Client Handbook

Safety Instructions and Guidelines

Weather Conditions

During the snow, ice and flood season, we will make every effort to continue your home care. But, the safety of our staff must be considered. When roads are too dangerous to travel, our staff will, if possible, contact you by phone to let you know if they are able to make the visit that day.

Floods

• Floods are most common and wide spread natural disaster.
• Be aware of flood hazards in your area. If the local authorities issue a flood warning, prepare to evacuate.
• Move essential items to the upper floors of your house.
• Do not touch electrical equipment, if you are wet or standing in water.
• Do not walk through moving water. Six inches of moving water can knock you off.
• Fill containers and bath tub with water in case water becomes contaminated or services are cut off.

Tornado

• Tornados are nature's most violent storms.
• When a tornado has been sighted, immediately go the basement. If there is no basement, go to an interior room on the lower level.
• Stay away from windows, doors, and outside walls. Get under the table, hold on and protect your head.
• If the patient is bed bound, move the patient's bed as far away from windows as possible. Protect the patient's head with pillows or heavy blankets.

Winter Storms

• Heavy snowfall and extreme cold can immobilize an entire region.
• Gather emergency supplies: A battery powered radio, flash light, food that does not require cooking, your medication, extra blankets, and extra drinking water
• Keep your home well heated. Stay indoors during the storm. Avoid drinking alcohol.
• Dress warmly even if you do not feel cold. Wear several layers of loose-fitting, lightweight, warm clothing.
• Wear mittens or gloves and a hat.
• Seek immediate medical attention if you have any following signs:
  • Drop in body temperature below 96 degree F, sleeplessness, confusion, slurred speech, stiffness in legs or arms, shivering.

Hot Weather Precautions

• Use air condition and keep house cool, if possible.
• Drink plenty of water. DONOT drink alcohol.
• Wear cool, light colored clothes, even if you don't feel hot.
• Signs of heat exhaustion: Cold, clammy skin, heavy sweating, nausea, weakness.
• Lie down, drink water and sponge off with cold wet cloth.
• Seek immediate medical attention if there are any signs of heat stroke:
  • Hot, dry skin, body temperature above 103 degree F or higher, fast strong pulse, confusion.

Safety Instructions

Medical Equipment and Oxygen

• Manufacture's instructions for specialized medical equipment should be kept with or near the equipment.
• Routine and preventive maintenance is performed according to the manufacturer's instructions.
• Emergency phone numbers are available in the home so that you can notify the company and obtain necessary instructions in case of equipment problem.
• Provide adequate electrical power for medical equipment that requires electrical power.
• If you have electrically powered equipment such as oxygen or ventilator, you must register at local power company. In case of power outage, notify local power supply company of your medical needs such as oxygen, ventilator, or IV pump. Check batteries regularly.
• Ensure electrical appliances and cords are clean and in good condition. Avoid “octopus” outlet with several plugs. Use grounded electrical outlets.
• Unplug electrical outlets before water comes in contact with the electrical outlets.
• There is no smoking around oxygen. Turn off oxygen before lighting candles.

Medications

• You need to know the name of each medication that you take, why you are taking it how to take it and its potential side effects.
• Never take medications that are prescribed for someone else.
• Do not take medications without reading the labels.
• Write down the list of medications that you take, show to your doctor and/or pharmacist to keep from combining drugs inappropriately.
• Report medication side effects to your health care provider.
• Take medications as instructed. Do not stop or change medications without your doctor's approval, even if you are feeling better.
• Keep all medications, cleaning agents, and poisons in their original containers.
• Store medications out of reach of children and pets.
• Store medications in a cool dry place according to instructions on the label. Protect medications from excessive cold or heat unless otherwise indicated.
• Medical supplies are secured in a clean dry area of your home. Dispose outdated medications by flushing pills down the toilet.
• Keep hazardous cleaners and chemicals out of reach of children, pets and confused individuals.

Fall Prevention

• Get up slowly to avoid dizziness.
• Lift feet while walking. Wear proper fitting shoes with rubber soles.
• Remove loose rugs and runners that tend to slide.
• Ensure steps are in good condition, free of objects and handrails, and are sturdy and fastened.
• Have good lighting throughout the house. Use night-lights for stairs, hallways, and bathrooms.
• Keep side rails (bed) up.
• Avoid slippery surface.
• Keep your telephone near your bed.
• Install grab bars in bathtubs and showers. Use non-skid mat or strips in the standing area.

Fire Safety Precaution

• Do not smoke while using oxygen. Do not smoke in bed.
• Do not use lighted matches or candles around any gas
• Do not use frayed electrical cords.
• Do not store gasoline in the home.
• Do not place heater near curtains, furniture or paper.
• Turn off heating pad before you go to sleep.
• Store flammable materials away from heat or fire.
• Have properly working smoke detectors in your home, hallways and near sleeping areas. Batteries are checked and replaced regularly.
• The heating system is checked and cleaned by qualified professionals.
• It is recommended to have a fire extinguisher located in a convenient location in your home.

In Case of a Fire, CALL 911

• Turn off oxygen (if any).
• Do not use elevators in a fire emergency. Leave the house through an alternate exit.
• If your fire escape is cut off, or unable to leave the house, remain calm. Close the door and stay in. Feel the door. If the door is hot or there is smoke outside, place towels (wet if possible) under the door to prevent the smoke from getting in the room.

Fire Emergency Procedures For Mobility - Impaired Persons

When the Fire Alarm sounds, do the following:

• If the fire is small and you have the proper fire extinguishers, PUT IT OUT.
• Prepare the client for evacuation. If wheelchair is unavailable, and client is not able to ambulate slide client to floor on a sheet or blanket and prepare to drag the client to safety.
• Get Disaster Supply bag, ventilator (in back pack), ambu bag (if necessary), necessary support equipment, and place on shoulders. . Keep hand free to transport client.
• Stay low and crawl to the door. Smoke fills a room from the ceiling down.
• Test the door with the back of your hand.
• If the door is hot, go to another exit.
• If the door is cool, open it slowly and go to your meeting place outside the home.
• Use a neighbor's phone and call for help (Dial 911).
• Do not go back in your home. You may be seriously injured.
• Report to the Fire Officer if anyone is suspected of being in the building after general evacuation; also report the location of the fire, if known.

Apartments

Follow the same rules and include the following:

• Take the stairs when exiting.
• Close the door behind you and take your keys.
• Do not use the elevator. Elevators may open at a floor on fire or stop working, trapping you inside.

Child Safety (in addition to general safety guidelines noted above)

• Store all medications out of reach of children.
• Keep cleaners and chemicals out of reach of children, pets and confused individuals.
• Keep side rails (bed or crib) up. Never leave child unattended on a high surface.
• Keep emergency numbers near your phone; include your doctor and the Poison control phone numbers.
• Poison Control Phone: 1-800-222-1222
• Always use a car seat or restraint appropriate for your child, install and use it properly.
• Keep electrical, phone and window cords out of the reach of your child, especially near cribs and on floors.
• Keep windows closed and locked when children are around. Do not leave children unattended on fire escapes or balconies.

Precautions for Client with Low White Blood Counts (Neutropenia)

• Take temperature at the same time each day, more often if not feeling well.
• Wash your hands after using the bathroom, petting animals, before eating.
• Avoid large crowds, people with contagious infections, colds and flu.
• Avoid changing infant diapers; if necessary wear disposable gloves and wash hands after.
• Ask your doctor if you need to wear a mask when you leave your home.
• Avoid children who have been recently vaccinated, often for 4 weeks after vaccination. Ask your MD for specifics on each type of vaccination to avoid and for how long.
• Avoid household cleaning, cleaning of pet excrement, gardening or repotting of plants.

Gravity Flow or Dial A Flow Delivery

• Remove tubing from the bag. Close the clamp.
• Pull off tab or flip off cap from medication bag
• Remove cap from spike end of tubing
• Push spike into opening on bag using twisting and pushing motion
• Hang the bag on the pole.
• Pinch the tubing chamber to fill chamber 1/3 - 1/2 full
• If using a separate “Dial-a-flow” regulator, attach this to end of tubing
• Open the clamp and allow the fluid to purge the air out of the tubing until fluid is dripping from the end of the tubing, close clamp.
• Flush the IV line with Saline
• Wipe IV end cap with alcohol and attach tubing to IV line, adjust rate for proper rate using counting method or dial-a-flow device. When using the dial-a-flow device, twist the regulator until the line is lined up with the appropriate rate of flow. Gravity infusions are gravity dependent and so the higher the bag is lifted on the pole, the faster the infusion will drip.
• Tubing is changed every 24 hours unless told otherwise
• After infusion is complete, disconnect tubing. If reusing tubing, apply sterile cap (red) to end of tubing. These will be contained in your supplies from the pharmacy. If for some reason they have omitted them, a cap from the end of a sterile Saline will fit on the end of the tubing and can keep the end sanitary until the next infusion.
• Wipe end of IV with alcohol, flush with Saline followed by Heparin via SASH protocol unless otherwise instructed

ELASTOMERIC PUMP PROCEDURE

• Remove medication from the refrigerator to allow to come to room temperature 1-2 hour prior to your dose time.
• Wash your hands.
• Gather your supplies: Prefilled Saline Syringes (2), Prefilled Heparin Syringe (1) if ordered, Alcohol swabs, Elastomeric device with medication
• Verify the medication for accuracy: Your name, Your medication, Correct dose, Expiration date
• Verify that the clamp on the tubing of the device is closed.
• Remove the cap from one of the Saline syringes, expel any air bubbles, swab the injection cap and flush the line as directed.
• Remove the cap from the end of the medication tubing and open the clamp to verify that the tubing is primed.
• Close the clamp.
• Swab the injection cap and attach the tubing to the injection cap.
• Open the clamp to begin the infusion. Note the time. Watch your medication to assure that the balloon inside of the device is collapsing slowly over time. If it doesn't begin to collapse, check the line for kinks, remove the tubing and reattach the tubing to assure a good connection.
• When the balloon is no longer extended, clamp the tubing and disconnect it from the injection cap.
• Remove the cap from the Saline syringe, expel any air bubbles, swab the injection cap and flush as directed.
• Remove the cap from the Heparin (if ordered) syringe, expel any air bubbles, swab the injection cap and flush as directed.