HHC Health & Home Care Clinical Policy And

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.
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