VENICE FAMILY CLINIC - Revised 3/2013 - VOLUNTEER CLINIC ASSISTANT HANDBOOK POLICIES, PROCEDURES & GUIDELINES
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
VENICE FAMILY CLINIC
VOLUNTEER CLINIC ASSISTANT HANDBOOK
POLICIES, PROCEDURES & GUIDELINES
Created By: VFC Medical Staff & Volunteer Services Department
Revised 3/2013Table of Contents
I. INTRODUCTION ............................................................................................................2
II. VENICE FAMILY CLINIC DRESS CODE....................................................................3
III. SAFETY GUIDELINES FOR VOLUNTEERS...............................................................3
IV. ROLE AND RESPONSIBILITIES OF VOLUNTEER CLINIC ASSISTANTS ............4
V. PATIENTS’ CHARTS......................................................................................................6
VI. PLACING PATIENTS IN THE EXAM ROOMS ...........................................................6
VII. PROCEDURES AND TESTS ..........................................................................................7
VIII. PATIENT WORK-UP ....................................................................................................10
IX. PRIORITY HANDLING OF ACUTELY ILL ADULTS: .............................................11
X. PRIORITY HANDLING OF ACUTELY ILL CHILDREN:.........................................11
XI. INFECTION CONTROL/AIDS RISK REDUCTION GUIDELINES: .........................11
X. VFC HYPOGLYCEMIA PROTOCOL..........................................................................13
XI. CONTACTS: ..................................................................................................................14
XII. VOLUNTEER REMINDERS ........................................................................................15
XIII. VOLUNTEER SKILLS SIGN OFF SHEET ..................................................................16
Attachments:
Pediatric progress note
General Adult progress note
Homeless Patient Progress note
VFC Hypoglycemia Protocol
Glossary of Symptoms
Basic Spanish for Clinic Assistants
1I. INTRODUCTION
Venice Family Clinic (VFC) is a free, primary medical care clinic serving low-income
families in greater West Los Angeles. VFC provides basic health care, as well as
specialized medical and social services to children and adults who have no other access to
such care.
Venice Family Clinic first opened its doors in 1970 in response to the needs of a community
that was medically underserved. Today, we serve over 23,000 patients each year. VFC is
formally affiliated with the UCLA School of Medicine. UCLA provides malpractice insurance
coverage for paid and volunteer medical staff.
VFC services are provided largely in part, by volunteer health professionals, including over
500 physicians who serve on a rotating basis. The paid medical staff includes 18
physicians, four nurse practitioners, four pharmacists, and six registered nurses.
Many of the volunteer physicians are residents from UCLA, Kaiser, Cedars-Sinai, and
Harbor, who volunteer as part of their training. Other volunteer providers come from private
practices, HMO’s and the faculty of UCLA.
VFC greatly depends on its large volunteer program. The volunteers include physicians,
registered nurses, nurse practitioners, pharmacists, health educators, clinic assistants,
psychiatrists, social workers, fundraisers, board members and others. The generous
support of volunteers enables VFC to offer high quality medical care at low cost per patient.
In all, approximately 2,200 people volunteer at VFC each year.
Venice Family Clinic is a private clinic that depends on fundraising events. Approximately
60% of VFC’s 22.3 million dollar operating budget is raised from non-governmental sources
(i.e. individuals, foundations and corporations).
Our patients are the ‘working poor’, unemployed, and homeless individuals without health
insurance. Only 25% of our patients have insurance — Medi-Cal or Medicare — and 73%
have annual incomes at or below the federal poverty level. 77% are minority group
members, 60% are female and 29% are children. VFC is their family doctor.
Thank you for joining our team. We appreciate the time you are taking to help us provide
these services. To help us provide the utmost quality of care, please adhere to the
following policies, procedures and guidelines we have created for you in the following
pages. We need your cooperation to make sure we best serve our patients as well as
continue to offer a strong Clinic Assistant program.
2II. VENICE FAMILY CLINIC DRESS CODE
This policy covers staff as well as all volunteers who work in patient care areas, i.e.
upstairs. Because Venice Family Clinic employees and volunteers represent the entire
organization to the public, we expect employees and volunteers to dress appropriately for
their jobs and respectfully for the people they serve. This dress code has been developed
to give staff and volunteers guidance in understanding the Venice Family Clinic’s
expectations and definition of appropriate dress.
Venice Family Clinic expects that everyone will choose clothing that is in good taste, that is
appropriate for the job duties to be done and that allow the job duties to be done safely.
1. Scrubs only.
2. Closed shoes must be worn at all times in VFC. If wearing tennis shoes, they must
be laced.
3. Must be groomed and fragrances must be kept to a minimum.
4. Name badges with work title must be worn at all times.
5. Blue jeans may only be worn on casual Fridays.
6. Do NOT wear:
a. Overly tight or revealing clothes. e. Stained, rumpled clothes.
b. Casual outfits that look like f. Brief midriff tops or tank tops.
exercise outfits, i.e. sweats, etc. g. Shorts.
c. T-shirts with offensive or h. Flip-flops.
suggestive language. i. Hats or sunglasses indoors.
d. No sport team jerseys.
III. SAFETY GUIDELINES FOR VOLUNTEERS
The goal of these guidelines is to make us aware of safety and security issues that you
might face when volunteering at Venice Family Clinic.
1. Parking: Parking is available in our garage, in the lot between 604 Rose Avenue
and 622 Rose Avenue, in the lot on 6th Avenue, or on the street. Our
garage parking is usually full but it might be a good idea to try during the
evening hours. There is a parking lot available for those at the Pico site.
Always lock your car and do not leave valuable items in your car.
2. Checking in: When entering VFC, please use the main entrance and let the security
guard know that you are here to volunteer. Sign in on the volunteer sign in
sheet. Once upstairs, use the door by the elevators to enter VFC area. By
using this door you be admitted without interrupting the front desk staff.
Please remember that it is mandatory that you wear your name
badge while in VFC.
3. In Clinic: Please make sure that you read and follow the Universal Precautions
when dealing with patients. Never leave sharp objects exposed, discard
3them immediately in the sharps containers after use. If you accidentally
hurt yourself, report the incident to a staff RN immediately, or a staff
provider if there is no RN on duty.
4. Patients: Some of the patients that we see are under severe stress and/or have a
mental illness. You should not be dealing with a patient that is potentially
violent. If you observe any unusual behavior in a patient or if you suspect
that they might be under the influence of drugs or alcohol, you should notify
a staff person immediately and have them take over. Staff is trained to deal
with potentially violent patients. Do not let a situation escalate, CALL A
STAFF PERSON IMMEDIATELY! It is important to remember that we all
work as part of a team and that the following information of unusual
behavior can be crucial for another member of our team to know. Warning
signs of a potentially violent person:
a. Shouting/verbal abuse (escalating voice)
b. Pacing/agitation
c. Hyperactivity
d. Hitting or banging items
e. Body language — pay attention to it
Verbal abuse, foul language, threats, or any actual act of violence to a staff, volunteer, or
property is not tolerated at VFC. VFC has a system to warn and ban patients from VFC
when their behavior is unacceptable. Please report any incidents to a staff person. If a blue
folder covers the patient’s chart, this means Venice Family Clinic staff should only see the
patient, and you should not interact with them. Do not let patients into VFC area unless you
have called them in or you are sure that they have been called. Check with Dispensary or
Lab staff, or a Clinic Coordinator if a patient claims they were called.
IV. ROLE AND RESPONSIBILITIES OF VOLUNTEER CLINIC ASSISTANTS
Clinic Assistants have a very important role at Venice Family Clinic. They enable the
providers to see patients in a timely manner by taking preliminary health information, vital
signs, serving as translators, directly assisting the provider with treatments, performing a
variety of laboratory tests, and keeping the examination rooms in order.
Clinic Assistants also perform a number of important services for the patients who utilize
the Clinic, answering questions, giving directions, translating, and doing anything to make
the patient feel at ease.
Responsibilities of VFC Assistant include the following:
1. Clinic Assistants are asked to arrive with a pen (black ink only!) and a watch with a
second hand.
2. Clinic Assistants need to arrive at the scheduled times. For morning clinics, 9am, or
afternoon clinics, 1pm, and for evening clinics, 6pm. If you are going to be absent,
you MUST call or email the Medical Volunteer Coordinator, Carlos Gomez (310-
664-7834) or rcgomez@mednet.ucla.edu at least one day in advance. If you do not
4contact the Medical Volunteer Coordinator when you will be absent, you will be
asked to leave your volunteer position after 2 unexcused absences at VFC. If you
are calling in the evening or on a weekend (when the Medical Volunteer Coordinator
is not available), you should try the following numbers: Coordinator’s Station, 310-
664-7707, Front Desk, 310-664 7703, or Nursing Station, 310-664-7755.
3. Clinic Assistants are to remain until all patients have been seen in their clinic and
the rooms have been straightened out for the next clinic.
4. Clinic Assistants MUST sign in and out and total their hours for each visit. If you
don’t sign in each and every time you volunteer, it will be assumed that you are not
showing up. Signing in also enables VFC to document the many hours donated,
which is especially important in grant applications and reports for funding sources.
5. Clinic Assistants MUST wear their nametags at all times while in VFC.
6. Clinic Assistants must always remember to ASK QUESTIONS of the RN’s and staff
medical assistants when they are uncertain of procedures.
7. Clinic Assistants should sign all notes and/or forms so that VFC has a complete
record of who was involved in treating a specific patient. Additionally, if questions
arise later, VFC Assistant might be able to provide the answers. Write your first
initial, last name, and Vol. (for Volunteer) on the progress note. WRITE IN BLACK
INK ONLY!
8. Clinic Assistants are to take the initiative in performing tasks that they are trained
and authorized to do. Please don’t wait to be asked to help!
9. Clinic Assistants should make certain that examination rooms and work-up rooms
are straightened and kept clean. Picking up items dropped on the floor or left on the
counter, putting back instruments to their proper place and replacing supplies are
examples of how Clinic Assistants can be helpful. (Please note that VFC staff must
do much of the cleaning of VFC. Clinic Assistants can help by watching for little
clean-up problems. Your help is greatly appreciated!)
10. Clinic Assistants need to take the necessary precautions to protect themselves and
patients. The Venice Family Clinic adheres to State and Federal OSHA regulations
and is concerned about YOUR health and safety. All volunteers are required to read
the Safety Guidelines for Volunteers’ handout. Please ask about this and take time
to read it. VFC REQUIRES YOU TO WEAR GLOVES WHEN HANDLING ANY
TYPE OF BODY FLUIDS (BLOOD, URINE, SALIVA, VOMIT, FECES, ETC.) AS
WELL AS WASHING YOUR HANDS BEFORE AND AFTER EACH PATIENT
VISIT. Please make sure that you have read Infection Control/AIDS Risk reduction
Guidelines. If you have had contact with an infected wound, or a child who may
have a contagious illness (i.e. Chicken pox, poison oak), sanitize hands.
11. Serving the patients is the primary function of all Clinic Assistants. Although VFC
desires to provide medical training and practical experience to the greatest extent
possible, that goal is definitely secondary to meeting the needs of our patients.
Please do not ask providers if you can shadow them.
12. Clinic Assistants are responsible for learning all the basic procedures outlined in the
training workshop and in the following sections, and should become familiar with all
Clinic services. The outpatient clinic regulations of the State of California, under
which VFC is licensed, requires that each staff person and volunteer who has
5patient contact provide proof of a current TB skin test (within the last year) and a
Rubella and Rubeola immunization for Clinic records (anyone born before 1/1/57 is
exempt from the Rubella/Rubeola immunization). If your TB skin test has been
positive in the past. DO NOT HAVE ANOTHER, you will need to get a chest x-ray,
which is valid for three years. You will not be allowed to begin volunteering until you
show written proof of the above. There are two reasons for these regulations:
(1) to assure that a staff person or volunteer who may have contracted/been
exposed to Tuberculosis, is not unknowingly infecting patients and other staff or
volunteers, and,
(2) to periodically check and make sure no staff person or volunteer has
contracted/been exposed to Tuberculosis from the patients.
V. PATIENTS’ CHARTS
You will need to familiarize yourself with the chart and the chart layout, since you will be
writing in these charts along with the providers. Not only is the chart a valuable tool for
understanding the patient’s past medical care, it is also a legal document and must be filled
out correctly. You will get plenty of experience with the charts as you volunteer in VFC.
Please see attached progress notes and the proper way to fill them out. Included are the
Pediatric Progress Note, General Adult Progress Note, Homeless Progress Note, PECS
and Diabetes Progress Note.
Please note the following on the Pediatric Progress Note:
1. The height, weight and head circumference (taken up to the second birthday) were
recorded.
2. The method of temperature should be circled. All patients should have their
temperature taken as part of the work-up.
3. Blood pressure tests are not necessary until the patient reaches three years of age.
4. Children ages three years and older should have their blood pressure at every visit.
5. Children two years and under need birth weight recorded.
VI. PLACING PATIENTS IN THE EXAM ROOMS
One of VFC Assistant’s major responsibilities is to have the patients ready to be seen by
the provider. This includes:
1. Obtaining the patient’s chart from the rack at the front entrance
2. Calling the patient from the waiting room by the patient phone
3. Taking the patient into one of the work-up rooms, where weight, blood pressure,
pulse and temperature will be measured. All infants and children under the age of
two should be weighed without diapers and clothing. There is a measuring device in
one hall for height.
64. Any patient presenting emergent/urgent symptoms must be brought to the attention
of staff. Please refer to your Priority Handling of Acutely Ill Adults/Children’.
5. Escort the patient into an empty exam room, and always make sure the exam room
is clean.
6. Obtain a brief chief complaint and recording this in the chart.
7. Recording the patient’s name and room number on the appropriate Daily Patient
Log.
8. Do any additional work-up that may be necessary according to the ‘Work-Up
Required’ handout.
Daily Patient Logs:
Daily Patient Logs are posted inside the charting areas. The patient’s name and room
number should be recorded on the log. Please indicate in parentheses after the patient’s
name, his/her preferred language, E = English, S = Spanish.
VII. PROCEDURES AND TESTS
HOW TO TAKE A TEMPERATURE:
1. Getting Ready:
a. If the patient is a child, stay with the child and make sure he/she remains still.
b. Parent should assist in holding the child.
2. Taking the temperature:
a. By Mouth: All children approximately two years of age and older
i. Place thermometer in plastic sheath
ii. Place end of oral thermometer under tongue
iii. Tell patient to close mouth, but not to bite thermometer
iv. Leave in place until device signals, remove thermometer
v. Never leave a child unattended with a thermometer in rectum or mouth
b. By Rectum: Recommended for all children who are sick and who cannot cooperate
with oral temperatures.
i. Coat end of rectal thermometer sheath with K-Y Jelly
ii. Gently insert, no further than one-half inch
iii. Leave in place until device signals, remove thermometer
iv. Never leave a child unattended with a thermometer in rectum or mouth
c. By Armpit: Only if unable to do rectal or oral temperature, if child is well or if parent
refuses rectal temperature. (I.e. jaw wired, uncooperative toddler).
i. Armpit should be dry
ii. End of either thermometer should be held under arm with arm snug against
body
iii. Wait for device to signal
HEIGHT AND WEIGHT MEASUREMENTS:
Infants and children: Infants and children must have height and weight taken at all visits,
with shoes removed. Infants less than two years need to have their
head circumference measured. Infants 1yr and younger should be
7undressed for weight.
Adults: Weight should be taken at all visits
Height: Height should be measured with the patient standing erect, shoes off, feet
together, and eyes looking straight forward.
Weight: Weight should be measured after heavy clothing has been removed.
Head: Circumference: place the measuring tape at mid forehead and measure the widest
point around the head.
Infants: Infants should be weighed on the infant scale (in the work-up rooms). Before
using the scale, check to see that it balances at zero. The roll of paper on the
table should be changed before each patient. All of the infant’s clothing must be
removed. Note which scale is used.
BLOOD PRESSURES:
Blood pressure readings reflect the amount of pressure required to pump blood through the
body. Normally, the heart is pumping the required amount of blood through regular, healthy
blood vessels. The pressure in the arteries rises and falls with each heartbeat, thus, there
are two readings when blood pressure is measured.
Blood pressure is recorded as Systolic over Diastolic (i.e. 120/60).
Systolic: When the heart is working (contracting phase) and pumping blood. This is
the maximum amount of pressure the arteries usually undergo.
Diastolic: When the heart is between beats (relaxation phase) and resting for a
moment. This is the minimal amount of pressure the arteries constantly sustain.
Measuring blood pressure is a skill, requiring good hearing and eyesight as well as the
ability to coordinate between eyes, ears, and hand skills. Inaccurate blood pressure
measurements can result in false diagnoses, either diagnosing something where it doesn’t
exist or missing something where it does exist.
STANDARD TECHNIQUE:
The blood pressure cuff is placed around a person’s upper arm and inflated with air, thus
putting pressure over the brachial artery and temporarily stopping the blood flow. By
opening a valve, the pressure in the cuff is released, allowing the blood flow to gradually
resume. A stethoscope is placed over the artery at the bend of the elbow (antecubital
space). Blood pressure sounds (Korotkoff sounds) may be heard as rhythmic ‘beats’ until
total resumption of blood flow is achieved. The sound then disappears. The numbers you
record are (I, systolic) where you first heard the beat and (2, diastolic) when the sound
disappears.
Clinic Assistants should learn and practice the following steps in order to measure blood
pressure accurately:
Approach to Patient:
81. Introduce yourself to each patient and get chief complaint
2. Explain that you will be taking the blood pressure
3. Instruct the patient to relax, place feet flat on the floor, and sit up straight, keeping
arm at heart level
Placing the Correct Cuff Size:
1. Cuff should cover 213 of the upper arm
2. There are four kinds of cuffs: (I) children’s cuffs, (2) regular adult cuffs, (3) large
cuffs for obese patients, and (4) thigh cuffs for extremely obese patients
3. Palpate brachial artery
4. Clothing should be out of the way of the cuff
5. Apply cuff snug and evenly, one inch above the elbow
Stethoscope Placement and Inflation:
1. Place diaphragm of stethoscope on bare skin over brachial artery but NOT touching
cuff or tubing
2. Apply slight pressure of diaphragm with one hand
3. With the other hand, inflate cuff rapidly, using a smooth, continuous rate, to around
4. 160mmHg initially, or higher if necessary
5. Do not stop during inflation and start again
6. Deflate slowly, 2-4 mmHg mercury per heart beat
7. Read the manometer at eye level
Systolic Blood Pressure:
1. The first audible beat (the number on top)
Diastolic Blood Pressure:
2. The last audible beat OR THE LAST BEAT BEFORE A CHANGE IN VOLUME (this
is the bottom number)
Readings:
1. Always use EVEN numbers when recording blood pressure
2. Note which cuff is used and indicate if you had to use a small or large cuff
3. If you are unable to hear, try again after waiting about 1-2 minutes. Also you may try
the other arm. If you are still unable to hear, ask a staff member to help.
4. Normal range for an adult Systolic 100-140, Diastolic 60- 86
5. Normal range for a child: Systolic 90- 126, Diastolic 50-80
CHECKING BLOOD GLUCOSE LEVELS:
Have all supplies ready before beginning. Supplies needed:
1. Gloves — put on BEFORE starting
2. Blood glucose monitors — found in the Lab. You have to sign out for the machine.
3. Blood monitor strips — also found in the Lab. Make sure the strip code matches the
monitor code.
4. Alcohol pad
5. Cotton balls
6. Small band-aid
9Procedure:
1. Clean end of finger (patient’s preference) with an alcohol pad and dry with cotton
ball
2. Activate NEW lancet.
3. Turn machine on. Instructions will read:
a. I. Insert strip (you should insert the test strip),
b. 2. Wait and
c. 3. Apply sample.
4. To remove lancet end cover, twist and pull
5. Apply slight pressure to the finger until some blood appears; wipe away the first drop
of blood. Apply slight pressure again, until enough blood for a sample appears.
6. Wait until the glucometer beeps, for total blood sugar results and record results in
chart.
7. Remove used lancet and discard in Sharps container. Dispose of other materials
(alcohol pad, cotton, etc.) in regular trash.
8. Return monitor to its place
9. Remove gloves and wash hands
VIII. PATIENT WORK-UP
CLINIC WORK-UP REQUIRED
Adult Chief Complaint, height (at first visit), weight, BP, pulse, BS if diabetic, Peak
flow for asthma patients, BMI.
Women’s Chief complaint, weight. BP, specific GYN information on pink progress note,
BMI
Prenatal Weight, BP. Popra progress notes need to be placed in chart
HP New patient: Chief complaint, weight, height, BP, pulse, temperature, BMI
Follow-up patient: Chief complaint, weight, BP, pulse, BMI
Peds/Teens New patient: Chief complaint, weight, height, head circumference (if < two
years), temp. and BP (if three years of age and annually)
Follow-up patient: Chief complaint. weight, height, head circumference (if<
two years), and temperature
OTHER WORK-UP THAT MAY BE REQUIRED
1. Urine analysis should be done with assistance of staff, on anyone including pediatric
patients with any urinary symptoms such as frequency, burning, or blood in urine,
etc.
2. Peak flow meter measurement for patients with asthma
3. Check with the nursing staff if the patient is an anemic follow-up
4. Chief complaint should consist of one brief phrase or sentence.
**IF A PATIENT APPEARS ILL OR VITAL SIGNS ARE ABNORMAL (i.e., CHEST
PAIN, SHORTNESS OF BREATH, BLEEDING, DIASTOLIC BP ABOVE 110, HIGH
TEMPERATURE, ETC.), NOTIFY PROVIDER IMMEDIATELY!
10IX. PRIORITY HANDLING OF ACUTELY ILL ADULTS:
Since volunteer clinic assistants make the initial contact with patients presenting for care; it
is critical that symptoms and signs of acute or severe illness be recognized. Attached, you
will find a handout on Policies and Procedures for Acutely ill adults. Anyone presenting with
the complaints or findings from this handout should be referred immediately to the
attending physician, RN on the floor, staff CMA, or clinic coordinator.
X. PRIORITY HANDLING OF ACUTELY ILL CHILDREN:
Certain acutely ill children may be seriously and dangerously ill and should not be kept
waiting. A nurse or physician should be called immediately to evaluate a child who falls
into one of the following categories:
1. Any infant under six months of age who:
a. Has a fever greater than 100
b. Has diarrhea and/or vomiting
c. Is blue in color
2. Any child:
a. With a high fever (102° or higher orally and 103° or higher rectally) and
appearing unresponsive, and lethargic (toxic)
b. With a fever and a rash
c. Who has difficulty breathing or who is choking, wheezing, having an
asthma attack, crowing, croupy, or turning blue
d. With a systolic blood pressure over 126
e. With a diastolic blood pressure under 50
f. With a history of head injury who has symptoms such as drowsiness,
difficulty rousing, vomiting, or bleeding from the ear or nose
g. With convulsions or loss of consciousness
h. With severe abdominal pain
i. With uncontrolled bleeding
j. Who has ingested poison, medications, or a foreign body
k. With burns
l. With eye trauma
m. Anyone you are worried about or have any doubts about for any reason
XI. INFECTION CONTROL/AIDS RISK REDUCTION GUIDELINES:
It is recognized that AIDS syndrome is a complex disease with an extremely high mortality
rate caused by the human immunodeficiency virus (HIV). HIV is known to be transmitted
via blood and body fluids, (semen, vaginal secretions, breast milk). The increasing
prevalence of HIV increases the risk of exposure to health care workers. Therefore, this
policy outlines minimum precautions to be followed with all patients in an attempt to
minimize the risk of HIV and Hepatitis transmission. Recommendations are based on the
CDC Guidelines as reported August 21, 1987 and February 1989, (“Guidelines for
Prevention of HIV & Hepatitis B Virus to Health-Care and Public-Safety Workers”).
11Universal Precautions:
Since medical history and examinations cannot reliably identify all patients infected with
HIV or other blood-borne pathogens (such as Hepatitis B), blood and body fluid precautions
should be consistently used for all patients. All patients should be assumed to be infectious
for HIV and blood-borne pathogen.
1. Gloves should be worn when:
a. Touching blood and body fluids (semen, feces, urine, vomit, amniotic fluid,
vaginal secretions, breast milk, and joint fluid), mucous membranes or
non-intact skin of all patients
b. Handling items or surfaces soiled with blood or body fluids
c. Performing venipunaures or other procedures, such as hematocrits,
requiring vascular access
d. You have open sores or cuts
2. Gloves are to be changed after contact with each patient
3. Wash hands immediately after gloves are removed with soap and warm water
4. Wash hands and other skin surfaces immediately:
a. After using the restroom
b. Cleaning up blood, urine, feces, or vomit
c. Before preparing food
d. If contaminated with blood or body fluids
5. All sharp items are to be disposed of in puncture resistant containers in each
exam room, immediately after use
6. Because of the possibility of intranatal transmission of HIV, pregnant health care
workers should be especially familiar with and strictly adhere to these
precautions
7. Shoe covers should be worn if large blood contamination of floor occurs
Precautions for Handling of Laboratory Specimens:
Blood and other body fluids from all patients should be considered infective.
1. Gloves should be worn during venipuncture (i.e. hematocrit), and while
handling any open container of body fluids (i.e. during urinalysis).
2. Needles and syringes should not be recapped, in order to reduce needle-stick
exposure.
3. Needles, syringes and used blood tubes should be disposed of in the
puncture-proof containers located in each exam room and in the lab.
4. Care should be taken when collecting each specimen to avoid contaminating
the outside of the container.
5. All specimens of blood and body fluids should be placed in a sealed zip-lock
plastic bag for transport
6. Wash hands immediately after handling all lab specimens.
Environmental Considerations:
12No environmentally mediated mode of HIV transmission has been documented. However,
the following precautions should be routinely taken with all patients.
1. Disinfection of patient-care equipment
a. Gloves must be worn while handling contaminated equipment
b. When possible, equipment should be washed in warm, soapy water to remove
soil prior to disinfection
c. Cleaned instruments are to be soaked in germicide or a 1:10 dilution of
household bleach for 10 minutes. Containers of bleach are located in the nurses’
station.
2. Cleaning and decontaminating spills of blood or body fluids:
a. Visible material should be removed. Gloves should be worn.
b. Area should then be decontaminated using recommended dilutions of a
germicide or 1:10 solution of household bleach.
3. General housekeeping
a. Environmental surfaces (i.e. walls and floors) are not associated with transmission of
infection to patients or health care workers. However, it is important to keep VFC as
clean as possible. Bathroom and exam areas can be cleaned with regular soap and
water and can be disinfected with Citrace or 10% bleach solution, if needed.
4. Disposal of infective waste.
a. Potentially infective waste products include.
i. All blood containers and any disposable equipment used in collecting blood
specimens.
ii. All needles and syringes.
iv. Dressing materials saturated with large amounts of blood or body fluids.
v. Any disposable equipment utilized for invasive procedures (i.e. suture kits,
scalpels, and blades).
b. All potentially infective waste listed above should be disposed of in RED bags to
ensure proper handling by cleaning services.
c. Large amounts of blood and body fluids can be carefully poured down a toilet for
disposal.
X. VFC HYPOGLYCEMIA PROTOCOL
If blood glucose < 70:
1. Ask patient if having any symptoms. This includes sweating, shakiness, tachycardia,
weakness, dizziness, confusion, anxiety, blurred vision, fatigue. If symptoms are severe,
such as a seizure or loss consciousness, treat as an emergency. Alert all providers
overhead, open crash cart and administer Glucagon.
2. Alert a physician immediately if patient symptomatic or if blood sugar is < 60 with or
without symptoms. Diabetic patients may be unaware of severe hypoglycemia, yet still
require immediate attention.
133. Administer 15g of glucose gel or other glucose product. Appropriate alternatives are
juice, raisins, hard candy. Avoid diet or high fat products (Glucerna, Diet Coke)
4. Recheck blood sugar 15 min after treatment. If hypoglycemia persistent, repeat
treatment and recheck after 15 minutes. Once blood glucose returns to normal, pt
should consume a meal or snack to prevent recurrence.
XI. CONTACTS:
For all Clinic Assistant questions including scheduling, please contact:
Carlos Gomez
Medical volunteer coordinator
310.664.7834
rcgomez@mednet.ucla.edu
After hours or to speak to one of the medical staff:
Coordinator’s Station: 310-664-7707
Front Desk: 310-664-7703
Nursing Station: 310-664-7755
For general support, questions and concerns:
Ingrid Trejo
Director of Volunteer Services
310-664-7532
itrejo@mednet.ucla.edu
14XII. VOLUNTEER REMINDERS
Please be aware that some scenarios require additional steps. We are here to
help you and provide a great service to our clients.
Reminders for volunteers:
Complaints of (c/o) urinary problems: ask client to give a urinary sample and
leave it in the metal cabinet in the bathroom(s) by the lab. The sterile cups are
located outside the restrooms. A label must be placed on the sterile cup. Also
give hygienic towelette to all females (located in the drawer). Inform the assigned
Medical Assistant (MA) to “dip” the urine.
HIGH blood sugar (>350): ask for urine sample. Inform the assigned MA to “dip” the
urine.
LOW blood sugar (160/100): re-measure; RN/MA to be notified.
Fevers require an oxygen-saturation (O2-sat) measurement.
If c/o coughing give mask (adult and Pediatric).
Asthma/COPD/shortness of breath (SOB): Peak flow and O2-sat (if client is actively
having difficulty breathing, inform RN/MA immediately).
Any c/o rash: RN to be notified
Any vision concerns require a visual acuity exam. Ask assigned MA.
Any abnormal vital signs are to be documented on sign-up sheet.
If chief complaint (c/c) is for f/u on results. Obtain results and place in chart. Ask
assigned MA for further instructions.
Screen for smoking. If yes check box off, then ask them if they are interested in the
“No Butts” card (located in each work-up room). Document on progress note if
card given or if client declined.
Document body mass index (BMI) on all clients.
Document height on all new clients.
Screen for influenza vaccine: please help us by asking clients if they are interested
in getting the flu vaccine. If they are let the MA know. If not, then document on
progress note.
Scabies/Lice: disinfect work-up room after performing vitals. Wipe down all
surfaces with dispatch.
All women are to be screened ONCE per year for domestic violence (DV). Forms
in each work-up room.
All diabetic (DM) clients should be asked to take shoes off. Provider needs to
check feet. Use table paper to place on floor for client’s bare feet.
All clients should be asked if they brought in their medication(s). If yes, please
place all bottle(s) on tray or counter area.
Any unusual occurrence notify staff member.
Thank you for your interest in volunteering at VFC. We greatly appreciate it.
Thanks,
Nursing Staff
15XIII. VOLUNTEER SKILLS SIGN OFF SHEET
Name: ___________________________________________ Start Date: ______________
BASIC SKILLS Date Checked Off
Height and Weight – Adult ____________________
Height and Weight – Child ____________________
BMI ____________________
Temperature - Oral/Buccal ____________________
Temperature – Axillary ____________________
Temperature – Rectal ____________________
Pulse ____________________
Head Circumference ____________________
Blood Pressure – Adult ____________________
Blood Pressure – Child ____________________
SPECIAL SKILLS Date Checked Off
Blood Sugar ____________________
EKG ____________________
Visual Acuity ____________________
Audiometry ____________________
Women's Progress Note
Family Planning Notes
Pediatric Progress Note
Prenatal Progress Note
16Attachments
17_______________________________________________________________
_________________ __________________________ _______________________
_____________________
____________
Cl III I) \‘(SI I IC )RM Cl tNl( (‘C )l)F I)’\ I
N AM
(lIAR I 5 1)011
At)V[RSt DRC ‘C RE ACTI( IN
\ RS \1() SI N ]M Th
I-It. in.( 00) Wi. lbs.( 0)
Birth Wi. lbs. IIC crn.( 0)
Temp ORA B.P. ( 0)
0)
BMI ( Chief Complaint: CMA
HI SToRY
PhYSICAL NI Ab No Describe if abnormal PhYSICAl. NI Ab No Describe if abnormal
EXAM nl Ex EXAM nI Lx
General Back
Appearance (Scoliosis) — —
Skin Heart
I lead Lungs
\es (P1 RRI A, Breasts — —
conj strahismus
.
I ars Abdomen
( I Ni’s canals)
Nose Genitalia
I hroat I eeth I’ eel
Extremities
Neck Neuro/Des el
Other
I Eth’ - U A: glu bili ket sp.g bId ph pro -. uro nit leuk other______
Visual Acuit: RtLt_______ ‘*
Lens: Rt Lt Hearing: N Abn. Tvmpanometrx: N Abn.
Issues [)iscussed: Fever Mgt. Nutrition DentaI Lead Poisoning Safety DV DSmoking WIC Dev. Medi-Calins.
ASSLSSMLNF: Immun. up to date? Y’ N DTaP/lPV.’hlBV h1IB PCV DIaP ThPV R0TAV hIBV MMR DVaricella
v1MR’V IIepA OTd Tdap MCV4 IlPV PP[) FLU D’FaP.!IPV/IIIB
Records needed
O&P Tslenol Dose:
j PLAN:
2.
a.
3 4.
RTN APPT. IN: days/wks/mo WITH:
M1.DICAT ION Strength AMT INSTRUCTIONS RefiIl
Pros ider ignaturc Print name - MD
BILLING INFORMATION
Attending Note (Care provided under the continuity clinic exception rule, Billing at Level I. 2. or 3,
all residents and any interns with greater than 6 mos experience). I reviewed and discussed the case of’ this patient BILLED
ssith the resident, including the findings in history, physical examination and the diagnosis and treatment plan at the
time of toda’s visit I provided the personal direction in the services rendered at this visit and I agree with the findings, CPE DUE
diagnoses, and plans as documented in the resident’s note
CHDP DUE
Attending signature: (clearly sign). MD
Documents and Settings\monica\Msdocuments\CHDVSTFM2008d0cN0rma 12 18 08____ _______
_____
____
Vencemiy CInc
ADULT PROGRESS NOTE Patient Name:
CLINIC CODE Chart Number: _DOB
ADVERSE DRUG REACTION: — Today’s Date: —
hi 00) PRE S RE P JL F ThMP WEIGHT AGE BLOOD SUGAR BC B
UA gi bil ket sp g bid ph prot uro nit leuk othcr
CHIEF COMPI MN I: C A.
SMOKER: YES E NO
-- —
Immunization up to date: YES NO E PLAN: Td PPD fl E Assesed for Domestic Violence
[ Past Present None
L1Hlth Ed discussed with patient and understood LiLabs discussed with patient and understood
MEDICATION STRENGTh NUMBER INSTRUCTIONS #REFILLS
PROViDER SIGNATURE(S) MD.
PRINT NAME.
Attending Note: (care provided under the continuity clinic exception rule, billing at Level I,2or 3; all residents and any interns with
greater than 6 mos, experience)
I reviewed and discussed the case of this patient with the resident, including the findings in history, physical examination and tht.
diagnosis and treatment plan at the ime of today s visit, I provided personal direction in the services rendercd a this ‘y5 and I agree
with the fir ding diagnoses and plans a documented in the resident’s iote
S gnature (w ite c early) —
o’et md 6 ng \L,xJ Suwg por h,wmet 0060 0 ‘ LiLT PROGRNSS NO 0 06 o 1)_________ _____________________________/
__________________
______________
__________ ______________ __________ __________________________
_____________________
__________
_______________
______ _________
_____
___________________ ____
______
___________
_____
____________
_______
Venice Farmy Clinic
PATIENT NAME:
CHART NUMBER: DOB:
HOMELESS CLINIC PROGRESS NOTE TODAY’S DATE:
ADVERSE DRUG REACTION:
BLOOD PRESSURE PULSE__TEMP _WEIGHT____ AGE BLD SUGAR Hgb
UA: glu bili Ket sp.g bid_____ — ph pro uro nit leuk other
CHIEF COMPLAINT: C.A.
SMOKER: LI YES LI NO El CESSATION DISCUSSED Living Situation
How long homeless?
Family —
Income
Meals_____ Need help? C Yes C] No
Transport _Need help? C Yes C] No
Alcohol 13iast C] Current C] Never
Amount Last used
Drug use C] Past C] Current C] Never
Type Last used —
C] IVDU C Past C Current C Never
O Risk reduction discussed
Tetanus
PPD (q yr) TB symptoms
Psychiatric hx
Last PAP Mammo
PAP offered today DYes ONo C] Declined
Sexual activity M W # partners in past mos/yrs
Condom use C Always C Sometimes C] Never
Family Planning
Last HIV Test
HIV Test Offered DYes CNo C Declined
C HIV/STD prevention discussed
Domestic Violence C] Past C Present C] None
C Substance Abuse Resources C]Declined C]Needle Exchange C Dental Referral C] Tokens/Taxi
C] Mental Health Resources C Declined C Food Resources C Social Service/Shelter C] Condoms C] Hygiene Kit
C]Hep. B C]Influenza DPneumovax Cm CPPD CDeclined Vaccinations C] Out of stock CClothing/shower
Health Ed. Topic discussed with patient & understood Labs discussed with patient & understood
MEDICATION STRENGTH NUMBER [NSTRUCTIONS
PROVIDER SIGNATURE(S) — M.D.
PRINT NAME:
BREHOVE HOMELESS CLINIC PROGRESS NOTE 3117/2010glossary
of Symptoms
Symptom Definition
Abnormal Unusual loss of blood from stools, urine,
Bleeding bleeding gums, internal organs.
Chills A feeling of being cold and shivering, usually
with pale skin and a high temperature.
Cough Rapid expulsion of air from the lungs in order
to clear fluid, mucous, or phlegm.
Diarrhea Having loose and watery stools (bowel
movements) often.
Disorientation To lose a sense of time, place, and one's
personal identity.
Dizziness A feeling of unsteadiness.
Dyspnea Shortness of breath or difficulty breathing.
Fever A rise in the temperature of the body above
normal, usually when the body has an infection.
(A temperature taken by mouth greater than
100.4˚ Fahrenheit means you have a fever.)
Headache A pain located in the head, as over the eyes,
at the temples, or at the bottom of the skull.
Hemoptysis Coughing up blood (or bloody mucous).
Jaundice Yellowing of eyes, skin.
Loss of
No desire to eat.
Appetite
Loss of Not responsive, not aware, not feeling, not
Consciousness thinking (sometimes as a result of fainting).
(Unconscious)
Malaise Feeling generally weak and tired, and bodily
discomfort.
Nausea An unpleasant feeling in the stomach, with
an urge to vomit (throw up).
Pain An unpleasant feeling in the body that can range
from being mild to extremely painful. The pain
can be physical or emotional. Body pain is
physical pain, usually due to tissue damage.
Rash Red bumps (or flaky patches) on the body
that are sometimes itchy.
Sore Throat Pain or discomfort in swallowing.
Tremor An uncontrollable trembling, shaking, or
quivering from physical weakness, emotional
stress, or disease.
Vomiting To throw up what is inside the stomach
through the mouth.
Division of Communicable Disease Control IMM-835 (3/05)glossary
of Symptoms
Symptom Spanish Chinese Korean
Abnormal
Sangrado anormal
Bleeding
Chills Escalofrío
Cough Tos
Diarrea, excrementos
Diarrhea
líquidos
Desorientación,
Disorientation confusión mental
Sentirese
Dizziness desmayado
Dificultad de
Dyspnea respirar
Fever Fiebre
Dolor de
Headache cabeza intenso
Tos con
Hemoptysis sangre
Piel y ojos de color
Jaundice amarillo (ictericia)
Loss of Pérdida del
Appetite apetito
Loss of
Consciousness Desmayarse
(Unconscious)
Indisposcición o
Malaise malestar
Ganas de
Nausea vomitar o náuseas
Pain Dolor
Erupción o
Rash
sarpullido
Dolor de
Sore Throat garganta
Temblor
Tremor continuo
Vomiting Vómito
Division of Communicable Disease Control IMM-835 (3/05)You can also read
