Service Standard #9: Workplace Cleanliness

We maintain a professional, clean, organized work bag and work area, whether in the patient's home or in the workplace.

• Your work environment is a reflection of you. Take personal responsibility for maintaining high levels of cleanliness throughout your work area.
• Uncompromising levels of cleanliness are expected of everyone.

The year is 2016. The month is May. The date is the 25th. The place is the VNA of Boston. On Wednesday I will celebrate my 40th continuous year in home health. Never in my 40 years have I felt isolated or lonely. Home health is where I have met my lifelong adult friends. Home health is where I learned to be confident as a nurse and as a leader. Home health has seen me grow and accept challenging roles in my career. I started as a staff nurse and was in that role for 12 years. I then accepted the position of a home health aide manager. That was my first leadership role. In that role I served on the Board of Directors of the former Massachusetts Council of Homemakers & Home Health Aides. I was their treasurer and a member of their statewide speaker's team. In the late 80s all the regulations for home health aides were changing and I traveled around the state educating others about the new regulations. I co-published a home aide training manual during this time. While in this position I found my way to Stonehill College and completed a degree in Health Care Administration.
I left the Quincy VNA after 19 years in search of what I didn't know. I worked with 3 companies helping them prepare for their first JCAHO accreditation. They all passed! Out of that I accepted a dual position of staff education and human resource manager at a newly certified Asian home care agency in Boston's Chinatown area. That was my introduction to the inner city. That position was where I developed my passion for joint visits. My job involved recruiting nurses from all over the world, helping them through the immigration process, getting them through their state boards and out in to the field. I often refer to that job as my Cinderella job. While in that role I learned to do a complete head to toe assessment in Cantonese! I wish I still possessed that skill.

CMS began to cut funding and this small home care agency was at risk of closing the certified side of their business. I needed a full time job! It was one of those 'lifelong" home care friends, Denise Murphy, who led me to the doorway of the VNA of Boston. I accepted the position of evening clinical manager and learned quickly the VNAB-way. Over the past 18 years I have worn many hats. In addition to the evening manager role I have managed medical records and MD orders, been a Practice Advancement Specialist and now a Patient Care Manager/ Care Management Leader. I have met new, wonderful people here that have also become lifelong friends.

I am forever thankful for the wonderful nurse mentors I have met along the way. They are all still in my life and they all know how special they are to me.
In closing, I am asking one thing of my fellow home care lifers. On Wednesday, please reach out to a home care "newby" and welcome them to the best role in nursing.

Thank you for listening to my story.
Carol A. Morris BA RN COS-C

For questions call 617-886-6453 or Christine_Day2@vnacare.org.

• Contact Referral Center for assistance when Medication List (Discharge Med List if Facility Referral) is missing
• Use the intervention check-offs under the Medication Teach button
• Teach all High Risk medications within the 5 day OASIS window at SOC and within  2 days at ROC
• Document who was taught in the specified EMR section
• Document response to teaching for each medication
• SN teach all medication requirements before discharge to Therapy
• SN and Therapy reteach OR document that the patient/caregiver retained knowledge of prior teaching Medication teaching at Recertification and ROC

• Check that a medication you are documenting in the record is also in the Medication List
• Add the indication, diagnosis or condition for each medication (prescribed and OTC)on Medication List
• Qualify the purpose of all prn medications
• Define, when there are multiple doses prescribed for the same med, when each dose is used

1. All HIV patients should be on HIV medications. Review medication regimens and identify which drugs are used to fight HIV. If not on one, call the physician. It may have been missed and the medication not reordered in error during the care transition from the hospital.
2. It is important that patients are compliant with their daily regimen. Missing doses or days of therapy will cause the virus to multiply again and cause drug resistance to that drug. Resistance to a drug will mean doctors will need to do testing to find another drug that will work, something the patient will want to avoid.
3. Offer non-judgmental support. Patients still feel a stigma attached to the HIV diagnosis.

As for precautions, standard precautions are to be used in patient care.