WINNIPEG REGIONAL HEALTH AUTHORITY. WRHA Weekend Services. Public Health Nurse Procedure Manual. Original 2008 Revised December 2011 and Oct 2014

Transcription

1 WINNIPEG REGIONAL HEALTH AUTHORITY WRHA Weekend Services Original 2008 Revised December 2011 and Oct 2014 Updated November 2011 Page 1

2 Contents Introduction... 3 Purpose... 3 Sources of Referrals for Weekend and Statutory Holiday Services Hospital Postpartum and/or Infant Referrals Community Area Public Health Nurse Transfers Breastfeeding Hotline - Health Links/Info Santé Medical Officer of Health (MOH) Team Manager On-Call After Hours Unit Midwifery... 8 Public Health Staffing, Roles, and Responsibilities on Weekends/ Statutory Holidays Scheduling for Weekend/Statutory Holiday and Standby PHN Roles and Responsibilities Public Health Nurse # 1 Roles and Responsibilities Standby Public Health Nurse Procedures Staff Illness and Replacement Weekend Services Staff Planning Log Student Experiences on Weekends Orientation to Weekend Services Equipment and Supplies Weekend Services Chart Tracking Log Logging in to iphis Creating an iphis record Personal Safety and Working Alone 16 Directory (including office address, fax, phone) 16 Regional Security 16 Updated November 2011 Page 2

3 Introduction The Winnipeg Regional Health Authority (WRHA) public health program provides necessary services to postpartum families, communicable disease clients, and for public health emergencies occurring on weekends and statutory holidays. Weekend services are staffed by nurses experienced in public health and are supported by clinical standards and guidelines provided in the weekend services, healthy beginnings, and communicable disease control manuals. A range of information has been included in this weekend manual as a reference for the public health staff providing services on weekends and statutory holidays. The healthy beginnings postpartum standards manual is a companion document to the weekend services manual. Information and direction related to perinatal clinical practice questions and issues are located in the healthy beginnings manual, while information and direction about the daily workings of the weekend services are located in this weekend services manual. The healthy beginnings postpartum standards and clinical practice guidelines direct public health nurse (PHN) postpartum practice seven days a week. At this time, two of the standards have been implemented: the healthy beginnings postpartum standard # 1- contact # 1 and standard 2- home visiting, and associated clinical practice guidelines. Purpose The purpose of weekend services is to respond to: 1. Hospital postpartum and infant referrals for physician attended births. 2. Transfers from community area public health nurses. Follow-up on weekends/statutory holidays is provided to postpartum families when the mother and /or infant may be at risk. 3. Referrals received during the course of the weekend or statutory holiday requiring follow-up, such as home phototherapy, communicable diseases, and other urgent public health services requiring follow-up during the weekend or statutory holiday. Updated November 2011 Page 3

4 Sources of Referrals for Weekend and Statutory Holiday Services Referrals may be received from: Hospital postpartum and/or infant referrals Community area public health nurses Health Links/Info Santé Children s emergency department for home phototherapy follow-up Medical officers of health Team manager on-call After hours unit Midwifery 1. Hospital Postpartum and/or Infant Referrals 1.1. Practice Guideline: Public health nurse contact by telephone or in person will be offered as per Healthy Beginnings Standard 1- Contact 1 and Standard 2- Home visiting Practice guidelines for telephone contact, breastfeeding support, and documentation are located in Healthy Beginnings Postpartum Standards Manual in the Additional Information section and in the Breastfeeding Practice Guidelines Manual The primary focus should be on the health protective aspects of Standard 1: Contact #1 and Standard #2, prioritizing for the safety and well being of the infant and mother A strong linkage to the community area public health nurse should be conveyed to the family. The weekend PHN will ensure that each family: Has the telephone number and location of the respective community area public health office. The public health pamphlet is available for this purpose Is aware that a community area PHN will be contacting them. The public health nurse on the weekend will actively promote the community area public health nurse s knowledge of local resources, neighbourhood services, and their availability for ongoing support and education Standard 1 Contact #1-as per the Healthy Beginnings Manual: The PHN will contact the postpartum family the day after discharge for an initial postpartum assessment Guidelines for telephone contacts (algorithm) Proceed as per Standard 1 Contact 1, utilizing the red flags tool to guide the telephone assessment if the client answers the call If a client answering service is reached the PHN can leave a message: to identify self, briefly outline purpose of the call, provide the PHN contact number with a request to contact the PHN. The Health Links/Info Sante number can be provided for health related questions that may occur after regular working hours. Updated November 2011 Page 4

5 Depending on the PHN assessment of postpartum referral, if the client does not initiate contact, the PHN may determine that: It is appropriate to attempt a second phone call that day Even though a message/s were left, there are red flags and a door stop visit may be prudent There are no identifiable risks, the client is aware of contact numbers and the referral will be transferred to the primary community area If unable to reach client ascertain if phone number is correct. Check phone book or call MTS information at When contacting the hospital to acquire missing information on referral forms, please refer to the telephone numbers on the fax confirmation sheets. The confirmation sheets contain the fax and telephone number of each ward, and also list the referrals sent from those wards. Check the confirmation sheet to determine which ward sent the referral, and then call the specific ward Client has no telephone: Attempt contact through the alternate number that may be listed on the postpartum referral form to clarify the location of the client A door-stop home visit should be attempted the day after hospital discharge when client can not be contacted or when there is no telephone number provided If a door stop visit is attempted the PHN makes a reasonable attempt to access the client s home, for instance if it is a locked block the PHN attempts to gain access to the building and leave an unable to contact letter at the client s apartment door If it is determined that the client is located outside Winnipeg, the referral should be returned to the weekend clerk Home Visiting Standard - Standard 2: The PHN will assess the need to visit the day after discharge An initial home visit incorporates client history, referral information, and minimum components of assessment described in core clinical practice guidelines that includes: A clinical assessment for the health and safety of the mother and infant, including feeding Preliminary family assessment which may include the families first screen and/ or survey 2. Community Area Public Health Nurse Transfers Every attempt should be made to maintain continuity and build the client s capacity. The PHN should put a plan in place to minimize transfers to weekend services. Transfers are based upon the assessment that the infant would be at risk if public health nursing services were deferred to the next regular workday. Updated November 2011 Page 5

6 2.1. Transfers between Community Areas and Weekend Services WRHA Weekend Services Process for community area public health nurse to transfer client to weekend services All attempts should be made by the CHA PHN to prepare the client with the information and resources, and for PHN follow-up the following week. When transferring, advise client that the weekend PHN will contact them in the morning to determine the need for a HV Postpartum transfers: Complete the postpartum/ infant documentation on the client record utilizing the variance transfer form. Fax the variance transfer form and selected client chart pages to the weekend services office site. Communicable Disease follow-up: Consult with CD coordinator regarding communicable disease referrals for a decision as to whether the referral should be forwarded to weekend All referrals will be transferred by courier from the weekend services site to the community area offices the following day after the weekend or statutory holiday. All charts must be returned to the weekend services site or home office prior to the end of weekend services working day. Documentation must be completed on the Weekend Services Tracking Log (link) Postpartum referrals and follow-ups received on the weekend/stat. are to be contacted by the community area public health nurse the following work week, unless otherwise indicated on the weekend services transfer form. 3. Breastfeeding Hotline - Health Links/Info Santé Families are encouraged to connect with their community area public health nurse for breastfeeding support and information. The breastfeeding hotline is a complementary service when PHNs are not available, including nights, weekends, and statutory holidays Health Links-Info Santé Breastfeeding Hotline Service Information Health Links-Info Santé uses a computerized database that allows information from the client to be triaged, and to create a disposition based on standardized protocols. These protocols have been reviewed and revised by public health to be consistent with the healthy beginnings clinical practice guidelines. Information is documented on a call summary report, and with the consent of the client, this report is faxed to public health daily Breastfeeding hotline referrals (Call summary reports) from Health Links-Info Santé Breastfeeding hotline referrals are sent to weekend services by fax on weekends and statutory holidays The call summary report is reviewed by a public health nurse to assess the need for client contact Completed documentation is forwarded to the community area, similar to other weekend services documentation. A transfer summary must be completed and attached to the front of referral documenting what action, if any, was taken. Updated November 2011 Page 6

7 Health Links-Info Santé may contact PHN #1 to discuss client concerns and recommendations for follow-up, which will be negotiated based on the assessed need for weekend follow-up Issues from public health or the general public regarding the Breastfeeding Hotline service can be directed to the Health-Links-Info Santé manager during regular work hours Monday-Friday. Immediate issues on weekends or statutory holidays can be discussed with the Health Link-Info Santé team leader/or charge nurse Public health nurses working weekend services should inform the team manager oncall if there is a concern, document on the weekend summary report, and if appropriate complete an occurrence report. 3.4 Weekend Breastfeeding clinic appointments Calls for weekend breastfeeding appointments are received at 490 Hargrave. The admin person will advise the client that a PHN from their community area will be able to assist them. The client name and community area can be obtained and the client informed that their call can be forwarded or the admin can forward their information to a PHN who will call them back.. The call/information will be forwarded to the appropriate community area coverage PHN for follow-up. If a weekend PHN appointment is necessary, the community area PHN should fax central intake with their single page summary documentation of the phone call, or a variance form to advise of issue requiring follow-up 4. Medical Officer of Health (MOH) 4.1. Medical Officers of Health throughout the province take turns being on call The MOH receives calls through the After Hours system. If follow-up is required, they will contact the team manager on-call. The team manager will work with the MOH to determine what staffing resources are required to implement the required interventions (link to Weekend, Evening and Statutory Holiday-Public Health Services algorithm). 5. Team Manager On-Call 5.1. Referrals for public health nursing follow-up may be received through the team manager on call related to a variety of public health urgent /emergent issues. A WRHA team manager is on-call 24 hours a day, seven days a week and has the following responsibilities Reports on-call emergency situations to senior management Organizes the community response to public health emergencies or disasters, in collaboration with other providers of emergency services Responds to requests for public health services received after regular work hours Responds to the pager within 10 minutes, and is at work within one hour of the initial page Consults with PHN #1 regarding urgent or emergent calls and whether utilization of the weekend team is reasonable Consults with the MOH as required. May also contact the senior management administrator on call if considerable risk exists to client or public at large Updated November 2011 Page 7

8 Contacts the community team manager in the event of a communicable disease. The TM may call in staff that is familiar with the community area. If unable to contact the manager responsible for the community area, will attempt to contact the public health manager from the community pairing, and then the quad. If unsuccessful, attempts to contact any available public health manager within WRHA to book additional staff Schedules additional staff at overtime rates, as outlined in the public health Manitoba Nurses Union (MNU) collective agreement Communicates any unusual issues to the community area and weekend managers Reports clinical and service provision issues and recommendations to the weekend services management group. 6. After Hours Unit 6.1. At times the After Hours Unit may receive calls applicable for public health follow up. After Hours staff are to contact PHN#1 directly to assist with problem solving. 7. Midwifery 7.1. Referrals on midwifery clients may be received 7 days per week. For additional information on the management of midwifery referrals, refer to the healthy beginnings manual section titled GUIDELINES FOR PHNs AND MIDWIVES: WORKING TOGETHER WITH PERINATAL FAMILIES. This guideline states: The midwife is responsible for all aspects of postnatal care including assessment, teaching, making appropriate referrals, metabolic screening, as the primary care provider for both the woman and infant On the weekend the PHN can accept the postpartum referral form from the midwife as advisement that the baby has been born (i.e. for information only ), and forward the referral to the appropriate community area. Public Health Staffing, Roles, and Responsibilities on Weekends/ Statutory Holidays 8. Scheduling for Weekend/Statutory Holiday and Standby: 8.1. The public health nurse staffing schedule for weekend/statutory and standby services has been developed on an equitable basis among the community area offices and is posted in accordance with the union contract Each community area public health nursing team will ensure the scheduled shifts are filled Once assigned to work weekend/statutory holiday and standby, the PHN is responsible to work on those days. Public health nurses may trade weekends Changes to the names of assigned PHNs must be ed to the identified administrative support before the end of the last working day before the weekend or statutory holiday. Staffing schedule changes are communicated to the team manager oncall and to the weekend team. Updated November 2011 Page 8

9 9. PHN Roles and Responsibilities 9.1. The public health nurses will work as a team, during the hours of 9:00 am 5:00 pm daily, to provide services throughout the WRHA jurisdiction For weekends and statutory holidays: PHNs begin work in one central office location Ten nurses will be assigned to work each weekend; eleven on long weekends and statutory holidays; plus a standby PHN If a team member does not arrive to work by 15 minutes into the workday, one of the team members is to call the team manager on-call to follow-up One public health nurse is assigned as PHN #1 on the weekend schedule. The PHN#1 position is a leadership role to assist in staffing resource allocation, clinical issues, and day-to-day problem solving Public Health Nurses Daily Responsibilities on Weekends/Stats include: Responding to all referrals received for weekend services Contacting referrals according to healthy beginnings postpartum standards and referral information, by telephone and /or home visits as necessary Having a primary focus on the health protective aspects of standard 1: contact 1 and standard 2, prioritizing for the safety and well being of the infant and mother Providing home phototherapy services, as described in WRHA home phototherapy guideline at Ensuring strong linkages to community areas has been conveyed so that the family is aware and expecting follow-up regarding community resources, education and ongoing support Initiating the Families First screening and Parent Survey, completing as much as is feasible for postpartum referrals received on the weekend and statutory holidays Completing documentation by the end of the workday, to facilitate effective communication After completing documentation, ensuring that client records are in the appropriate baskets When no further service is anticipated during the weekend or stat, the client record is placed into the basket marked For Courier. The courier picks up records at 8AM following the weekend or stat If the client needs follow-up within the weekend /stat services time, documents should be put in the basket marked Follow Up Completing Monthly Reports of PHN Activity Discussing workload prioritization and any need for overtime with PHN # Overtime must be pre-approved by PHN # PHN#1 must initial the Paid Hour Adjustment (PHA) form, and then it can be forwarded to your own community area team manager for signature Ensuring that all home visits are noted on the weekend staff planning log and there is a safety plan using a buddy system If no check in occurs, then the buddy PHN advises the team manager on call. ( 99 at end of page number indicates urgent page) After PHN#1 has gone home, inform buddy PHN and team manager on call they are the call in person. Updated November 2011 Page 9

10 10. Public Health Nurse # 1 Roles and Responsibilities Hours of work: 8:45am to 4:45pm Qualifications: 2 years of recent general public health nursing practice Responsibilities include: Staffing and workload Conduct a preliminary review of all community area referrals, including new visits and follow-ups At 9:00 am, meet with the weekend PHN team to discuss the referrals Distribute referrals equitably, considering PHNs home community area where possible. Plan assignments to minimize travel time and costs Check with the public health nurses throughout the morning to determine status of work, and arrange for staff to assist each other with telephone contacting of clients as needed At a prearranged time, 10:30-11:00 am (depending on number and complexity of referrals), regroup as a full team to redistribute work where needed and update the chart tracking log. Assess each PHN s workload and re-assign home visits where necessary, based on risk/time criteria such as new postpartum, follow-up visit, major issues, continuity of client care Assign increased staffing and/or overtime as necessary. Call standby if deemed necessary Clinical Participate in client telephone triaging and home visits. The number of telephone calls and home visits may be less based on other PHN#1 responsibilities Problem-solve with PHN and team regarding clinical/practice issues Respond to calls from Health Links/Info Sante regarding breast-feeding concerns Consultation Provide immediate clinical consultation for nursing practice related to standards and clinical practice guidelines (Healthy beginnings manual, breastfeeding support guidelines, home phototherapy guidelines and webbased CD protocol manual) Provide consultation to the After Hours Unit or Mobile Crisis staff regarding public health services Provide support and guidance for the weekend administrative staff Leadership/ Supervisory Orient self and PHN team to office, staff, and resources Oversee weekend operational issues. This includes ensuring All charts and referrals are assigned and logged on tracking sheet safety assessments and plans are created and followed when issues are identified Overall facility issues such as door security and site cleanliness are addressed directly with the weekend team as they occur. Updated November 2011 Page 10

11 Concerns such as desk assignment, equipment, and office issues are resolved in the short term and communicated to the weekend services team manager Foster team building and sharing of knowledge and experience Encourage team communication throughout the weekend Problem-solve and assist with workload so PHN s take rest and lunch breaks Communicate performance and practice issues to team manager and/ or CNS responsible for weekend services Advise team manager on call of any significant events or occurrences, including if PHN #1 will require overtime Ensure any workload reports, occurrences (including initial investigation forms), and near misses/injury reports are documented and forwarded to the team manager responsible for weekend services In the event public health staff require post exposure interventions, ensure that the post exposure protocol is implemented (link) If the administrative support person is absent, assume administrative tasks related to weekend services support. (link) Initial paid hour adjustment forms (PHA) for pre-approved over time. PHAs can be forwarded to the community area for team manager signature and processing Complete the daily comments weekend summary form for the senior operating secretary for weekend services, and place in For Courier basket Administrative The weekday administrative staff can ensure sufficient supplies available through communication obtained on the weekend comments log. In the unlikely event a supply shortage occurs due to unanticipated demand, HSC nursing supervisors are available 24 hours per day seven days a week Contact HSC Paging. Ask for the Adult Medicine Nursing Supervisor and request the necessary supplies Communicate with the on-call team manager, if they are not aware Arrangements will need to be made for transportation of supplies from HSC Advise HSC to send the bill the Manager of Facility Supports and Services for Centralized Services at Hargrave Ave Document the need for supplies on the weekend communication log so that the appropriate Managers can be aware of the order and expect the invoice. Updated November 2011 Page 11

12 11. Standby Public Health Nurse Hours: Monday through Friday from 1630 to 0030; Saturday, Sunday and Statutory Holidays from hrs (Confirm hours) One public health nurse will be on standby for urgent/emergent public health situations. These situations may include response to public health referrals, communicable disease control, and disaster or emergency situations Key Roles and Responsibilities include: Support the delivery of public health services to clients on weekends, statutory holidays, and after regular work hours Carry pager provided in standby bag. The stand-by PHN is expected to call back within 10 minutes and report to work within 1 hour of the initial page. (Ensure that there are extra batteries in the bag in case the batteries need to be replaced) Have a pass key for 490 Hargrave. Obtain 490 pass from your home office Be prepared with the necessary supplies to complete postpartum home visits on the weekend by ensuring your nursing bag is stocked as when working a scheduled weekend Complete a paid hour adjustment (PHA) form for hours worked. On weekends and stats the PHA should be initialled by PHN #1 and submitted to your community area team manager.. Hours of work commence upon arrival to the designated office, facility, or community location, unless otherwise indicated. 12. Community Area Team Manager At the beginning of each year, the 12 month weekend schedule (beginning May and ending April) is prepared based on a mathematical formula to distribute weekend shifts among community areas. The number of shifts is not negotiable If a weekend shift becomes vacant for any reason, it is a priority to fill the shift to ensure smooth weekend public health services. The manager is responsible for ensuring weekend shifts are distributed equitably among PHNs within the office. Shifts are scheduled per position. For example, if an office is assigned 20 weekend shifts for 4 PHN positions each position would be scheduled 5 shifts for the year. If two of the positions were part time those PHNs would still be scheduled for 5 shifts in the year Manager Roles and Responsibilities: Facilitates the weekend orientation process in conjunction with the community area CNS, prior to the staff member working their first assigned weekend Provides on-going evaluation and performance management of public health nurses Follows up on weekend operational issues and occurrence reports Informs weekend services management team of issues related to weekend services identified by public health nurses Ensures all community area assigned shifts, including PHN #1 shifts, are filled at time of the new schedule and with vacancies/illness Reviews the weekend assignment prior to the posting of the 4-week schedule to confirm his/her assigned shifts are filled. Updated November 2011 Page 12

13 Fills vacancies by approaching remaining staff to pick up the shift and arranges for alternate days of rest (ADRs) as per collective agreement. (It may be helpful to negotiate for another PHN to fill the weekend shift, thereby allowing some time to fill the vacancy and schedule the new staff member to later weekend vacancies) Assigns shifts in accordance with the collective agreement (Article 1501 of the MNU public health collective agreement). If the manager believes there are additional circumstances to consider in filling the vacancy, a call should be made to the team manager responsible for weekend services to discuss the need for overtime or other creative measures to meet this demand. This should occur at least one week in advance of the shift. 13. Team Manager for Weekend Services The team manager for weekend services is responsible for overseeing general operations and problem solving issues. This includes: Overseeing completion of the weekend services staffing schedule Developing and communicating operational guidelines for weekend services Providing support to community area team managers for problem-solving and collaborative strategies to resolve staffing issues 14. Clinical Nurse Specialist (CNS): The CNS for weekend services is responsible for clinical, practice, and problemsolving issues. This includes Providing clinical support and consultation regarding clinical practice issues with public health staff as needed Following- up on clinical practice issues arising related to weekend services Participating in the planning, education, evaluation and development of guidelines and recommendations related to weekend services. 15. Paediatrician On-Call The HSC Children s hospital ambulatory care group paediatricians are available to public health nurses for consultation regarding infant health concerns and questions when the client s paediatrician or family physician is not available on weekends and holidays. The number is on the back of the staff planning log. Procedures 16. Staff Illness and Replacement Public Health Nurse Illness Prior to the Weekend If the PHN assigned (regularly scheduled or standby) to work an upcoming weekend is ill and anticipates being unable to work they must advise their community area team manager The community area team manager will advise the weekend management group admin support of the replacement If unable to obtain a replacement public health nurse, the team manager for weekend services is notified The TM for weekend services will advise PHN#1 and the admin person of the vacancy Updated November 2011 Page 13

14 16.2. Illness during the Weekend/Stat Public Health Nurse: Contact PHN #1 and inform them at 0845 or throughout that day when the illness becomes evident. Prior to 8:45am a message can be left on PHN#1 s voice mail Administrative assistant: Contact PHN#1 when the illness becomes evident, message can be left on voice mail. Standby PHN: If illness occurs during weekend or statutory holiday, the assigned standby PHN is to contact PHN#1 who can problem solve with the team manager on-call as needed PHN#1: If PHN #1 becomes ill, the PHN is to notify the team manager on-call. Another PHN working must assume PHN #1 responsibilities. 17. Weekend Services Staff Planning Log The log is a tool to facilitate communication and ensure safety for the team of public health nurses working on a weekend or statutory holiday. Client names are not needed The log provides the following information: location of home visits brief description of the work assignment for each PHN frequently used telephone numbers safety buddy pairs for the day Guidelines for use: A master planning log is completed after the home visits and work assignments for the day have been initially planned The master log is photocopied and distributed to each PHN, with the PHN#1 retaining the master log PHNs contact PHN#1 with revisions to their planned home visiting schedule PHNs contact their buddy nurse with changes to their schedule PHN#1 maintains a current log, updating the log as changes occur in the assignment of home visits and utilizes the information to equitably redistribute work The log is submitted with the daily comments forms. All other copies are put in confidential shredding after the weekend or stat day. 18. Student Experiences on Weekends The following is based on the WRHA Public Health Practicum Student Orientation Manual section Weekend Services Limitations to Nursing Students Experiences. Please refer to the Practicum Student Orientation Manual for the full text and rationale The overall role of students on weekends and statutory holidays is one of observation. On weekends and statutory holidays, a nursing student may observe and co-visit with their preceptor Student nurses are not to initiate contact with clients nor provide unsupervised interactions. The public health nurse prior to co-visiting must obtain permission from the family for student involvement. Updated November 2011 Page 14

15 19. Orientation to Weekend Services Orientation to Weekend Services should match PHN learning needs. Prior to being independently scheduled, it is recommended that Public Health Nurses work with their preceptor or another team member during Weekend Services. Staff orienting to weekends are in addition to scheduled positions, to provide adequate time for learning and guidance. The role of the PHN orientee is intended to be observation and co-practice. Equipment and Supplies 20. PHNs are expected to bring their own equipment and supplies when working on weekends, statutory holidays, and stand-by. This may include, but is not limited to: Scale Sphygmomanometer with regular and large BP cuffs Stethoscope Thermometers and probe covers Penlight Calculator Latex/non-latex examination gloves Alcohol swabs; Virox/Percept wipes Disposable paper measuring tapes Lactation support supplies: feeding cups, feeding tubes, non-allergenic tape, syringes Map Cellular phone Hand cleanser Headsets: If staff has headsets assigned to them in their permanent location and position, they should bring that equipment to use on weekends Computers: Nurses will have access to computers at assigned workstations. They will need to enter their name and their password at the opening login screen, and then change the context box to reflect their permanent base location. The computer loads the nurse s programs and files as if they were working from their home office location. Once finished, please log off. Permanent staff will change the context back to their office location after the weekend Documentation: A supply of documentation forms is available in the Weekend Services supply cabinet. The documentation forms and client file folders utilized during weekends and statutory holidays are the same format as during the regular work week The expectations for documentation style and appropriate content are unchanged between regular work days and weekend/stats. Each set of documents for a client will be inserted into a client file folder A transfer summary form is to be attached with each client file folder for communication between the public health nurse working Weekend Services and the community area public health nurse. Updated November 2011 Page 15

16 Standard no contact letters will be used on weekends-(link) see following sample. The locations of the community area offices and several telephone numbers for after hours service are on the back of the letter. The hours 9:00 am to 4:00 pm are used in the letter to provide PHNs opportunity to respond to client needs and document within the work day Documentation and statistical collection for clients who attend the weekend breastfeeding support clinic is the same as for breastfeeding clinics during the week. 21. Weekend Cellular Phone The PHN #1 position will be assigned a cell phone with voice mail to facilitate communication between weekdays and the weekend. Documentation in Momentum - Breastfeeding Drop ins Health Services Directory Access Centres Community Offices Weekend Services Chart Handling Procedure Weekend Services Chart Tracking Log Logging in to iphis Creating an iphis record Personal Safety and Working Alone Directory (including office address, fax, phone) Regional Security Updated November 2011 Page 16