presented by Tina Marrelli & Kim Corral
This course addresses the common safety-related factors in the community and home environments. Home care team members can be exposed to a number of potentially serious hazards which range from dangerous pets (eg. biting) to firearms (ie. guns) in homes. Environmental hazards include smoke, needlesticks, unhygienic homes, germs and pathogens, structural house problems, hoarding and many others. This course seeks to identify some of these safety hazards and dangers so that clinicians and managers/leaders can better understand and apply their risk management and safety policies related to such situations and protect their team members.
Tina Marrelli is the President of Marrelli and Associates, Inc., a publishing and consulting firm working in home care for more than 30 years. Tina is the author of 13 books, including the Handbook of Home Health Standards: Quality, Documentation, and Reimbursement, (6th edition, 2018). Other books include A Guide for Caregiving: What’s Next? Planning for Safety, Quality, and Compassionate Care for Your Loved One and Yourself (2017), Hospice and Palliative Care Handbook (3rd edition, 2018), The Nurse Manager’s Survival Guide (4th edition, 2018), and the best-selling home health aide educational system, Home Health Aide Guidelines for Care: A Handbook for Care Giving at Home and its accompanying Nurse Instructor Manual. Tina served on the workgroups that defined the first hospice nurse standards as well as serving as a reviewer in 2014 for the revised Home Health Nursing: Scope and Standards of Practice through the American Nurses Association. Tina attended Duke University, where she received her undergraduate degree in nursing. She also has master’s degrees in health administration and in nursing. Tina has worked in hospitals, nursing homes, and public health and has practiced as a visiting nurse or manager in home care and hospice for more than 20 years. Tina also worked at Medicare’s central office (CMS) for four years on Medicare Part A home care and hospice policies and operations as well as serving as the Interim Branch Chief for Medicare Part B. Tina loves policy and the nuances that frame care, practice, and delivery. Tina is an international health care consultant, specializing in home care and models of care provided in the community to people at home. Tina and her team of specialized consultants have been in business since 2002 and provide services related to the “design and implementation of challenges to providing home and community-based care.” In that capacity, they have served more than 100 clients throughout the world, clients who represent varying segments of service to home care and/or related products. Services include custom presentations, software development, educational services, serving as Team Leader with a team that served as quality monitors to the OIG, accreditation services, new organizational start-ups, due diligence, feasibility studies, and more. Tina has been the editor of three peer-reviewed publications, most recently for Home Healthcare Nurse (now Home Healthcare Now), on which she served as the Editor-in-Chief for eight years. She is also an Emeritus Editor for Home Healthcare Now. In addition, Tina serves on the editorial boards of the Journal of Community Health Nursing and The American Nurse. Tina is the Chief Clinical Officer for e-Caregiving, www.e-Caregiving.com, a web-based support and educational system for family and friend caregivers created to support advocacy and improve care across the health care continuum.
Kim is a registered nurse with a master's degree in Education and over 30 years of home health experience. She is an experienced leader in home health care, having held both clinical and operational positions at regional and national levels for large corporate home health organizations. She brings a passion for providing the clinical voice of quality, while increasing efficiencies. She has extensive experience speaking for state home care associations, national home care organizations, and local home care organizations on regulatory compliance, successful strategies for clinical/operational success, OASIS data collection and strategies, quality outcome improvement, developing successful QAPI programs, documentation standards, and operational processes to support OASIS and ICD-10 accuracy.
A knowledge of the community is key to safety-related initiatives in providing home care visits to people in varying neighborhoods and areas. Sadly, we only have to watch the news to hear that there is another random shooter or other dangerous and scary event. This chapter seeks to help answer the question: what if? The Centers for Medicare and Medicaid Services (CMS) established national emergency preparedness requirements for all organizations, such as home care and hospice, participating in the Medicare and Medicaid programs. In the State Operations Manual (section 484.22) are the related Conditions of Participation for Home Health Agencies (HHAs). These became effective in November, 2017. The bottom line is that we have an important role to play and that we must be prepared, whether the emergency be caused by nature, such as ice storms, tornadoes, or hurricanes, or other situations, such as an active shooter situation.
There is a method of assessing a neighborhood or community through an effective and detailed Windshield Assessment. This seemingly simple process can identify much information about a given neighborhood or area. This windshield assessment is accomplished to identify possible safety hazards and risks for both the clinicians and their patient populations.
The fundamentals for home visit safety begin on the road. This includes a car in good working condition, a method for getting roadside assistance, having a full tank of gas, not leaving your purse on the passenger seat where it can be seen, and not leaving patient records where patient information might be seen (HIPAA). This also includes looking around your car for safety concerns on getting in and out of the car. These and other common safety concerns will be addressed in this chapter.
There are a number of common and known hazards in homes. The home care clinician must have an awareness of their surroundings at all times in the community and in the patient's home. Hazards found in the home can include dangerous pets, smoking, poor structural maintenance, infestations, unclean homes, blood-borne pathogens, unsafe water, tripping hazards, and many more. Others include risks to personal safety from violence, stalking, and abuse.
Sadly, there have been instances of home care clinicians walking into situations that resulted in death and injury. These are related to the practice environment. This chapter seeks to educate and help minimize such situations, when possible.