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The receiving facility and medical control physician must ensure that the skills and equipment available during transport will meet the anticipated needs of the patient diabetes medications in renal impairment buy 5mg dapagliflozin. If the referring hospital chooses to perform its own transport for the purpose of "saving time" and getting the patient to the receiving hospital sooner diabetes onset symptoms order 5mg dapagliflozin, they must understand that they are fully responsible for the patient until arrival at the receiving institution diabetes insipidus algorithm purchase dapagliflozin 10mg. The referring physician and hospital may be held liable for using inappropriate transport services blood glucose 250 cheap 10 mg dapagliflozin. The medical director should be available to the team 24 hours a day or should clearly designate an appropriate physician for alternative coverage. The transport coordinator is a registered nurse who coordinates the day-to-day activities of the transport team. This person must be experienced in handling transport calls and in offering management suggestions for the period before the arrival of the transport team. Experience and Background Training of Staff Each transport nurse will be currently licensed as a registered nurse by the Iowa Board of Nursing. Specific training and experience in the care of critically ill neonates is necessary. The transport nurse must be able to provide appropriate care for the patient being transported by air/ground from the time of arrival at the referring hospital, while the patient is loaded on the aircraft/ground transport vehicle and during the transport until the time the patient is admitted to the neonatal center. Guidelines for Training of Personnel Involved in Transport Guidelines for Perinatal Services, Eighth Edition, Appendices Updated August 2013 47 Appendix 11 Each transport nurse shall be able to provide care necessary for life support and/or stabilization of the patient during transport. Responsibilities shall include a working knowledge of all equipment used during transport. Continuing education, training, competency and quality review should be documented to ensure that the team members remain qualified to perform necessary services and procedures. The development of an effective neonatal inter-facility transport service requires multiple resources, but in particular, needs skilled healthcare professionals trained and experienced in neonatal transport. In order to maintain these resources in a cost-effective manner, a minimum volume of neonatal transport patients is required. Substantial commitment from hospital administration is necessary to provide a system that will meet the goal of safe, skilled neonatal transport. Guidelines for Air and Ground transport of Neonatal and Pediatric Patients (3rd Edition). Guidelines for Perinatal Services, Eighth Edition, Appendices Updated August 2013 48 Appendix 12 Appendix 12. Discharge Planning and Health Education the following are guidelines for minimum discharge education that should be provided to parents or care taker prior to discharge of mother and baby from the hospital: 1. Research has shown that umbilical cord drying time is decreased with as needed cleaning of the cord with water rather than alcohol. Parents should notify their physician if the cord or skin around the cord is reddened or has foul-smelling drainage. Breastfed babies should be fed every 1-1/2 to 3 hours to total 8-12 feedings in a 24-hour period. Recent research has shown that even moderate degrees of hyperbilirubinemia are associated with an increase in minor neurologic dysfunction throughout the first year of life. Follow-up should be provided within two days of discharge for all neonates discharged < 48 hours after birth. It is necessary to provide supervised "tummy time," that is, time when the baby is awake and observed by the parents or caregivers at all times, to help prevent head-positioning deformities, and encourage development of upper body, trunk and neck strength. Parents who smoke should be provided with information on smoking cessation programs. Parents should be encouraged to leave the house to smoke, and to not smoke in the car. Parents should be encouraged to call their physician for any of the following signs in the newborn: Breathing difficulties Seizures, loss of consciousness Lethargy, irritability Decreased feeding for 24 hours Vomiting more than one to two entire feeds in one day, or projectile vomiting No urine output for more than 12 hours Bowel movements that are black, watery, loose, or of increased frequency Guidelines for Perinatal Services, Eighth Edition, Appendices Updated August 2013 49 Appendix 12 Reddened umbilical site Redness, drainage, swelling, foul odor around circumcision site Jaundice covering abdomen/extremities Pustules/rashes other than normal newborn rashes White patches on the mouth that remain after the mouth is gently wiped with a wet cloth or that cannot be removed with gentle scraping Axillary temperature under 97. Demonstrate temperature taking and reading a thermometer Any baby who appears "ill" 12. The first newborn visit should be two to three days after discharge in infants discharged at < 48 hours of age.