Positioning the Infant for Feeding & Feeding the Infant

1. Wash your hands.
2. Prepare the bottle and formula as directed in the Care Plan. Extra prepared bottles should be covered and kept in the refrigerator for no more than 24 hours. Always use clean bottles that have been sterilized. Bottles can be sterilized by placing the bottles, caps, and nipples in boiling water for 5-10 minutes. Some clients may have bottle sterilizers. Use them according to the manufacturer’s instructions.
3. Ensure the bottle is warmed. To warm, immerse the bottle in warm tap water for several minutes. Alternatively, you can hold the bottle under warm tap water, turning it clockwise to warm the formula evenly. Some clients may have a special baby bottle warmer. Learn how to use it according to the manufacturer’s instructions. Never use a microwave to warm bottles as it can create hot spots in the liquid and could heat the plastic on the bottle, causing a possible burn to the baby.
4. Shake the bottle well after warming to ensure contents are mixed. Shake a few drops onto the inside of your wrist to test for temperature. It should feel warm, not hot or cold. If it is too hot, allow the bottle to cool before feeding the baby. If it is too cold, continue to warm the bottle as described above.
5. Sit in a comfortable chair. Maintain good posture, keeping your back straight and aligned. Position the baby in the cradle or football hold. Always ensure the baby’s neck and head are supported.
6. Stroke the baby’s lips with the bottle nipple until her mouth opens. Place the bottle nipple inside the baby’s mouth gently. Never force the nipple into the baby’s mouth.
7. Always keep the baby’s head higher than her body while feeding. This helps to prevent choking. Never put a baby in a lying down position with a bottle propped. This could cause choking. Be sure the nipple stays full of milk so that the baby does not swallow air while sucking.
8. Talk or sing to the baby in a soft, quiet voice during feeding. Create a soothing, relaxing atmosphere for the baby while feeding.

Burping a Baby

When the baby has finished feeding, or if she stops sucking, burp her. You may need to burp the baby during the feeding, periodically stopping the feeding to burp the baby. To burp the baby, lift the baby to your shoulder, supporting her head. Use a burp cloth or towel over your shoulder to catch any spit up. Alternatively, you can hold the baby on your lap, supporting the baby’s head by holding her chin with your thumb and forefinger. Ensure her head does not fall backward. You can also lay the baby down on a burp cloth positioned over your lap. The baby will be face down on their stomach. Your arm should be placed under the baby’s chest, supporting the neck and hand. Pat or massage up the back with the palm of your hand. Once the baby has burped, you can return her to a safe position or continue with the feeding. Clean the baby’s face with a warm, wet washcloth.

Changing a Diaper

After feeding, change the baby’s diaper. Always wear gloves when changing a baby’s diaper. Remove and discard the soiled diaper. Do not leave the baby unattended to discard the diaper. You can set it aside and discard it later if a garbage can is not within reach. Cleanse the baby’s perineal area with a warm, wet washcloth or baby wipes. Ensure the perineal area is completely clean and completely dry. Leaving urine or feces on a baby can lead to diaper rash or infection. Always wipe from front to back for female babies. Apply powder, ointment, or cream as directed in the Care Plan. Unfold the diaper and place it flat under the baby’s bottom. To place the diaper under the baby’s bottom, gently grasp her feet in your hands and lift just high enough to slide the diaper under her bottom. The tabs should be toward the back of the diaper, on either side of the baby. Pull the front of the diaper up, between the baby’s legs. Fold the right and left sides of the diaper toward the middle. Peel tape on the tabs open and secure diaper by gently pressing them against the front of the diaper.

Replace any soiled clothing with clean clothing. Ensure the baby is placed in a safe area, such as her crib.

Documenting the Baby’s Intake and Output

Input can be measured by measuring the amount you put in the bottle and subtracting the amount of fluid left. Output is usually recorded by number of diapers for urine output and number of bowel movements. Some agencies may require that you weigh the wet diaper. Record and report any observations, such as changes in the baby’s feeding habits, difficulty for the baby sucking during feeding, or an unusual amount of spit up.

1. Discard any formula remaining in the bottle. Wash the bottle, nipple, and ring in hot, soapy water with a bottle brush. Rinse well. Sterilize it before using again.
2. Discard gloves and wash your hands.

Procedure: Infant Bath

Infant bathing is an important task for the Home Health Aide/Personal Care Aide. Infants should be bathed at least once per day, and according to the Care Plan. Never leave a baby unattended during a bath, not even for one minute. Home Health Aides/Personal Care Aides must always support the baby’s head and neck with one hand, while using their other hand to wash the baby. Remember, babies are unable to regulate their own body temperature. Home Health Aides/Personal Care Aides should always ensure they keep the baby covered whenever possible, and immediately after their bath, wrap a towel or blanket around them.

1. Wash your hands.
2. Gather all supplies needed (baby wash, baby shampoo, baby lotion, bath linens, clean basin or infant tub bath, clean diaper, powder/ointment/cream). Always have your supplies nearby. Never leave a baby unattended during a bath.
3. Ensure the temperature of the room is warm. Prepare the bath water to the correct temperature.
4. Wash your hands. Don gloves during diapering and bathing.
5. Bring the baby to the bath area.
6. Place the baby on a blanket or towel. Undress the baby.
7. Lower the baby gently into the water. Support the baby’s head and neck at all times. One hand will always be holding the baby while you will wash the baby with the other hand.
8. With a warm, wet washcloth (do not use soap), gently wipe the baby’s eyes, using a clean area of the washcloth for each eye. Clean from the inner corner of the eye (the side closest to the nose) to the outer corner (the side closest to the baby’s ear). Then clean the rest of the baby’s face. Pat the baby’s face dry.
9. Use a warm, wet washcloth to wet the baby’s hair. Be careful to not let water or shampoo get into the baby’s eyes. With a small amount of baby wash or shampoo, lather the baby’s hair. Rinse with a warm, wet washcloth. Pat the baby’s head dry completely.
10. Wash the baby from neck to feet using a small amount of baby wash and a washcloth. When washing a female baby’s genitals, wash from front to back. Rinse completely. Wash the baby’s bottom thoroughly.Rinse completely.
11. Remove the baby from the bath and cover her with a towel. Pat the outside of the towel gently to dry the baby. Babies are unable to regulate their own body temperature. Always ensure the baby is kept warm and covered.
12. Apply powder, ointment, lotions, and creams as directed on the Care Plan.
13. Diaper and dress the baby.
14. Provide nail care if directed.
15. Place the baby in a safe place, such as in her crib.
16. Clean and store all equipment used. Discard dirty diapers and linens appropriately.
17. Remove gloves and wash your hands.
18. Document the procedure and any observations or changes in condition.

Introduction to Assisting with Self-administration of Medication

The assistance of self-administration of medications by Home Health Aides is not allowed in every state or country. You should be specifically trained and assigned to provide assistance with medications. Personal Care Aides are not allowed to assist with administration of medication under any circumstance.

Assisting with self-administration of medications is different than administering medications. Only licensed providers such as physicians, nurse practitioners, registered nurses, and licensed practical nurses may administer medications to patients. Home Health Aides may ASSIST patients with self-administration of medication. Personal Care Aides must never assist with medications in any way.

Assisting with medications means the HHA may remind patients about taking their medications, bring the medication to the patient, and bring other equipment needed to take the medication such as an inhaler to the patient. The HHA may bring liquid such as water to the patient so they can take their medication. Home Health Aides should assist the patient into the correct position so the patient may take their medicine. For example, for medications taken by mouth the patient should be in a fully upright position. This helps to prevent choking and allows the medication to move down the esophagus into the stomach. Medication should never be crushed unless the Care Plan specifically states. Remember to always keep medications stored in a locked area.

If the Home Health Aide notices a patient taking a medication incorrectly or if the patient has a reaction to the medication the HHA should inform the supervisor. If medications are dropped or mixed up with other medications the HHA should inform the supervisor. If the HHA becomes aware of herbs, supplements, and medications the patient is taking and which they have not told the healthcare team about they should inform their supervisor.

Home Health Aides may also show the patient the medication and read the label to the patient so that the right patient, right medication, right dose, right time, and right route may be checked. Understanding and following the 5 Rights of Medications helps to avoid medication errors. The Five Rights of Medications include: The Right Patient, The Right Medication, The Right Dose, The Right Time, and the Right Route. If Home Health Aides ever have a concern about any of these rights, they should speak to their supervisor immediately. The safety and well-being of a patient depends on their Home Health Aide.

Procedure: Checking the Right Person (Patient)

1. Wash your hands.
2. Read the container label on the medication bottle.
3. Check the name on the label to make sure it is the same as the patient’s.
4. Check the name on the label against the name on the Care Plan and against the patient’s ID band if they are wearing one. If the patient can respond, ask them to tell you what their name is.
5. If the patient’s name is the same as what is written on the label, proceed to hand the bottle to the patient and/or assist with administration as trained and ordered on the Care Plan.If the names are not the same, STOP! Do not proceed further.
6. Contact a supervisor for further instructions.
7. Explain the reason for this to the patient. Patient safety is the number one priority. If the medication bottle does not have the patient’s correct name, this puts the patient in danger of taking someone else’s medication.
8. Record and report any problem about the medication in question to a supervisor.

Procedure: Checking the Right Medication

1. Wash your hands.
2. Read the container label on the medication bottle.
3. Check the expiration date on the medication bottle.
4. Check the name of the medication on the label to make sure it is the same as the medication listed on the Care Plan.
5. If they are the same, proceed to hand the bottle to the patient and/or assist with administration as trained and ordered on the Care Plan.
6. If they are not the same, or if the medication has expired, STOP! Do not proceed further.
7. Contact a supervisor for further instructions.
8. Explain the reason for this to the patient.Patient safety is the number one priority. If the medication bottle does not have the patient’s correct name of the medication, this puts the patient in danger of taking someone else’s medication.
9. Record and report any problem about the medication in question to a supervisor.

Procedure: Checking the Right Dose

1. Wash your hands.
2. Read the container label on the medication bottle.
3. Check the dose on the label against the dose for that medication listed on the Care Plan.
4. If they are the same, proceed to hand the bottle to the patient and/or assist with administration as trained and ordered on the Care Plan.
5. If they are not the same, STOP! Do not proceed further.
6. Contact a supervisor for further instructions.
7. Explain the reason for this to the patient. Incorrect dose information could lead to the patient taking too much or not enough of a medication.
8. Record and report any problem about the medication in question to a supervisor.

Procedure: Checking the Right Time

1. Wash hands.
2. Read the container label on the medication bottle.
3. Check the time for taking the medication listed on the bottle against the time specified in the Care Plan.
4. If they are the same, proceed to hand the bottle to the patient and/or assist with administration as trained and ordered on the Care Plan.
5. If they are not the same, STOP! Do not proceed further.
6. Contact a supervisor for further instructions.
7. Explain the reason for this to the patient. Taking a medication at the incorrect time could lead to potentially having too high or too low of a dose of medication in the body.
8. Record and report any problem about the medication in question to a supervisor.

Procedure: Checking the Right Route

The route for medication means the method by which the patient will take the medication. Routes for taking medications can include the: mouth, ear, eye, rectum, inhalation, and vagina.

1. Wash hands.
2. Read the container label on the medication bottle.
3. Check the route for taking the medication listed on the bottle against the route specified in the Care Plan. If they are the same, proceed to hand the bottle to the patient and/or assist with administration as trained and ordered on the Care Plan.
4. If they are not the same, STOP! Do not proceed further.
5. Contact a supervisor for further instructions.
6. Explain the reason for this to the patient. It is important to take medications the appropriate way.
7. Record and report any problem about the medication in question to a supervisor.