Policy Manual sample

MDT Home Health Care Agency, Inc. 206  Six (6) prep pads  Three (3) pairs gloves  One (1) D 5 W 500 mL • Pediatric:  One (1) microdrip set  Two (2) 23 g butterfly  One (1) 60 mm airway  Two (2) tongue blade (for airway insertion)  One (1) 0.15 mg EpiPen Junior Injector  One (1) epinephrine 1:2000 (IM)  One (1) diphenhydramine (Benadryl) 25-50 mg PO, IV or IM  Six (6) prep pads  Three (3) pairs gloves  One (1) D 5 W 500 mL • The pharmacy responsible for dispensing the intravenous medication or investigational drug shall provide the anaphylaxis kit in a separate container that is appropriately labeled with the contents. The kit will contain emergency medications in unit-dose, age-specific and ready-to-administer forms, whenever possible. PROCEDURE: • The Clinical Supervisor/Case Manager is responsible for ensuring that orders for the anaphylaxis kit along with specific criteria for administering emergency medications are in place prior to administration of the intravenous or investigational medications. • Prior to administering each dose of the intravenous or investigational drugs, the skilled nurse must verify that the contents of the anaphylaxis kit are complete and have not expired. • The skilled nurse shall instruct the patient/family/caregiver to store the anaphylaxis kit in a safe and secure location in the patient’s place of residence, if appropriate, and shall document the instructions. If there is not a safe and secure location in the patient’s home or if the home is not a safe and secure location for the kit, the nurse shall retain the kit in his/her possession.