MetaNeb/index.html

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G Tube/J Tube Feedings and Medication AdministrationCOLLECT SUPPLIES:60mL Syringe Water (sterile if MD ordered) Ordered Medications/Tube feedingGloves

Information:The G/J is a percutaneously placed combination tube, a PEG/J. A g-tube (large lumen) is placed into the

stomach in the same manner that the PEJ was placed. Once the g-tube is in place, a smaller lumen tube is threaded to it and into the jejunum. The PEG/J has 2 ports on the end of it. One runs to the stomach and the other runs to the small bowel. The G/J tube has the advantage of allowing a patient to administer medicine through the gport, and to decompress the stomach, even while feeding through the jport. Sometimes, it is replaced by a button, called a Bard Button or MIC-KEY, 3 to 8 weeks after surgery

For more information, please visit: https://www.g-pact.org/gastroparesis/nutrition/feeding-tubes/g_j-tubes

CARE for the tube:You will clean the skin around the G-tube 1 to 3 times a day (or per MD orders) with mild soap and water. Try to remove any drainage or crusting on the skin and tube. Be gentle. Dry the skin well with a clean towel.Your provider may also want you to put a special absorbent pad or gauze around the G-tube site. This should be changed at least daily or if it becomes wet or soiled. DO NOT use any ointments, powders, or sprays around the G-tube unless told to do so by your provider.

Different Procedures:

Gravity Method:

Wash your hands. Check MD orders. Gather your supplies (feeding set, extension set if needed for a G-

button or MIC-KEY, measuring cup with spout, room temperature food, and a glass of water).

If there is a G-tube, close the clamp on the feeding tube. Hang the bag high on a hook and squeeze the drip chamber below the bag to fill it

halfway with food. Next, open the clamp so that the food fills the long tube with no air left in the tube. Close the clamp. Insert the catheter into the G-tube. Open toward the clamp and adjust the feeding rate, following your provider's

instructions. When you are finished feeding, it may be recommended that you add water to the tube

to flush it out. G-tubes will then need to be clamped at the tube, and the feeding system will need to

be removed. If you are using a G-button, or MIC-KEY, system:

Attach the feeding tube to the feeding system first, and then fill it with formula or food. Release the clamp when you are ready to adjust the feeding rate, following your

provider's instructions. When you are finished feeding, your provider may recommend that you add water into

the tube to the button.

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Feeding with the Syringe Method: Wash your hands. Gather your supplies (a syringe, feeding tube, extension set if needed for a G-button or

MIC-KEY, measuring cup with spout, room temperature food, water, rubber band, clamp, and safety pin).

If resident has a G-tube: Insert the syringe into the open end of the feeding tube. Pour the formula into the syringe until it is half full and unclamp the tube. If you are using a G-button, or MIC-KEY, system: Open the flap and insert the bolus feeding tube. Insert the syringe into the open end of the extension set and clamp the extension set. Pour the food into the syringe until it is half full. Unclamp the extension set briefly to fill

it full of food and then close the clamp again. Open the button flap and connect the extension set to the button. Unclamp the extension set to begin feeding. Hold the tip to the syringe no higher than your child's shoulders. If the food is not

flowing, squeeze the tube in downward strokes to bring the food down. You can wrap a rubber band around the syringe and safety pin it to the top of your shirt

so that your hands are free. When you are finished feeding, your nurse may recommend that you add water to the

tube to flush it out. G-tubes will then need to be clamped at the tube and the feeding system, and removed. For a G-button or MIC-KEY, you will close the clamp and then remove the tube.

7

Proper Handwashing Techniques

Microbes are all tiny living organisms that may or may not cause disease.

Germs, or pathogens, are types of microbes that can cause disease.

Wet your hands with clean, running water, turn off the tap, and apply soap. Using soap to

wash hands is more effective than using water alone because the surfactants in soap lift soil

and microbes from skin, and people tend to scrub hands more thoroughly when using soap,

which further removes germs.

Lather your hands by rubbing them together with the soap. Be sure to lather the backs of

your hands, between your fingers, and under your nails. Lathering and scrubbing hands

creates friction, which helps lift dirt, grease, and microbes from skin. Microbes are present on

all surfaces of the hand, often in particularly high concentration under the nails, so the entire

hand should be scrubbed.

Scrub your hands for at least 20 seconds. Healthcare workers are likely to come into contact with disease-causing germs and risk spreading serious infections to vulnerable patients, so they may need to wash hands longer. Nonetheless, evidence suggests that washing hands for about 15-30 seconds removes more germs from hands than washing for shorter periods. Accordingly, many countries and global organizations have adopted recommendations to wash hands for about 20 seconds (some recommend an additional 20-30 seconds for drying).

Rinse your hands well under clean, running water. Soap and friction help lift dirt, grease, and

microbes—including disease-causing germs—from skin so they can then be rinsed off of hands.

Rinsing the soap away also minimizes skin irritation.

Dry your hands using a clean towel or air dry them. Germs can be transferred more easily to

and from wet hands; therefore, hands should be dried after washing.

8

Bedside Shift Change/Report

ARRIVE 10 minutes before scheduled start-time, be ready to CLOCK-IN 10 minutes prior to the

beginning of your shift.

Narcotic Counting; LOG-IN and sign off in computer if count is correct, If Narcotic Counting is

not correct, then do investigation between two staff. If there is no agreement, then call

supervisor, manager etc. Fill out incident report for this incident.

Change of shift rounds. Walk into each room give (receive) a report on current condition of

each resident, check on patient and room condition, ask questions. Be polite and courteous.

Emergency Check (bedside ambu-bag, etc.) to be performed and Charted.

1) Check Oxygen tanks if they are full/empty make sure you have sufficient amount in case of

emergency.

2) Check for default settings:

o Pulse Oximeter should be set to 92% (or lower) per physician’s order.

o SET Heart Rate default to 60 BPM.

o Check Oxygen tubing connection to vent.

o Check for emergency tracheostomy tube should be at bedside. Tracheostomy tube

should be regular size and a size smaller and cuff syringe.

o Check external batteries if they charged or need to be charged.

o Check phone connections and be aware of WHO do you call in case of emergency (On-

Call RN) (notification), in addition to calling: 911.

2) Reporting/communicating exchange of information

Shift Caregiver [RN, LPN and CNA] must assure excellent communication regarding resident condition, including also ANY changes of resident condition in a timely manner to the on-duty facility RN, or LPN, and resident’s Primary Care Physician, and the Power of Attorney (POA) of the given resident.

Staff should closely monitor each resident’s Vital Signs, any signs of distress, overall mental and emotional condition, and listen to resident's complaints (if verbal) and report to facility RN-manager.

At the end of shift all scratch paper to be shredded, put away, new orders/faxes filed.

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Bedpan and Incontinence CareCOLLECT SUPPLIES:Chuck’s Pad Toilet Brush Adult brief (if applicable to specific client) Plastic/disposal bagGloves Barrier cream Peri-Wipes Bedpan or Fracture pan

INITIAL PROCEDURES:❖ Client indicates a need for the bedpan❖ Apply gloves before proceeding.❖ Collect ALL supplies (see above).❖ Provide privacy for these procedures (completely close resident hallway door and open French door,

while activating all blinds to provide privacy. Also, turn on bathroom fan timer to help with odor elimination.

❖ Adjust bed and client body position according to client-specific best practices.❖ Place disposable Chuck’s pad between bedding and the client’s posterior❖ Place a chuck on the bedpan to be used❖ Position client onto the bed pan properly.❖ Obtain comfort acknowledgement from client❖ Ensure call-signal device is held or capable of being held (as needed) by the client ❖ Ensure privacy ❖ Prepare the designated bedpan emptying area.❖ Return to client when signaled to remove the bedpan❖ Remove bedpan with the chuck’s pad as prevention against potential for any spilling.

➢ Use moist peri-wipes for client cleanse➢ Apply approved barrier cream or ointment➢ Apply properly fitted adult brief/underpad or FRESH/CLEAN set of client underwear.➢ Place any soiled washable items into a plastic bag and then into a laundry basket not on a floor➢ Put any soiled disposable items into a plastic bag (adult brief, wipes, chucks, toilet paper)➢ Discard waste bag immediately into outside garbage container.*

❖ Provide all restorative care to client before cleaning the supplies➢ Client comfort, re-position, etc.

CLEANING THE SUPPLIES:❖ Throw away soiled disposable chuck pad into trash and ❖ Use chemical dispatch wipes to disinfect bedpan if it is soiled❖ Wipe bedpan clean with toilet paper and return it to a CLEAN and DRY BASIN.❖ Spray and wipe clean any spills on all surfaces contacted by soiled supplies.❖ Do not rinse any supplies in sinks.❖ Do not leave your shift without cleaning the supplies; made ready for any re-use❖ Night-shifts: soak supplies in 10% bleach and 90% water if in doubt about integrity of supply

cleanliness.

* MAY combine incidental waste with other house garbage waste IF all waste is then discarded IMMEDIATELY into outside garbage container.

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CNA/HCA 12-hr Night Workflow

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Time Task Comments Initials (optional)

1915 Clock in on time Must call if running late

1930 Receive report from day CNA

2000 Initial turns/repositions Document care in ECP

2100 Prep night med pass/blood glucose check for bedtime/bedtime snack

Bedtime snack only for diabetics

2200 Perform scheduled noc bed bath; perform scheduled turn/CLRT

Document care in ECP

2230 Finish any last minute incontinence care for all residents as/if needed

Document care in ECP

2300 Empty dishwasher if done into dish cabinet

Keep noise level at minimum

while performing house work0000 Clean off all tables/counter

tops/kitchen appliances

0100 Empty Foley catheter Document in ECP

0200 Turn, if CLRT not available Document care in ECP

0300 Downtime/take lunch break

0400Downtime/finish any unfinished

laundry/re-stock paper towels, toilet paper, gloves where needed, etc.

Use this time for laundry,

organizing, etc.

0500 Meal prep, if any has been requested per day CNA

0600 Empty foley Document in ECP

0630 Tidy up home/bathroomsQuietly to not

disturb sleeping residents

0700 Give report to the day CNA & clock out on time

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CNA/HCA 12-hr Day WorkflowTime Task Comments Initials (optional)

0650 Clock in on time Must call if running late

0700 Receive report from noc CNA

0715 Begin breakfast prep/coffee

0730 Retrieve VS from required residents and input into ECP

Except those known late

risers.

0800 Serve breakfast for risen residentsPerform first

scheduled turn/CLRT

0900 Finish breakfast/load dishwasher Clear table

1000 Incontinence care/transfer to W/C’s Document care in ECP

1100 Lunch prep

1200 Serve lunch--take 30 min lunch Coordinate with nurse/staff

1300 Incontinence care/turns Document care in ECP

1400 Scheduled Bed Baths Document care in ECP

1500 Downtime/Cardboard breakdownUse this time for

laundry, organizing, etc.

1600 Start cooking dinner

1645 Serve dinner/pick up around house

1715 Transfer from W/C’s to bed Resident to be in bed by 1715

1800 Finish loading dishes/empty trashPerineal

care/Empty Foley

1900-1930 Give report to noc CNA clock out on time

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RN/LPN 8-hr Day WorkflowTime Task Comments Initials (optional)

0750 Clock in on time Must call if running late

0800 Look up meds/VS/CBG

0800-0930 Morning med pass Document care in ECP

1000 Wound care Document care in ECP

1030 Order any re-stock needs for woundcare/medications

Document care in ECP

1100 Assist CNA prn, prep noon med passObtaining CBG is

nurse responsibility

1200 Med pass/insulin coverage during lunch take 30 min lunch

Coordinate with nurse/staff

1300 Make any case coordination call needs to PCPs, etc.

1400 Be available to help CNA with turns during scheduled bed baths

1500 Cover 15 min break for CNA

1600 Dinner med pass prep

1645-1715 Pass meds with meal/finishObtaining CBG is

nurse responsibility

1715 Wrap up all documentation Document care in ECP

1730 Clock out on time

**This is only a guide and should not supersede immediate resident care needs throughout the day.

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Receiving a Referral Checklist

o Inquire about how family/referral source heard about us and

make note

o Offer a scheduled tour of home

o Gather as much subjective information about resident’s current

condition and family’s expectations

o Offer marketing materials (i.e. Facebook page, company website,

card)

o Offer a copy of the admission contract and scoring tool

o If referral is through placement agency, verify active contract on

file, if not, terms need to be reviewed and negotiated per

ownership

o Face to face meeting, if family chooses our home, for initial

assessment and scoring tool completion

o Provide family with assessment findings and initial admission

invoice

o Finances must be received by facility prior to admission and all

admission checklist completed no later than admission day

(unless client is DSHS payor source).

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Admission Checklist

o Scoring tool (facility-specific) completed

o Initial/Admission Nursing Assessment completed

o Admission agreement completed

o Initial Invoice has been received and approved per resident/family

o Fall Prevention Plan signed

o Risk of Side Rails Use signed

o Risk of Side Rails Use literature provided to resident family

o Medicaid Conversion Policy signed

o Hi-School Pharmacy Intake Packet completed and signed

o Copy of Insurance Cards, Social Security Card, state approved ID

(front and back) [passport acceptable if does not have a state ID]

o Copy of any legal paperwork pertaining to the care of the

resident (i.e. Power of Attorney, Healthcare Proxy,

Guardianship, etc.)

o Signature of Nurse Delegation Paperwork

o Initiate Negotiated Care Plan (to be completed within the DSHS 30

day grace period)

o Personal Belongings document to be completed per CAN within

24 hours and signed by resident or resident representative

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o Integration of resident information into ECP to initiate care in a

timely manner

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Trash and Miscellaneous Checklist

o Day CNA to take trash bins to front street in front of entry sign;

face trash bins toward house to avoid wind blowing bins open

o Night CNA to clean all lint overflow from front porch early in the

evening to avoid buildup on front porch

o All indoor bins must be emptied at end of night shift, if full and

PRN when they are full.

o When shred box is full, night CNA to empty into black bag in

backyard shed before end of night shift

o Re-stocking to happen at night

o Make sure grated garbage disposal cap is always in sink to prevent

unwanted objects from entering garbage disposal, unless the

disposal is actually in use.

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Job TitleNursing Assistant Department Reports To FLSA Status Prepared By Approved By Last ModifiedNursing Licensed Staff Nurse N/A Marcel Nicorici Marcel Nicorici 2017-04-17

Job SummaryProvides basic patient care under direction of licensed staff nurse.

General Accountabilities Answers patient call signals, signal lights, bells, or intercom systems. Turns or repositions bedridden patients per MD orders. Provides physical support to assist patients to perform daily living

activities. Reviews patients' dietary restrictions, food allergies, and preferences

to ensure patient receives appropriate diet. Measures and records food and liquid intake or urinary and fecal

output, reporting changes to medical or nursing staff. Records vital signs, as directed by medical or licensed staff nurse. Gathers information about patient condition, treatment plans, or

appropriate activities. Observes or examines patients to detect symptoms that may require

medical attention. Documents or otherwise reports observations of patient behavior,

complaints, or physical symptoms to licensed nurses. Reminds patients to take medications or nutritional supplements. Feeds patients or assists patients to eat or drink. Supplies, collects, or empties bedpans. Undresses, washes, and dresses patients who are unable to do so for

themselves. Changes bed linens or makes beds. *The company reserves the right to add or change duties at any time.

Job Qualifications Education: High school diploma or equivalent; successful completion of

WA state approved Nursing Assistant program. Experience: One year of related experience, or new internship as

applicable upon hire. Completion, or ability to complete of WA DSHS approved AFH minimum

qualifications within 60-day company probationary period.

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o DSHS Mental Health, Dementia, Nurse Delegation, Nurse Delegation with emphasis on Diabetes, Developmental Delay, and WA Food Handler's Card

Must obtain First Aid/CPR with AED certification within thirty (30) days of hire, if not already possessed.

Must obtain current TB ppd, or gold top serum test within two (2) days of hire [2-step if never been done before].

Must have clean background check returned by WA DSHS BCCU within one (1) week of hire.

Skills Excellent verbal and written communication Service orientation Active listening Social perceptiveness Coordination Monitoring

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Job TitleRespiratory Therapist Department Reports To FLSA Status Prepared By Approved By Last ModifiedRespiratory DON and/or ADON N/A Diana Nicorici Marcel Nicorici 2017-04-17

Job Summary Administers respiratory therapy care and life support to patients with

deficiencies and abnormalities of cardiopulmonary system, under directions/active orders of physician.

Educates certified facility staff in appropriate respiratory care of dependent residents and maintains up to date best practice acts with them.

Re-orders necessary respiratory supplies as needed from current respiratory suppliers per resident-specific needs.

Keeps in close contact with licensed staff nurses and DON/ADON for any resident needs that must be addressed and cannot be resolved without their assistance.

Documents in electronic medical record (ECP) observations and pertinent documentation/interventions upon each resident visit.

General Accountabilities Reads prescription and reviews patient information to assess patient

condition and determine requirements for treatment such as type and duration of therapy, and medication and dosages.

Determines most suitable method of administering inhalants, precautions to be observed, and modifications which may be needed that will be compatible with physician's orders.

Sets up and operates devices such as mechanical ventilators, therapeutic gas administration apparatus, environmental control systems, and aerosol generators.

Operates equipment to ensure specified parameters of treatment such as volume, gas concentration, humidity, and temperature, and to administer medicinal gases and aerosol drugs to patients.

Monitors patient's physiological responses to therapy such as vital signs and blood chemistry changes.

Performs broncho-pulmonary drainage and assists patient in performing breathing exercises.

Performs pulmonary function tests to be used by physician in diagnosis.

Observes equipment function and adjusts equipment to obtain optimum results to therapy.

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Consults with physician in event of adverse reactions. Maintains patient's chart that contains pertinent identification and

therapy information. Inspects and tests respiratory therapy equipment to ensure equipment

is functioning safely and efficiently. Orders repairs of equipment when needed. Demonstrates respiratory care procedures to trainees and other health

care personnel. *The company reserves the right to add or change duties at any time.

Educational/Certification Requirements Education: Pertinent RT program approved by WA Department of

Licensure; Diploma; Associate's/Bachelor’s degree Experience: Appropriate certifications and/or licensures with 2-3 years

of related experience preferred. Completion, or ability to complete of WA DSHS approved AFH minimum

qualifications within 60-day company probationary period. o DSHS Mental Health, Dementia, Nurse Delegation, Nurse

Delegation with emphasis on Diabetes, and Developmental Delay Must obtain First Aid/CPR with AED certification within thirty (30) days

of hire, if not already possessed. Must obtain current TB ppd, or gold top serum test within two (2) days

of hire [2-step if never been done before]. Must have clean background check returned by WA DSHS BCCU within

one (1) week of hire.

Skills Excellent verbal and written communication Monitoring Judgment and decision making Service orientation Active listening

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Job TitleLicensed Practical Nurse Department Reports To FLSA Status Prepared By Approved By Last ModifiedNursing DON/AON N/A Diana Nicorici Marcel Nicorici 2017-04-17

Job Summary Cares for ill, injured, or convalescing patients or persons with

disabilities in hospitals and similar institutions.

General Accountabilities Administers prescribed medications or starts intravenous fluids, noting

times and amounts on patients' charts. Documents in electronic medical record (ECP) appropriately. Observes patients, charting and reporting changes in patients'

conditions. Answers patients' calls and determines how to assist them. Measures and records patients' vital signs. Provides basic patient care or treatments. Works as part of a healthcare team to assess patient needs, plan and

modify care, and implement interventions. Supervises nurses' aides or assistants. Assembles and uses equipment, such as catheters, tracheotomy tubes,

or oxygen suppliers. Records food and fluid intake and output. Collects samples, such as blood and urine from patients, and performs

routine laboratory tests on samples. Prepares patients for examinations, tests, or treatments and explain

procedures. Helps patients with bathing, dressing, maintaining personal hygiene,

moving in bed, or standing and walking. Sterilizes equipment and supplies. *The company reserves the right to add or change duties at any time.

Job Qualifications Education: WA State Department of Licensing approved

Diploma/Certificate/Associate's degree in nursing Experience: Unencumbered WA LPN license with 1-2 years of related

experience

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Completion, or ability to complete of WA DSHS approved AFH minimum qualifications within 60-day company probationary period.

o DSHS Mental Health, Dementia, Nurse Delegation, Nurse Delegation with emphasis on Diabetes, Developmental Delay, and WA Food Handler's Card

Must obtain First Aid/CPR with AED certification within thirty (30) days of hire, if not already possessed.

Must obtain current TB ppd, or gold top serum test within two (2) days of hire [2-step if never been done before].

Must have clean background check returned by WA DSHS BCCU within one (1) week of hire.

Skills Excellent verbal and written communication Service orientation for elevated quality resident care Active listening with all residents, families, and employees Monitoring Nurse Assistant Performance on a day to day basis Coordination of care and daily resident schedule Social perceptiveness and appropriate phone etiquette is a must

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Job TitleRegistered Nurse Department Reports To FLSA Status Prepared By Approved By Last ModifiedNursing DON/ADON N/A Diana Nicorici Marcel Nicorici 2017-04-17

Job Summary Assesses patient health problems and needs, develops and implements

nursing care plans, and maintains medical records. Provide support to staff Nurse Assistants and Licensed Practical Nurses

as needed (PRN). Keeps in contact with outpatient medical team, such as but not limited

to: Home Health Care, Primary/Specialty Care Physicians, Hospice Care, and any other resident care related medical and social team members.

General Accountabilities Keeps in close contact with DON/ADON for any changes in resident

status'. Maintains accurate, detailed reports and records via provided

electronic medical record system (ECP). Administers medications to residents and monitors residents for

reactions or side effects. Records residents' medical information and vital signs. Monitors, records, and reports symptoms or changes in residents'

conditions to appropriate medical staff (i.e. Primary Physician, Hospice, etc.).

Modifies resident treatment plans and/or care plans as indicated by residents' responses and conditions.

Monitors all aspects of resident care, including social and psychological well-being.

Prepares residents for and assists with examinations or treatments. *The company reserves the right to add or change duties at any time.

Job Qualifications Education: WA Department of Licensing approved program:

Diploma,Associate's and/or Bachelor's degree in nursing Experience: 1-2 years of related experience; or equivalent combination

of education and experience Licensing: Unencumbured WA state nursing license

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Completion, or ability to complete of WA DSHS approved AFH minimum qualifications within 60-day company probationary period.

o DSHS Mental Health, Dementia, Nurse Delegation, Nurse Delegation with emphasis on Diabetes, Developmental Delay, and WA Food Handler's Card

Must obtain First Aid/CPR with AED certification within thirty (30) days of hire, if not already possessed.

Must obtain current TB ppd, or gold top serum test within two (2) days of hire [2-step if never been done before].

Must have clean background check returned by WA DSHS BCCU within one (1) week of hire.

Certification: Must obtain CPR/First Aid within 30 days of hire, if does not already have it.

Skills Excellent verbal and written communication Service orientation for elevated quality resident care Active listening with all residents, families, and employees Monitoring Nurse Assistant Performance on a day to day basis Coordination of care and daily resident schedule Social perceptiveness and appropriate phone etiquette is a must

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