HHC Health & Home Care Clinical Policy And

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HHC HEALTH & HOME CARE Section: 10-19 Postpartum/Maternal/Newborn: Bilirubin Sample Collection __RN PURPOSE : Evaluation & Management of Hyperbilirubin in the Newborn. EQUIPMENT: Sterile lancet Pedi “bullet” lab tubes Alcohol sponge Gauze or cotton Bandaid Gloves Impervious trash bags Puncture-proof container PROCEDURE: 1. Adhere to Universal Precautions 2. Warm heel with soft 4 X 4, moistened with warm water for 3-5 minutes or milk heel. 2. If the baby is breastfeeding, have the baby latched-on the breast, to pacify the baby during the procedure. 3. Cleanse heel with alcohol prep. Wipe dry with sterile gauze pad. 4. Puncture heel with sterile lancet. Wipe away first blood with sterile gauze pad. Allow another large blood drop to form. 5. Collect specimen in plastic bullet container until filled. Close bullet. Apply band-aid to heel. 6. Label specimen and place in specimen bag. 7. Proper disposal of all medical waste. 8. See Bilirubin workflow 10-20. AFTER CARE: 1. Document in patient's record: a. Patient's response to procedure. b. Complications and management. c. Time drawn, amount of blood drawn, type of test being ordered by physician, name of laboratory, and location of drop-off of specimen. 242
HHC HEALTH & HOME CARE Section: 10-20 Postpartum/Maternal/Newborn: Bilirubin Workflow __RN Purpose: Evaluation & Management Of Hyperbilirubin In The Newborn BILIRUBIN PROCEDURE: 1. Referral is faxed from B8 Nursery, Neonatal Intensive Care Unit “NICU” or assessed by Intake Planner. Planner will complete intake process paper work for faxed referrals and submit “Intake Demographic” Information & 485 to appropriate A.D.N. for all referrals. 2. A.D.N. assigns field RN to patient. 3. OSC enters patient’s name, medical record number “MR #”, demographics and initials of nurse assigned to the patient in the team serum bilirubin logbook. 4. The nurse contacts the patient’s home and verifies all demographic information in preparation for visit. 5. Copy of each teams daily serum bilirubin log is faxed to hospital transportation department by the scheduled transporter and he/ she retains a copy for pickup of specimens later in day. Prior to faxing, OSC verifies log with A.D.N. to determine log is complete. 6. A serum bilirubin is obtained via heel stick by the assigned field RN. RN places specimen in specimen bag. RN completes specimen coordination form and lab requisition, placing both in outside pocket of specimen bag. Nurse calls “scheduled specimen transporter” after each specimen has been obtained, also confirming demographics. 7. Nurse instructs family to keep specimen in the refrigerator until pickup by transporter. Family is instructed to call home care if no pickup by 3 to 4:00 p.m. The nurse provides family with ER/NICU referral should they be instructed to go to the ER/NICU in the event of an abnormal result, as per M.D. 8. All families without a telephone are instructed by the nurse to provide an emergency contact /telephone number so that HHC Homecare can make contact with them in the event of an abnormal result. The nurse notifies the OSC of the emergency contact number to be noted of the bili-log book. 9. If the family cannot provide a contact person/number, the family is instructed to call the homecare office the same day for the results. If call is after 5pm the Administrator on Call “AOC” will forward information. 10. Specimens are picked up by agency transporter and delivered to chemistry laboratory. Laboratory personnel stamp time received on home care specimen coordination form. Transporter returns specimen coordination form to team OSC. 11. Approximately 1½ to 2 hours after the specimen is received by lab, the OSC checks results in the computer (HDS). Using specimen coordination form & log, the OSC verifies patients name & MR #. The OSC attaches print out of results to specimen coordination form & gives all results to the assigned A.D.N. (This process is done during business hours, between 9:00am – 5:00pm.) 12. If results are not processed in the lab by 5:00 p.m., a copy of each team’s serum bilirubin log and all specimen coordination forms are given to the AOC. 13. During business hours the assigned ADN contacts the attending Neonatologist on call to report results. Patients name, date of birth, serum bilirubin levels and trends are reported. 14. MD instructs A.D.N. if repeat serum bilirubin is indicated or if patient needs to go to ER/NICU due to a critical level or need for weekend / holiday follow-up. 15. After business hours, serum bilirubin results of 15 mg/dl or greater are reported to the AOC by laboratory. 16. The AOC will notify the Neonatologist on call (as per the schedule provided) with the results. The neonatologist will be given patient’s name, DOB and Bilirubin results. 17. If the patient is a Queens Hospital Center “QHC” patient, indicated by a MR # beginning with 301, the AOC will call 718-883-3939 and report results to MD on call at QHC. 18. As instructed by MD the AOC will call the family to discuss appropriate action. 19. The AOC may utilize 911 for those patients who require hospital follow-up and can not be contacted. 243
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