Home healthcare and hospice operate in an extremely diverse world with a diverse team involved in the provision of care. In addition, our patients come from a variety of backgrounds. This month's issue of Home Healthcare Nurse celebrates both forms of diversity. Articles in this issue focus on cultural competence as well as diversity in the roles of home healthcare providers and the types of services provided. The articles also present the diverse needs of providing safe patient care: reducing medication errors, documenting care appropriate to enable safe transition from one care setting to another, helping the patient adjust safely to new self-care regimens, event-free survival with heart failure, and home-based cardiac rehabilitation.
Deborah Hines reviews online resources available for organizations to assess their cultural competence and engage in ongoing staff development to provide culturally and linguistically appropriate patient care in her CE article, "Cultural Competence: Assessment and Education Resources for Home Care and Hospice Clinicians." The online version of Home Healthcare Nurse supports the provision of culturally and linguistically appropriate care with an additional article reviewing web-based resources for learning about Spanish culture and accessing Spanish-language patient education materials.
Nurses Brenda M. Ewen, Honda Combs, and Gail M. Faraone, with oncology pharmacist Carl Popelas, describe their team's performance improvement journey from a medication error to the implementation of a statewide practice change designed to improve patient safety in the delivery of home infusion in "Chemotherapy in Home Care: One Team's Performance Improvement Journey Toward Reducing Medication Errors." Previously there was no single policy involving all the potential providers-physicians, infusion companies, infusion centers, and home healthcare agencies-involved in providing chemotherapy at home. New standards for the verification of the correct dosage and flow rate were developed by a task force that included representatives from each provider group and chemotherapy was moved from the home setting to cancer centers. The new process of double verification has reduced the potential for error and increased patient safety.
Another team of nurses and pharmacists, Stephen M. Setter, Cynthia F. Corbett, and Joshua J. Neumiller, address the issue of medication management in transitional care in "Transitional Care: Exploring the Home Healthcare Nurse's Role in Medication Management." They cite studies that have documented that 20% of the patients discharged from the hospital to home experience an adverse health event. Almost two-thirds of those events were medication related. They advocate a transition team that includes a pharmacist as well as a nurse and physician to reduce the potential for medication errors as patients, particularly older adults, migrate from an inpatient facility to home care. A clear definition of the patient's medication regimen, including the elimination of prescription duplication between the primary care and discharge physicians and a review of all over-the-counter agents, herbal medications, and supplements the patient is used to taking at home, will enable the nurse to prepare the patient and his or her family for responsible self-management.
Prevention of a hospital readmission or emergency room visit is another important aspect of home healthcare patient safety. Cynthia Beck and Shivani Shah review four studies of measures to assist cardiac patients in maintaining a positive health-related quality of life in their article titled "Research on Health-Related Quality of Life and Cardiac Conditions."
Jennifer Kennedy, in the second CE offering, discusses the vital role of nurse practitioners (NPs) in the provision of hospice care, under new Centers for Medicare and Medicaid regulations in "Demystifying the Role of Nurse Practitioners as an Integral Part of the Hospice Plan of Care." Ms. Kennedy stresses the importance of documentation of the nurse practitioner's visit to facilitate the patient's continued eligibility for hospice care as well as provides other important information about NPs in hospice.
Another diverse member of the hospice and home healthcare team is the volunteer. Emily Swanson celebrates the importance of volunteers in assisting hospice and home care clinicians to provide the best care possible in "In Celebration of Home Healthcare and Hospice Volunteers." From filing documents to providing respite for a family caregiver, volunteers provide much-needed backup support for our service teams and our patients.
Finally, in this month's commentary, "To Be," Ruth Mulhern shares the story of a memorable patient and his hospice care team. This story demonstrates how sometimes being is more important than doing.
Read our articles, learn from them, and join Home Healthcare Nurse as we celebrate the diversity of our care providers and our patients. In this new year may you all continue to provide care that is safe as well as culturally and linguistically appropriate.