Safety and emergency management - the theme of this issue - are important areas for every home health agency and hospice to monitor and initiate planning and management regarding. The Medicare Conditions of Participation for home health agencies (e.g., G159) guides us that our plan of care should include safety measures to protect the patient against injury. The Joint Commission's National Patient Safety Goals support that home health agencies perform activities to reduce the risk of patient harm resulting from falls, improve the safety related to medications, and identify risks associated with home oxygen therapy. Many state regulations also guide agencies to establish disaster protocols to implement in the event of a natural or man made disaster. All these items lead us to establishing policies and protocols to help keep our patients as safe as possible in their homes.
Steps that should be considered to help keep a patient safe in their home include fire safety. Here organizations should train patients in the areas of careless smoking, smoke detectors, closing doors during a fire, oxygen use, and evacuation plan.
Each organization should have a plan in place to assess and assist in the reduction of patient falls. First, visiting clinicians should understand which patient (who) is at risk. In addition, they should perform an assessment of not only the patient's fall risk, but also the risks that exist in the specific home including items that can cause a fall, such as clothing, lighting, or floor coverings.
Disasters can impact a home health agency or a hospice anywhere. In the Homeland Security Preparedness Planning guide, which is included in this issue, the emphasis is on Assessing Needs, Preparing Supplies, and Making a Plan. When talking with home health agencies, it is clear that preparing for a disaster is not something that can be done as a storm is arriving or after the flood has occurred. The time is now!!
Some real world suggestions from some organizations that have been there:
Preparation:
- Develop a plan to triage patients.
- Develop a plan to organize shelter placement and evacuation.
- Code patients upon admission to their severity level risk at time of disaster.
- Utilize an information sheet that provides patients with the current list of medicines, treatments, pharmacy, physicians, and contact information to take with them upon evacuation.
- Upon the eventuality of a disaster, order extra supplies to deal with the aftermath of the occurrence.
Implementation
- Know where the shelters are!! Keep tabs on their availability and location as during times of disaster, they may change.
- Encourage patients to evacuate early. Once the disaster has arrived (or is arriving) the support needed to evaluate them may not be available.
- Gather a list of patient contact numbers at their evacuation destination to follow up with them after implementation.
Safety is not something we can only think about every now and then. It needs to be an integral part of each agency's admission, performance improvement, and day-to-day processes.
Contributors of the real world suggestions:
Rose Rash, RN, Director of Nurses, Angels At Home, Inc, Corsicana, Texas
Jacinda Sanders, RN, Administrator, Epic MedStaff Home Healthcare, Dallas, Texas
Brian Bienvenu, OT, R and R Homecare, New Orleans, Louisiana
Peggy Norregaard, RN, Branch Director, Gentiva Health Services, Houston, Texas