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NURSE PRACTITIONER ORIENTATION Guidelines Revision 2012 Updated June 8, 2011 -1- Table of Contents OPERATIONS .....................................................................................................................................................3 ELEMENTS OF NP ORIENTATION: .........................................................................................................................3 ELEMENTS OF NP ORIENTATION - CONTINUED: .....................................................................................................4 AFTER OFFER ....................................................................................................................................................4 SITE/SETTING OPERATIONAL LOGISTICS ..............................................................................................................4 FINANCE.............................................................................................................................................................5 PROFESSIONAL PRACTICE AND INTEGRATION .......................................................................................................5 FRASER HEALTH PRACTITIONER ENCOUNTER REPORTING ....................................................................7 INTRODUCTION ...................................................................................................................................................7 COMPLETING DAILY ENCOUNTER RECORDS .........................................................................................................7 DIAGNOSTIC SERVICES .......................................................................................................................................9 EXCELLERIS LAUNCHPAD ................................................................................................................................. 10 NP NEW HIRE CHECKLIST ................................................................................................................................ 11 APPENDIX ........................................................................................................................................................ 12 APPENDIX 1 ..................................................................................................................................................... 12 Nurse Practitioner Learning Plan ............................................................................................................... 12 APPENDIX 2 ..................................................................................................................................................... 17 Example of Prescription Information .......................................................................................................... 17 APPENDIX 3 ..................................................................................................................................................... 18 Nurse Practitioner Office and Exam Room Equipment and Supplies ....................................................... 18 APPENDIX 4 ..................................................................................................................................................... 23 Fraser Health Nurse Practitioner Encounter Report Summary ................................................................. 23 APPENDIX 5 ..................................................................................................................................................... 24 Updated June 8, 2011 -2- Professional Practice & Integration Purpose: The purpose of this document is to guide orientation for Nurse Practitioners (NPs) in Fraser Health. It is intended to be used by Nurse Practitioners and hiring Directors or Managers to ensure that a suitable orientation is provided for each NP new to Fraser Health. NP orientation is managed by the hiring Director, Manager, or designee. Operations Prior to hiring an NP please review all the following documents in the NP Resource Center located on the FH website under Professional Practice and Integration. These documents include: 1. NP Role Implementation Planning Tool 2. NP Job Description 3. Hiring Guidelines http://fhpulse/clinical_support_services/professional_practice/practice/scope_of_practice_a nd_regulations/nursing/Pages/NursePractitioners.aspx Elements of NP orientation: 1. New employee orientation: Fraser Health is committed to ensuring all new employees are supported through an orientation as they integrate into the organization. The Online New Employee Orientation covers Fraser Health’s vision, Purpose and Values, the Emergency Codes, Quality and Patient Safety issues, Infection Prevention and Control issues, plus an overview of the roles of the departments a typical employee is likely to come in contact with during the first weeks of work. https://fhaneo.primesignal.com/ATutor/mods/terms_and_conditions/terms_and_conditions. php 2. NPs are Excluded Staff. It is the responsibility of each new NP to be familiar with the Terms and Conditions of Excluded Staff. http://fhpulse/benefits_and_people_resources/paying_you/Management%20%20Mana gement%20Support%20Excluded/29October%2010,%202010%20Terms%20and%20Conditions%20Excluded.pdf Updated June 1, 2011 -3- Professional Practice & Integration Elements of NP orientation - continued: 3. Orientation to work setting/location 4. NP clinical role – this section focuses on unique aspects of NP practice such as encounter reporting 5. NP – self-assessment of learning needs in NP role; for completion by NP then discussed with manager/director and possibly the collaborating physician. NP self – assessment is based on the CRNBC NP standards https://www.crnbc.ca/Pages/Default.aspx and are incorporated as part of the NP’s Performance Plan http://fhapps/fha_perfman_nw/perf_plan/perf_plan.asp For example of learning plan – see Appendix 1 After Offer Site/Setting Operational Logistics 1. Tour of work area 2. Keys/access card 3. Office space & supplies 4. Computer PC & Printer Profile and log-in: Complete on-line “Information Services – Request Access for a New User”. Allow 2 weeks for processing. http://fhpulse/sites/IMServiceCatalogue/Lists/Service%20Items/DispForm.aspx?ID =859&RootFolder=%2fsites%2fIMServiceCatalogue%2fLists%2fService%20Items &Source=http%3A%2F%2Ffhpulse%2Fsites%2FIMServiceCatalogue%2Fdefault% 2Easpx Arrange VPN Access http://myfh/sites/IMServiceCatalogue/Lists/Service%20Items/DispForm.aspx?ID=8 63&RootFolder=%2fsites%2fIMServiceCatalogue%2fLists%2fService%20Items Arrange Meditech access and training as mentioned in the Hiring Guidelines. http://fhpulse/education_and_professional_development/meditech_clinical_training /Pages/Default.aspx 5. Parking 6. Communications Team/staff communication – Communication book/board – Staff meetings Updated June 1, 2011 -4- Professional Practice & Integration – Patient/resident/client conferences (rounds) Telephone – #, local – Voicemail – Phone list – On-line directory E-mail – Internal – OWA Blackberry http://fhpulse/computers_and_technology/online_resources/PDA%20How%20Tos/ BlackBerry%208310%20-%20New%20or%20Replacement.pdf 7. Picture ID http://fhpulse/benefits_and_people_resources/photo_id/Pages/Default.aspx 8. Prescription Pads see example in Appendix 2 9. Business cards http://fhpulse/graphics_and_printing/business_cards/Pages/Default.aspx 10. Order a stamp with NP name, title, MSP number and prescribing number 11. Notification of privileges: Lab, pharmacy, diagnostics as appropriate per setting Finance 1. Payroll Timekeeper Pay cheque 2. Expense reimbursement Review policy regarding allowable expenses Expense submission – Employee Expense Report 3. Education Funds Your Operations Director manages the funds designated for NP professional development and related forms. 4. Examination room space and equipment – see Appendix 3. Professional Practice and Integration Professional Practice and Integration (PPI) represents inter-professional teams whose work advances the strategic imperatives of integration and standardization. Updated June 1, 2011 -5- Professional Practice & Integration In collaboration and partnership with internal and external stakeholders, PPI advances scope optimization, best practice, clinical education and quality practice environment as per Fraser Health regional initiatives. As an NP within Fraser Health you have a professional reporting matrix to the Executive Director PPI, and Chief Nursing Officer (CNO). PPI will also assist and support you with professional issues such as: Legislation/regulation interpretation Liaison with Ministries, regulatory bodies Liaison with Fraser Health services e.g. Programs, HR Practice consultations Manage Professional Development Funds NP Contacts: Executive Director, PPI/CNO and Director, Professional Practice – Nursing Community of Practice: All NPs in Fraser Health have a collective Community of Practice (CoP) which meets monthly. The purpose of the CoP is to create a forum that allows Nurse Practitioners to regularly connect in person or via teleconference to promote best practice and build capacity in the Fraser Health Authority. For a complete copy of the Terms of Reference for the CoP http://fhpulse/clinical_support_services/professional_practice/practice/scope_of_practice_a nd_regulations/nursing/Pages/Default.aspx The above link and document is currently being revised and will need to be updated in the manual. To be added to the Fraser Health NP distribution list please contact the Administrative Assistant to the Executive Director/CNO of Professional Practice., Updated June 1, 2011 -6- Professional Practice & Integration Fraser Health Practitioner Encounter Reporting All NP new are required to have their MSP number prior to the offer of employment. Introduction Nurse Practitioners can not bill the Medical Services Plan (MSP) for the services they provide to BC residents. To monitor services provided, the Ministry of Health requires Nurse Practitioners (NP) required to submit encounter records to MSP. The Encounter Record is considered the same as a medical claim submitted by other health care providers. For more information regarding MSP, go to Section 2 of the Ministry of Health Nurse Practitioner Resource Manual. http://www.health.gov.bc.ca/msp/infoprac/np/ Encounter Record Submission Authorization Once the NP has received their practitioner number, they must complete and sign the HIBC “Encounter Record Submission Authorization” form HLTH2871 which is available on the MSP website Shortcut: https://www.health.gov.bc.ca/exforms/mspprac/2871fil.pdf Often the form will be included with your MSP Number letter. Forward the completed form to: Ian Perry, Finance, 5th floor, Sherbrooke Centre, RCH Completing Daily Encounter Records Paper Record: There are three options: i) Day sheet: If you receive a computer listing of your clients on a daily basis, it can be modified and used as your encounter record. The following information should be included: PHN number, last name and first initial. You need to add two columns to the sheet, one for the Encounter Code and one for ICD9 codes. ii) Fraser Health Nurse Practitioner Record Summary: (see Appendix 4) This sheet is useful if you have client’s labels that you can attach to sheet. The sheet can be modified to include your site’s particular information e.g. Payee number, location code and Practitioner MSP number: iii) Nurse Practitioner Encounter Form (see Appendix 5) You need to hand-write in all the information. The following information is required for an encounter code to be processed by MSP: Updated June 1, 2011 -7- Professional Practice & Integration Practitioner Number (MSP number) Payee number Last name, first initial and Personal Health Number (PHN) of the patient Number of services Date of service Location code Diagnostic code Electronic Recording If your office has electronic billing system in place, the Medical Office Assistant (MOA) should be able to send your billing information to the Ministry. It is the same system used to bill for the physician services. You can record each patient’s encounter codes and ICD 9 codes on the day sheet. NP Encounter Authorization.pdf For a guideline on encounter codes, ICD 9 codes and how to submit please check: http://www.health.gov.bc.ca/msp/infoprac/np/msp_resource_np.pdf Monthly, send your encounter codes to: Omega: c/o Burnaby Hospital Medical Administration 3935 Kincaid Street Burnaby, BC V5G 2X6 Updated June 1, 2011 -8- Professional Practice & Integration Diagnostic Services The Laboratory Services Guidelines are divided into two sections: 1. Laboratories 2. Reporting results and follow-up system Nurse Practitioner Clients may access laboratory services either on site (if available) or at a near by community lab. Any service provided on site must meet the standards for processing specimens, transportation and have reporting system in place. 1. Laboratories: The following section will look at the provincial laboratories the Nurse Practitioner will be accessing. Contact client services at each of the above agencies to register as a provider and to enable you to receive test results. Client services will need your provider information including your name, MSP provider number, and clinic and contact information. The following laboratories will be included: a) b) c) d) a) Provincial Health Services Authority Laboratories i. British Columbia Centre for Disease Control ii. British Columbia Cancer Agency iii. Children’s & Women’s Health Centre of British Columbia Fraser Health BC Biomedical Services Life Labs British Columbia Provincial Health Services Authority Laboratories For healthcare provider contact information, services and supplies click on: http://www.phsa.ca/AgenciesAndServices/Services/PHSA-Labs/Contacts.htm British Columbia Centre for Disease Control British Columbia Cancer Agency Cervical screening program Children’s & Women’s Health Centre of British Columbia All maternal screening is done at Children’s and Women’s Health. Testing includes: Quad marker screen Updated June 1, 2011 -9- Professional Practice & Integration Serum Integrated Prenatal Screen (parts one and two) Maternal Serum AFP b Excelleris Launchpad The Excelleris Launchpad program will deliver lab results from Life Lab British Columbia (formerly MDS), BC Bio, VCH, FHA, Valley Medical Labs and a few additional hospital labs to your computer. It will speed up your access to lab results, allow you to search a lab history on any of your patients and give you the ability to run a cumulative chart on any tests you choose. There is no cost to Nurse Practitioner for access to Launchpad, and currently have almost 4500 physicians & Nurse Practitioners across the province using the program to access their results. To get the program running at your location Excelleris has to install a digital certificate on your computer and create a connection to our site which will allow any users with an active user ID & Password access to an inbox with all of your current labs. From that point you can view results on screen, print out selected results, search lab history on any patients and chart any test using the cumulative function. Launchpad also offers a PharmaNet link which at this point only allows Physicians to pull up a drug history and drug interaction profile on any of their patients. If your office is looking at going to an EMR, currently Excelleris is able to import into all of the major EMR’s operating in the province. To set up access to Excelleris Launchpad you will need to contact Excelleris @ 1-866-7284777 and provide you contact information and MSP billing number and they will contact you to arrange for a set up date. The program takes about 5-10 minutes to set up and training takes about 20 minutes. You can access more information on the program via their web site at http://excelleris.com Updated June 1, 2011 - 10 - Professional Practice & Integration NP New Hire Checklist Operations Responsibilities: Immediately arrange e-mail - internal (need employee number) o OWA VPN Access Order Business Cards (confirm name and initials to be used) Order Blackberry Order laptop Photo ID Multi-site parking if appropriate to setting (Director to sign and employee to complete and submit Arrange time with appropriate person to: review timesheets, payroll submission, expenses (including mileage, parking), vacation requests, sick calls Employee: On-line New Employee Regional Orientation (refer to Employment Letter for link) NP Encounter Authorization Photo ID (complete remainder of form and arrange for photo) Multi-site parking pass (complete remainder of form and submit to Parking) Completion: “Addition to Provider Dictionary”. See Guidelines in the NP Resource Center. Meditech Access and training - Click on the hyperlink and follow the registration instruction. Performance Planning In-service (refer to Employment Letter- already booked in, please inform MOA so that she may note this in your clinic schedule) Clinic MOA: Order self-inking stamp with name, title, MSP number and prescribing number. Confirm with NP what title to use. Name (first, last), MN NP(F) Nurse Practitioner Prescribing # MSP # Clinical Orientation: contact ________________________________________ to arrange see attached schedule- clinical contact: _______________________ Updated June 1, 2011 - 11 - Appendix Appendix 1 Nurse Practitioner Learning Plan NURSE PRACTITIONER LEARNING PLAN KEY For ratings: NLP = Needs Learning & Practice KNP = Knowledgeable but needs Practice CP = Competent Practice PP = Proficient Practice CATEGORY 1: ASSESSMENT & DIAGNOSIS OF CLIENT HEALTH/ILLNESS STATUS 1.1 Performs an advanced, comprehensive & holistic health assessment. health history & complete physical examination. considers the psychosocial, emotional, ethnic, cultural & spiritual dimensions of health involves underst&ing with clients the meaning of their health/illness experiences & how their daily living is affected 1.2 Synthesizes health assessment information & uses critical thinking & clinical reasoning skills to identify health concerns & risks identify normal & abnormal states of health make differential diagnoses. 1.3 In the process of making a diagnosis, combines client assessment findings with the application of scientific & experiential knowledge, considering such things as: developmental stages; behavioural sciences; lived human experiences & personhood; pathophysiology & psychopathology; epidemiology & infectious diseases; multiple etiologies; & clinical manifestations of acute illnesses/injuries, chronic diseases, emergency health needs & normal health events. Updated June 8, 2011 - 12 - XP = Expert Practice Professional Practice & Integration 1.4 Orders appropriate screening & diagnostic investigations. Interprets reports of these investigations based on sound clinical reasoning, scientific evidence & critical thinking. Examples include laboratory tests, x-rays, & ultrasound. 1.5 Diagnoses diseases, disorders & conditions while attending to clients’ responses to the illness experience. 1.6 Communicates with clients about health findings &/or diagnoses. Discusses health outcomes & prognosis. Collaborates with clients to identify & choose treatment or care options. 1.7 Supports & counsels clients with their personal responses to diseases, disorders or conditions while creating an environment in which effective learning can take place. 1.8 Initiates timely, effective collaboration with &/or consultation with/referral to physicians, other health care & social service providers as appropriate to assess & diagnose client health/illness status. 1.9 Documents timely, accurate & relevant clinical data, findings & conclusions. CATEGORY 2: HEALTH CARE MANAGEMENT, PHARMACOTHERAPEUTICS & THERAPEUTIC INTERVENTIONS 2.1 Collaborates with clients &, where applicable, their families & other members of the health care team to set priorities for the management of diseases, disorders, or conditions. Intervenes appropriately, including initiating effective emergency care & crisis intervention. 2.2 Critically appraises & applies current, relevant research findings in decision- making about health care management & therapeutic interventions. 2.3 Initiates timely, efficient collaboration with &/or consultation with/referral to physicians, other health care providers & other sectors as appropriate to manage clients’ diseases, disorders or conditions. 2.4 Collaborates with clients to share decision-making in the provision of care & monitoring diseases, disorders or conditions by: using relevant knowledge about humanities, behavioural sciences & lived human experiences to help clients adopt health practices that will achieve their desired state of wellness; negotiating with clients a plan of care that integrates clients’ wishes, scientific rationale & evidence-based practice guidelines; writing orders for treatment based upon evidence-based practice for the specific client population; advocating with or on behalf of clients to ensure their health needs are met; helping clients throughout the teaching/ learning process to plan, follow & evaluate therapeutic regimes; monitoring with clients the effect of the chosen treatments & recommending adjustments to the client as necessary (treatments include traditional & complementary or alternative health therapies as well as products that clients use); Updated June 1, 2011 - 13 - Professional Practice & Integration using sound clinical reasoning skills & established outcome criteria to evaluate & document the initial & ongoing outcomes of the plan of care negotiating ongoing contact to help clients monitor & evaluate their plan of care & health/illness status. 2.5 Applies knowledge of pharmacology, including pharmacokinetics, pharmaco-dynamics & evidence-based practice, in selecting, prescribing & monitoring drugs to treat diseases, disorders or conditions & injuries. Carries out these competencies as appropriate for the NP’s scope of practice & clinical practice setting. Additional competencies required by NPs for prescriptive authority are: consults and/or collaborates with and/or refers to physicians and pharmacists as appropriate; selects drug therapy based on knowledge of pharmacology, drug interactions, client health history and disease, disorder or condition; uses health teaching principles when prescribing, educating and supporting clients in recommended drug use; prescribes drug therapies while considering the active participation of clients, best outcomes, and cost effectiveness; considers the power dynamics and marketing strategies of the pharmaceutical industry when prescribing drugs; writes prescriptions that meet both provincial and federal standards and legislative requirements including responsibilities relevant to prescription and management of controlled substances; monitors with clients their response and adherence to drug therapy, and recommends any changes needed to achieve desired effects; identifies when misuse of drugs by clients occurs and takes steps to prevent further misuse; and uses Pharmanet for the purpose of documentation or acquiring information. 2.6 Carries out counselling and other advanced therapeutic interventions, such as minor surgical and invasive procedures, essential for the clinical management of diseases, injuries, disorders or conditions. 2.7 Uses and evaluates current technologies appropriate to the delivery of health care services. 2.8 Facilitates and fosters active communication, learning, partnerships, and collaboration among clients and appropriate resources. 2.9 Develops, uses and evaluates follow-up and information systems within the practice setting to ensure clients receive coordinated health services, to demonstrate client outcomes and to contribute to nursing knowledge. 2.10 Consults and/or collaborates with members of the health care team about variations in health outcomes at the individual and systems levels to develop quality improvement and risk management strategies. 2.11 Demonstrates facilitation, conflict resolution, coalition building and change management skills when working with Updated June 1, 2011 - 14 - Professional Practice & Integration clients and other health care providers. CATEGORY 3: HEALTH PROMOTION AND ILLNESS/INJURY PREVENTION 3.1 Collaborates with clients to identify and assess trends or patterns that have health implications for families, groups or communities. This involves working with other health care providers to gather and synthesize qualitative and quantitative information from a variety of sources about determinants of health. 3.2 Participates with other health care providers and other sectors to plan and develop health promotion/prevention programs based on client needs, culture, evidence-based strategies and available resources. Such programs include implementing evidence-based screening for populations-at-risk and harm-reduction strategies that are populationbased. 3.3 Participates in the implementation, monitoring and evaluation of health promotion and illness/injury prevention programs in partnership with other health care providers, communities, social and public service sectors. 3.4 Collaborates with other health care providers and other sectors to use knowledge of determinants of health and principles of community development to help groups or entire communities obtain the services they need to meet their health goals. 3.5 Advocates for and creates an environment that facilitates learning and maximizes client participation and control of their own health, including living with chronic disease and meeting their own health needs. 3.6 Advocates for health promotion at the policy level and promotes healthy public policy by participating in legislative and policy-making activities that influence health services and practices. 3.7 Recognizes that culture influences health/illness experiences and client use of health care services. Adapts practice to meet the needs of an ethnically and culturally diverse population. CATEGORY 4: NURSE PRACTITIONER PROFESSIONAL RESPONSIBILITIES & ACCOUNTABILITIES 4.1 Understands the changes in scope of practice from that of registered nurse practice and how this affects responsibilities and accountabilities when assuming the title and role of nurse practitioner. 4.2 Understands and incorporates the additional professional and legal standards and ethical decision-making involved in the diagnosis and treatment of acute and chronic illnesses, including prescribing medications. 4.3 Defines the specific area(s) of practice and the client population for whom she/he is competent to provide health care services in the nurse practitioner role. Provides only those services and refers clients who require health services beyond the individual nurse practitioner’s competence. Updated June 1, 2011 - 15 - Professional Practice & Integration 4.4 Assumes responsibility and accountability for formally requesting consultation and referring clients to physicians or other members of the health care team at any point in the assessment and management of client health/illness status. This is essential whenever the client’s condition requires care beyond the nurse practitioner scope of practice or the individual nurse practitioner’s competence. 4.5 Practises in accordance with legislative acts, regulations and bylaws relevant to the nurse practitioner’s area of practice and client population served. 4.6 Explains the role and responsibilities of the nurse practitioner including own area(s) of expertise, to clients, other health care providers, social and public service sectors, the public, legislators, and policy-makers. 4.7 Anticipates and engages clients and other health care providers and other sectors to manage legal, ethical, moral and clinical issues relevant to health care provision at the client or organizational level. 4.8 Takes part in regular professional development and accepts personal responsibility for maintaining nurse practitioner competence, including, but not limited to, continuing education related to prescriptive authority. LEARNING PRIORITIES Focus Activities/ Strategies 1.. 2. 3. 4. 5. Updated June 1, 2011 - 16 - Completion date Appendix 2 Example of Prescription Information Name of clinic [LOCATION] [ADDRESS] [CITY], BC [POSTAL CODE] Fax: 604 [#] Phone: 604 [#] Date:______________________________________ Name:_______________________________________ Address: ______________________________________ Date of Birth: _____________PHN_________________ Please Label Contents Rx Signature:____________________________________ (NP/MD ) Prescriber Number: _________________________ REPEAT 1 2 Updated June 8, 2011 3 4 5 EVERY___DAYS NO REPEAT - 17 - Professional Practice & Integration Appendix 3 Nurse Practitioner Office and Exam Room Equipment and Supplies The following Office and exam room list is a guideline. I. There are several key factors to consider when consider the equipment and supplies. Key factors: 1) Location: a. Urban vs. rural b. Pre-existing space eg. Hospital, medical office, community services c. New space to be designed 2) Other team members a. Pre-existing members and systems in place b. New team members and new program c. Offsite team members 3) Supportive services a. Pre-existing and onsite b. Laboratory services eg. Onsite, home visiting services, publicly funded services, private lab c. Transportation of specimens d. Access to printer , fax machine, refrigerator, public washrooms, waiting room, sink, clean and dirty utility room 4) Population to be served: a. Geriatrics b. Wheel chair ( movable examine table, more space needed in exam room) c. Children ( play area, increased safety issues) d. High risk- difficulty accessing off site services 5) Disposable verus autoclave equipment a. costs consideration b. space, c. equipment d. experiences support staff e. access to autoclave services II. The equipment charts will be listed in the following tables a. Office Equipment b. Exam equipment c. Procedures d. Women’s Health e. Pediatric f. Laboratory specimens g. Geriatric h. Emergencies equipment, supplies and medications i. Home visiting bag Updated June 1, 2011 - 18 - Professional Practice & Integration a) Office Equipment and supplies FHA web link for ordering supplies http://fhpulse/capital_finance_and_purchasing/purchasing/Documents/Office%20Supplies%20Gran d%20and%20Toy%20(3).doc One time expense Desk with computer drawer and filing drawers Filing cabinet Computer Chair Small table with chairs ( counseling and/or student space) Book shelves Bulletin board Cabinet for locking client files or space at MOA Cabinet for locking up medications Stapler Paper clip holder Three hole punch Ruler Binders Hanging file folder (label requisitions) Desk lamp Coat hook Desk organizers( pencils, files etc.) Ongoing supplies Chart supplies (charts, label system, dividers) Paper, (legal, letter, letterhead) Pens, black, red Pencils Paper clips Staples Post-its File folders, hanging folders Labels holders for file folders CDs Markers Push pins Envelopes, (legal, letter) Phone book Business cards Prescription pads b) Examination room Medical equipment Exam room Exam table Stool Exam light Chair Foot tools Garbage can with foot step Utility cart or OR tray Set of ophthalmoscope, BP & thermometer, ear speculum holder with wall transformer Adults scale Reflex hammers, Tuning forks Safety goggles, Mask ( should be fit tested) Peak flow meter Sundry glass jars set of 5 ( to hold exam *glucomometer *Doppler & pulse attachments *Oximeter, Peek flow meter BP cuffs small adult, large cuff Stethoscope Snellen Visual chart & Rosenbaum chart, Illiterate E chart, Ishihara colour chart Woods lamp Doppler & pulse attachments Updated June 1, 2011 Medical supplies Disposable dressing trays Tongue depressors Cotton swabs Ear speculums size 2.5mm 4mm Sterile water, Distilled water Peak flow meter covers Thermometer probe covers Sterile Q tips Thermometer probe covers Cleaning solution syringe 10 cc ( 10),syringe 3 cc syringe TB syringe 26 g Exam paper Anascopes Reagent strips, urine 4MD or 10 Reagent strips, blood glucose Lancets Lubricant Cups & sterile urine bottles - 19 - Professional Practice & Integration c) Procedures One time purchase equipment Needle driver Scalpel handle Biopsy punches Scissors ( suture removal, bandage) Finger tube Wet soak tray Ear syringe K-basin Adson forceps Tissue forceps Sponge Forceps Dressing forceps Mosquito forceps 5mm dermal curette 2mm dermal curette nasal speculum nasal forceps metzenbaum scissors straight scissors Curved scissors Autoclave (Rural setting) Ongoing supplies for procedures Elastoplast tensor bandages 10 cm, 20 cm Disposal scalpel with handle Scalpel blades #15 Sutures nylon 3.0, 4.0, 5.0, chromic 3.0 Dermabond Proxi strips Disposal able ear curettes 2mm Punch biopsy Disposable dressing trays Disposable suture removal kits Disposable staple removal Small bottles of saline solution for cleaning 60 cc syringe ( 1 or 2) Gauze 4X4 (sterile & non sterile) Gauze 2X2 Bandage tape, (paper, water proof) Lidocaine 1% and 2% with and without adrenaline Alcohol wipes band aids Sterile towels Sharps containers Non latex gloves, sterile & non sterile d) Women’s Health Equipment *Metal speculums Large, extra small, different shapes Equipment for IUD insertion and/or endometrial biopsy Uterine Tenaculum Uterine sound instrument Speculum light Doppler Measuring tape Ongoing supplies Cytobrushes Spatula Pap smear slides & containers Cytospray pH paper Pregnancy dip sticks Disposable speculums CT swabs Doppler gel endometrial biopsy* Cytology solution* Hand mirror Baby’s Best Chance e) Pediatric Equipment Infant & Child BP cuff Infant scale Pediatric ambu bag Pediatric mouth pieces Measuring tape Measuring box ( for measuring length of infant scale Updated June 1, 2011 Ongoing supplies Diaper wipes Diapers Stickers Bubbles solution Immunization records - 20 - Professional Practice & Integration f) Laboratory Supplies Laboratory testing Tourniquets Refrigerator *Centrifuge ( Rural setting) Microscope Cooler for transportation Supplies Auto drop vacutainer Vacutainer needles Vacutainer butterfly needles Alcohol swabs Dot bandages Blood tubes ( gold, green, purple, red, blue see laboratory services) Charcoal swabs CT swabs GC swabs Viral swabs Sterile urine bottles Fungal slide Pin worm bottles O&P stool bottles Sharps container Plastic specimens bags Slides g) Geriatric Geriatric Monofilaments Neurologic hammer Goniometer Triceps skin fold caliper Mini Mental Exam h) Emergency equipment. Low Risk Office Urban area Close to emergency department No parental medications given No procedures done in office Low volume of patients Few sick patients Updated June 1, 2011 Moderate Risk Invasive procedure done in office Delay or no EMS access Walk in clinic High volume of clients High Risk Rural or remote location No local Hospital Invasive procedure done in office Delay or no EMS access Walk in clinic High volume of clients Low risk office supplies as well as: Syringes 60ml, 10ml, 5ml, 3ml Glucometer & strips Medications: Nitroglycerin spray 0.4mg ECASA 80mg Narcan Lorazepam sublingual Glucose solution 50 % Moderate risk Office supplies as well as: Intubation tray: laryngoscopes ( 2 sizes, ) endotracheal tubes (3-8), magill forceps, Suction equipment, tonsil tip Oxygen supplies: nasal prongs, tubing, rebreather bag, oxygen tank, pulse oximeter Intravenous supplies: tourniquets, - 21 - Professional Practice & Integration catheters (14, 18, 22, 25), IV pole, tubing Obstetrical tray: delivery tray, cord clamp, sterile towels Aerosol therapy: nebulizer with mask or areochamber ( 3 sizes), aerosol masks Medications: Oral and parenteral haloperidol (10mg), loraxepam (4mg parental) salbutamol, ipratropium bromide by aersol metered dose inhaler or nebulizer Updated June 1, 2011 - 22 - Professional Practice & Integration Appendix 4 Fraser Health Nurse Practitioner Encounter Report Summary Fraser Health Nurse Practitioner Encounter Report Summary Name: Provider Number: Employer Number: Location: Month/year: Name/PHN/DOB Updated June 1, 2011 Date Encounter Code Encounter Code ICD9 codes - 23 - Appendix 5 OMEGA COMPUTER SERVCES LTD. Payee Number: T0900 13375 Batch Claim Entry Practitioner Number: Clear Data Write Claims DATE TO DT No. Ser. SC FEE ITEM AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Updated June 8, 2011 - 24 - ICD-9 MVA BCMSP/ PHN De p No. LOC INIT SURNAME © Notice BT 1 REF# 1 BT 2 REF# 2 ICBC FAC. ORIG DATA CNT ORIG. SEQ NUM ORIG. DATE REC'D COMMENT