Main

MANAGEMENT OF THE AGITATED OR COMBATIVE PATIENT

Effective Date: 
Wed, 06/03/2015
Reviewed: 
Tue, 04/16/2019
Revised: 
Fri, 01/31/2020
Policy: 

When a patient is combative or agitated and staff are concerned for the safety of themselves or others, Police can be called. Staff will attempt to manage the situation, trying to protect staff and patients, while awaiting the arrival and assistance of police.

Procedure: 
  • Assess the situation early. Use your intuition. Do what is necessary to be safe as the first priority
  • For acute situations where a strong show of support is needed, Dial 44, remove headset, and page "Dr. Arnold to  Location" three times. Call police by dialing 911. If the situation prevents you from calling 911, either use a panic alarm or clearly request another person in the area to call 911
  • In a less acute situation when a staff member would prefer to not be alone with a student due to potential agitation, they are to call the Charge Nurse cell phone and say the room/location they are in, and that they are going to be late for their appointment with Dr. Arnold.   The Charge Nurse will then immediately go to that location, possibly taking another staff member or manager with them
  • Dr. Arnold responders: all available managers plus Behavioral Health Consultant. Do not storm the area. First manager assesses and takes command. Additional responders are sent away as necessary as soon as situation is assessed but everyone is on alert
  • Move the patient to a quieter location as needed as quickly as possible
  • Minimize the number of people interacting with the patient to:
    • A support person
    • A provider
    • Someone from CAPS or the BHC
    • Manager on hand to observe and coordinate
  • Try not to confine the patient more than necessary:
    • Keep doorway open
    • Allow patient to leave the building

At the call for Dr. Arnold – Specific Job Responsibilities

  • Manager : Assumes lead for situation
  • Manager: Determines that police/EMS has been alerted
  • Nursing/MAs: Move other patients out of the area
  • Charge RN/Triage/Reception: Divert patient care to other locations or reschedule non-urgent visits
  • MA in Impacted Area: Close doorways to waiting areas front and back. Provide support and observation
  • South Wing Staff: Close doorways to West Wing
  • Reception: Consider evacuating waiting areas to outside or mural room. Deploy staff members at doorways to avoid more people entering building/area
  • Lab/X-ray: Prepare to meet and guide Emergency Responders. Prepare for stat labs if necessary
  • Manager in Charge pages when Dr. Arnold event is concluded

Illegal, disorderly, disruptive or other inappropriate, non-clinical behavioral matters will be reported immediately through normal supervisory channels.  The University Police, Student Judicial Affairs, or other departments will be notified as appropriate.  An Incident Report of the events will be documented after the matter has been resolved.

Arrangements will be made for a debriefing/review within 72 hours of situation and policies will be revised as indicated.

PRIVACY & SECURITY OF HEALTH INFORMATION *

Effective Date: 
Tue, 05/19/2015

RISK MANAGEMENT: PUBLIC HEALTH *

Effective Date: 
Tue, 05/19/2015
Reviewed: 
Thu, 02/08/2018
Policy: 

The Student Health Services actively mitigates risk to our community through communicable disease (CD) prevention, identification and response and through on-going community emergency preparedness and response.    The chair of the Quality management committee is responsible for oversight of these risk reduction activities.  The SHS works with campus colleagues and our local community for disease prevention and response.  The SHS works closely with local, state and national health agencies to mitigate risk.  The SHS works with campus counsel and with the University of California Office of the President Risk management services on risk mitigation and response.

Procedure: 

The Quality Management Committee will hear an annual report of disease occurences, emergency preparedness activities, risk mitigation activities and incidence rates for influenza, gastroenteritis, STIs, and other CDs as indicated.

The communicable disease identification and response policy outlines specific CD management policies and procedures.
The Emergency Preparedness policy outlines on-going emergency preparedness policies and procedures.

OPTOMETRY - END OF DAY CLEANING *

Effective Date: 
Fri, 04/24/2015
Reviewed: 
Thu, 03/22/2018
Policy: 

The Optometry Department performs daily cleaning.  

Procedure: 

Certol ProSpray wipes (yellow top canister):

  • Exam chair
  • Stool

**Remove filmy build-up by wiping surfaces with plain water and paper towel as needed**

Sani-Cloth wipes (black top canister):

**Use a minimum of 2 cloths to properly wipe down all the following items**

  • Counter top and area around sink
  • Faucet handles
  • Cupboard and drawer handles
  • Keyboard and mouse
  • Inner and outer door handles
  • Retinoscope handle
  • Lamp arm

 

70% isopropyl alcohol wipes:

**To be performed in front of patient at start of every exam**

  • Phoropter forehead and nose rest
  • Slit lamp chin and forehead rest
  • Cover paddle
  • FDT forehead and nose rest

OPTOMETRY OPENING PROCEDURES *

Effective Date: 
Thu, 04/23/2015
Reviewed: 
Thu, 03/22/2018
Revised: 
Mon, 02/29/2016
Policy: 

See the Opening Procedures for Optometry below.

Procedure: 
  • Turn on main desk computer and exam lane computers. Log in to Windows and open and log in to Point and Click (PnC) EMR.
  • Open Google Chrome with the following tab: Eyemed. Log in to site so that insurance authorizations can be checked at each patient visit.
  • Check phone messages.
  • Open Master Optometry Excel log (found under Desktop, Optometry).
  • Open CL Log and Frame Log (found in Desktop, pub.optometry, My Documents).
  • Organize any glasses or contact lens orders from Optometry Technician that have been left on the desk. Bill appropriately if not yet billed. Add to Master Optometry Excel log spreadsheet. Add to Frame Log the frame that was sold, and to CL Log the CL order that was made, with the date and number of boxes.
  • In PnC, make a brief chart note for each Optometry Technician order that was left on the desk, indicating that the patient came in with the Optometry Technician and ordered glasses or CL, etc. on which date. The Optometry Technician is not able to make entries in PnC as they are not licensed.
  • Respond to Instant Messages in PnC.
  • Pick up CL or frame shipments in the Pharmacy.
  • Leave CL boxes in Pharmacy under pt’s name.
  • Place all glasses in appropriate cases with lens cloths and leave in Pharmacy under pt’s name.
  • Send secure messages to pts using PnC indicating their glasses and/or CL are ready for pickup in the pharmacy.
  • Uncover and turn on exam lane equipment.
  • Retrieve/unlock ophthalmic meds from locked cabinet and prepare for exam use.
  • Unpack any frame shipments and label with prices and stock the displays (see top desk drawer folder labeled Glasses Inventory - has inventory and price list).
  • Restock contact lens solution starter kits in upper cabinets (back exam room).

OPTOMETRY APPOINTMENT MAKING **

Effective Date: 
Thu, 04/23/2015
Policy: 

Optometry appointments need special consideration and are performed by Insurance staff.

Documentation of vision insurance is required.

Attached File: 

INSTRUMENT CLEANING STEPS

Form Type: 
HC
Form Number: 
XXX

SIGNING OUT FOR MEDICATIONS FROM THE PHARMACY *

Effective Date: 
Tue, 03/10/2015
Reviewed: 
Thu, 10/11/2018
Revised: 
Mon, 04/12/2021
Policy: 

All dispensed prescription medications must be acknowledged and signed out on the signature pad at the pharmacy in the Propharm POS (Point of Sale System) with a valid signature.

Students can have another person pick up their prescriptons, if they authorize a specific person, by phone, email or secure message.  For ongoing pick up, use the attached form. The pharmacy staff will document this information in Propharm.  

If the patient is not the person signing out, then that person or the pharmacy staff member will document the name and/or other identifying information and the reason as needed, at the Pickup Signature Capture in the Propharm POS when having the person sign the signature pad.

Examples of alternate documentation:

Insurance rebill

RN sign out - when picking up prescriptions to administer or for patients too ill to pick up the prescription on their own

Rx reconciliation - when verifying after the fact that the prescription was picked up

Pharmacy staff member initials for pt - when signing out on behalf of the patient

 

PATIENT-CENTERED MEDICAL HOME *

Effective Date: 
Wed, 03/04/2015
Reviewed: 
Tue, 04/24/2018
Revised: 
Tue, 04/24/2018
Policy: 

The Student Health Center practices as a Patient Centered Medical Home.  A Patient Centered Medical Home provides comprehensive and coordinated primary care in active partnership with the patient.  A Patient Centered Medical Home provides care which is patient-centered, directed by a physician, nurse practitioner or physician assistant.  The care provided is comprehensive, accessible, continuous, and organized to meet the needs of the individual patients served.  The core principle of this practice is that the patient is empowered to be responsible for their own care.   A Medical Home provides evidence based quality care and has a quality management program which continuously monitors and improves the care delivered by assessing:  the patient/provider relationship, accessbility, comprehensiveness, continuity and quality of care.

The Student Health Center demonstrates its practice as a Patient Centered Medical Home when it meets the standards established by the AAAHC in chapter 25, sections A through K.

REFERRALS FROM CAPS TO PRIMARY CARE *

Effective Date: 
Mon, 01/26/2015
Reviewed: 
Fri, 06/01/2018
Revised: 
Fri, 06/01/2018
Policy: 

In order to facilitate timely and effective communication between CAPS and primary care providers, every effort is made to clearly communicate the urgency and relevant medical and mental health concerns.  There are two types of CAPs referrals to Primary Care:  Same Day Urgent and Non-Same Day.

 

 

Procedure: 

For Same Day Urgent referrals:

The CAPS provider will contact the Charge Nurse to request a same day appointment and provide the appointment information to the student.

The Charge Nurse will attempt to schedule a 40 minute appointment with a primary care clinician if the schedule permits. Alternatively a 20 minute slot will be used if there are no other options.

The Charge Nurse will enter the reason code as "CAPS URGENT SAME DAY REFERRAL."

The primary care provider will consult with the charge nurse prior to evaluating the patient for critical safety and follow up information. In the event there are any additional questions or the CAPS professional  (or back-up) has additional information to share, the CAPS provider and primary care provider will communicate directly. The CAPS professional should make every attempt to complete at least a draft of the clinical note detailing the relevant clinical information for the same day referral.

The primary care provider should make every attempt to CC or instant message the CAPS provider their signed note upon completion.

 

For Non-Same Day Referrals:

The CAPS provider completes the Non-Same Day Referral chart note, indicating the relevant note for the primary care provider to review.  This note is visible to all primary care staff. CAPS staff should indicate if student needs to be seen within one week or can be seen within two to four weeks, as well as the general category of the referral.

The CAPS provider instructs the student to present to Primary Care Reception to schedule the appointment.

If a student presents to Primary Care Reception stating they were referred by CAPs, reception staff will review Visits/Notes in the EMR to review the Non-Same Day Referral from CAPS to SHS for instructions on visit type and priority.

It is the student's responsibility to present to Primary Care Reception to schedule the appointment

Syndicate content