Much has been written about safety and the need to improve safety in all healthcare settings. Safety is a key component of quality. Medication errors and other misadventures are reported in the media and unfortunately, on a frequent basis. In the home setting, falls, medications, and other areas of concern fall under the broader umbrella term of safety. In this issue, many articles address varying topics that are components of quality and safety seen in the home setting. Norma Anderson addresses team member safety in "Safe in the City"; sadly, national stories about this problem show that staff safety considerations are more important than ever. Two articles about depression and the loneliness that can impact our patient populations emphasize the importance of observation and assessment for those with this health condition.

One part of safety is related to infection control and prevention efforts. In fact, the Association for Professionals in Infection Control and Epidemiology (APIC) has urged all 50 states to proclaim an International Infection Prevention Week, October 19 to 25, 2008. And we know that infection control is more important than ever as Mary C. Vrtis outlines important information about Clostridium difficile in "Preventing Epidemic Outbreaks in Home Health."

Safety also has implications about how we practice, educate, and evaluate care. For example, there are varying models of providing care at home: the team model, varying case management models, and others. Some organizations have specially trained "admission" (only) nurses, while others use a different system/process for patient admissions to home care and hospice. I have received a commentary about the positive aspects of the admission nurse model, but I would like the opposing view for a point/counterpoint commentary about this topic. Feel you have the "best" viewpoint and can articulate the whys? Please e-mail me at news@marrelli.com.

In the July/August 2008 issue of Home Healthcare Nurse editorial entitled "A Penny for Your Thoughts," I explained about the requests I have had from some nurses about the need for a nurse-focused professional association, and asked for your feedback. First, all of the feedback was positive; we have volunteers!! Here are parts of the responses: "Tina, you're absolutely correct[horizontal ellipsis]We do need an organization for those of us doing home care. I've been in this field for over 22 years and it does have unique challenges, especially in rural areas." "This is a big transition for our nurses coming out of acute care." "Keep us posted." "In all likelihood it's been a long time coming. (I'm sure there are those who would argue that there is no need for more specialty trade groups, feeling they are already adequately represented by the larger whole.)" "It needs to be a grassroots effort among the nurses themselves and come from the ground up[horizontal ellipsis]and truly be a group devoted to the support of the home care nurse." "I think it is an exciting proposition." "I am also a member of my state nursing association[horizontal ellipsis]they do a very good job meeting the needs and concerns in the acute care setting; however, they do not address the needs of home care. I would like to see, at a minimum[horizontal ellipsis] local community units[horizontal ellipsis]continuing education and networking. I believe this is very important[horizontal ellipsis]. It seems that the nursing world is turning its back on HHC nurses." "I would be glad to organize a home care organization chapter in California." "As a longtime subscriber and contributor to Home Healthcare Nurse, I was very much in agreement with your editorial, 'A Penny for your Thoughts'[horizontal ellipsis]I do believe we home healthcare nurses need to have a professional organization and be the first in line to join again." "I opened my issue and started with your editorial-I think that's a great idea"[horizontal ellipsis] "I recently ran across a blog and the author spoke about how being a home care nurse changes the way you perceive patients for the rest of your life-even if you leave home care. I wanted to stand up and shout." "I think a professional organization would be great, and I am definitely willing to be a part of that. Just let me know." "I think assns should work to advance the profession of HHC nursing as a more recognized specialty[horizontal ellipsis]what does it mean to be an HHN?"[horizontal ellipsis] "I would love to see HHNs come more to the forefront in all this 'health planning' that is going on at the Federal level. It is time to be proactive[horizontal ellipsis]"

I thank all of you who responded to me and am sorry I could not fit all the comments. I now ask: Where would you like to go from here? I am looking for a state representative or two from each state; this will be a grassroots efforts and a "virtual" entity[horizontal ellipsis]whatever it becomes. Feedback is still welcomed and I look forward to hearing from you!!

TINA MARRELLI, MSN, MA, RN