Licensed Practical Nurse (LPN) - Full-time (All Shifts) | Inpatient Services

GENERAL JOB DESCRIPTION

The Licensed Practical Nurse works with agency clients inthe Adult Residential Program (both STC and LTH/IOP). The Licensed PracticalNurse orients clients to the agency and the expectations of services which areto be received through the Medical Staff and managing the agency clients’medical care. The Licensed Practical Nurse facilitates health care services asa support to the clients’ own self-management. All residents are responsiblefor their own health care services and management of their medicationadministration and supply of that medication. It is not the policy of the agencyto provide all medical services to agency residents.

DUTIES &RESPONSIBILITES

It is the duty and responsibility of the Licensed PracticalNurse to:

• assess potential residents for appropriatenessfor the treatment program;
• complete an updated assessment on each clientafter admissions;
• complete a medical treatment/discharge planbased on updated assessment;
• communicate the treatment plan with thetreatment team upon admission and on a monthly basis;
• provide on-going health education to allresidents as outlined in the Residential Program Manual;
• provide on-going assessment of acutemedical/nursing needs of all residents and refers residents to appropriatetreatment centers;
• monitor prescribed medication consumption andtreatments that includes assessing resident knowledge and understanding ofmedication and treatment regimens, as well as, accuracy of administration;
• coordinate the management of patient’s medicationstock including pharmacy pick-up and drop-off of meds, calling in refills forclients, and upkeep of how medication is stored;
• conduct urine drug screens on all residents asdirected to do so;
• conduct weeklypsycho education classes;
• follow treatment care plans set forth by themedical staff;
• document all pertinent health relatedinformation about residents on the resident chart that is done routinely andaccording to nursing standards of practice;
• complete Incident Report form before the end ofa shift if applicable; and
• maintain HIPAA guidelines; and
• perform other duties as assigned.

Client Inductionduties include the following:

• Nurse will review all admissions packets todetermine if potential client is eligible for program and if they need PPD,medical records requested, H & P, Psych evaluation. On review of thecandidate’s drug of choice, last use and consumption level, a determination ofneed for medical detox may be necessary as well.
• At time of admission, ALL new admits will meetwith a staff nurse. At that time, MARs form, determination of med call schedulefor patient, education on med refill process, med slips, and general healthconduct will be explained and documented by the nurse and placed into a medicalchart.
• Nurse will place PPD within 72 hours ofadmission to the program and read within 72 hours of placement. Any clientswith a positive PPD or showing signs of possible TB infection will be referredto the Wetmore Clinic for further follow up.
• Photocopy any insurance or Medicaid card forchart. Document emergency contact and relationship in the event client goes toER or needs financial assistance for medical.
• Review of chart will be determine if patientwill go onto the psychiatry schedule based on initial determination to enterprogram. (i.e. follow-up, first visit within 30 days, or prn).

Psychiatry dutiesinclude the following:

• Work with Community Health Center (CHC) staff toensure that clients who are in need of a psych evaluation as indicated by theirinitial screen or at the Chief Medical Officer’s request are scheduled for anappointment.
• Work with treatment staff to report appointmentsand assist in scheduling if needed.
• Print out notes/visits from the EHR for clientcharts and submit for filing.
• Receive any verbal orders by providers,document, and facilitate them.

Medical dutiesinclude the following:

• Medical slips will be picked up twice daily fromthe treatment team office.
• Nurse will take vital signs on patients thathave medical complaints that require triage and present them to the CHC withthat patient’s chart ready for review.
• All HIV screening will be offered to OHL clientsby the CHC. The Nurse will coordinate with the CHC as needed.
• Nurse will call and coordinate clients to CHC asneeded.
• Nurse will review all charts seen by the CHC andor arrive by medical feedback sheet and follow instructions as directed. It maybe necessary to educate client on diagnosis and treatment plan with goals.
• Print out notes/visits from electronic healthrecords for client charts and submit them for filing.

Treatment TeamMeetings duties include the following:

• Nurse will attend the weekly treatment teammeeting and bring any concerns to the Counselors regarding clients and listento concerns of the Counselors and assist if it is a Medical Staff issue.
• Nurse will bring and present the MAR book in theweekly treatment team meetings.

Discharge dutiesinclude the following:

• All clients discharged or graduated from OHL,will obtain their personal medication from the front desk and sign anacknowledgement receipt of the medications that they receive. This receipt isto be scanned into the client’s chart.
• Medical Staff Daily Inquiries – Report withnight staff for shift change.
• Check in with the Front Desk to know if anyclients went to the ER after hours and attain paperwork. Medical visits must beaccompanies with a medical feedback sheet, any pertinent labs, and notes forthe visit. All clients going out of the house for medical appointments will beobligated to stop at the nurse’s office to report what occurred in the visitand submit any paperwork before going back on the floor.
• Pharmacy Coordination – Occurs as needed.Pharmacy coordination may include but is not limited to MHSD, Avita, St.Vincent DePaul’s, and local community pharmacies.
• Facilitate medication refills by instructingclients how to fill out a medication refill request, attain refills, andarrange for payment.
• Call medications in to pharmacy prior todeparture, patient must fill out sheet with financial request.
• Document on a pharmacy log which clients havepending medications.
• On arrival of medications, document all arrivalsinto each client’s chart.
• Insert any medication information sheets intopatient’s chart.
• Any clients that have stat prescriptions sendand fill ASAP if they are antibiotics, anti-inflammatory medication, etc…
• Clients who do not request medications prior torunning out will have this reported to the client’s individual Counselor.

Protocol includes thefollowing:

• All new admits will have a medical record in theEHR. These records will hold clients’ recent PPD, intake packet fromadmissions, a medical reconciliation form of all meds, and any medical recordsthat arrived for the client such as History and Physical, Psych Evaluations,Hospital Records, Labs. This chart will be made when the nurse meets the clientand is assembled by the Medical Staff.
• The Medical Staff will establish appropriatemedications which can be used at OHL. Narcoticsmay not be used in the Adult Residential Program (there may be exceptions in avery few cases to this policy but approval for the use of any narcotic mustcome from the Program Manager prior to administration of such medication.) Certainpain relievers are acceptable on a case by case basis with documentation fromthe medical provider who provided the pain reliever. The Nurse may beinstructed to give clients comfort medications as outline in the policy andinstructed by Community Health Center Staff or the Chief Medical Officer.
• The Medical Staff will establish what medicationcalls the client will use for their medication regiment. There are fourmedication calls per day. As needed medications will be used on a case by casebasis. This schedule will be written down for the client to have as a referenceand present to their Counselor.
• The clients’ schedule will be documented into alog for medication calls. This log will allow nursing staff to know when aclient has been missing medication calls or not taking them correctly.
• Medication stock will be stored under lock andkey in the Nursing Office Medication Room. Clients will only be allowed accessto their medication during medication calls and in special circumstances basedon the situation and nurses’ clinical judgment.
• All staff will observe the taking of medicationat each medication call. Observing the bottle instructions, the amount of pillsclient takes, and how low the medication appears in the bottle. Encouragingpatients to be aware of their stock of medication is part of the MedicalStaff’s duties.
• Missed medication calls will results in clientmissing medication if it is too close to the next medication call based onclinical judgment. There will only be three grace opportunities to take late ormissed medications. At that time the nurse will notify that client’s Counselorof the behavior to have it addressed as part of their treatment. These casesshould be logged into nurse’s log to be presented in treatment team meetings.
• Ideally, all medication refills must be paid bythe client. Patient must be instructed at time of orientation as to howmedications are filled and how frequently.
• All medication refills need to be written onto amedication refill slip and submitted to the Medical Staff. Depending on levelin the program, client’s role in refilling their medications will change toallow them to participate more independently.
• Patients will be oriented to the process offilling out a medical slip when they are sick.
• Patient will be informed that all sick visitsare triaged and addressed in order or urgency. Clients will not be allowed togo to EH for primary care issues unless indicated.
• If a client repeatedly complains of issues thatare impeding their capacity to participate in a residential program, they maybe considered inappropriate for the program and discharged if indicated.
• All suicidal attempts will result in immediatedischarge. Suicidal ideation is to be addressed directly with OHL Staff and theclient’s safety will be managed accordingly.

Discharge Planningduties include the following:

• All clients are to be told their obligation tostop by the Nursing Office prior to discharge or graduation to receive theirmedications. Clients are to be made aware that if they leave OHL at night or ona weekend, they may return to the nurses’ office in 72 hours, medications willbe discarded and a note in chart will indicate last day at OHL noting they didnot participate in a discharge plan as contracted.
• All new clients will sign in their medicationsand sign out their medications. All clients will be given the phone numbers toBehavioral Health and the Primary Care Clinic’s as part of their orientation inthe event they leave without a discharge plan.

Daily Task Listincludes the following:

• Report in with staff. Review the night log forany ER visits or medical complaints from the night. Match to Incident Reportsas needed.
• Review all needed actions for the day dealingwith the CHC as needed: medication orders, lab draws, chart reviews of or anypending documents to file.
• Review the intake schedule for admissions andprepare appropriately.
• Review medical slips submitted by clients ofOHL. Triage slips to determine urgency of CHC visit. Number of clients seen isvariable. Report client needs to the CHC if warranted.
• Respond to emails in timely fashion and carboncopy appropriate parties.
• Coordinate new admits into the CHC for aninitial H & P and placement of PPD. Range of clients is determined onactivity of admissions.
• Conduct medication calls.
• Review Admissions packets on all candidates forthe Residential Program and advise on eligibility and needed documentation forany medications.
• Receive charts at admit and review for allnecessary components using chart content checklist. Send Residential Programstaff all needed documents: H & P, TB skin tests, Psych evaluations.
• Orient any new admits to the medical side of theResidential Program: medication calls and refills, sick slips etc…
• Coordinate all received medications at arrival to be available to client by first available medication call.
• Review any outside facility medical records for residential clients and determine follow-ups as needed.
• Email Counselors promptly regarding any clientsoff the floor with new medical orders that would affect their treatment and ofany pending offsite medical visits.
• Review Discharge Summary and/or be aware of any clients leaving. List medication stock on form and have client sign for it.Photocopy and scan into client chart.

Weekly duties include the following:

• Attend Multi-disciplinary TeamMeeting. Participate in the medical components of clients cases as needed.
• Coordinate patient referrals withthe Psychiatrist and Nutritionist Follow-up on providers’ instructions.
• Meet weekly with the CommunityHealth Center as needed.
• Pull discharged clients and note discharge date on a progress note and file.
• Manage the MAR daily, weekly, and monthly as needed and file all MAR into client’s charts.
• Review MAR for patterns of missedmedications by clients, inquire with client as to why, report to Counselor, andBehavioral Health contract as needed.
• Manage the medicationsrefrigerator and discard old medications.

PHYSICAL DEMANDS

The employee may sit comfortably to do paperworkapproximately 30-40% of the time. Walking, standing, bending, and carrying oflight items such as papers, books, or small parts approximately 60-70% of thetime. Employee must be able to walk about the facility and climb stairs. Localtravel is required no more than 10% of the time.

WORK ENVIRONMENT

Work is normally performed inside a temperaturecontrolled office setting.

MINIMUM QUALIFICATIONS

Minimum qualifications include the following:

• LPN license
• Healthcare CPR
• Must be able to work independentlywith limited supervision
• Must be able to handle a largecaseload of medication management for clients

PREFERRED QUALIFICATIONS

Preferred qualifications include the following:

• Substance Abuse treatment experience
• Residential substance abuse program experience.