1. Marrelli, Tina M. MSN, MA, RN, FAAN

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Much information has been published and otherwise communicated about safety and healthcare. Since the Institute of Medicine's (IOM) groundbreaking report "To Err is Human: Building A Safer Health System," the safety of patients has been studied and questioned. In 2013, the Lucian Leape Institute and the National Patient Safety Foundation released the white paper "Through the Eyes of the Workforce: Creating Joy, Meaning, and Safer Health Care." For the full report, see Although it is inpatient-focused, the information from this paper provides a strategic vision for improving patient safety (Lucian Leape Institute at the National Patient Safety Foundation, 2013, p. ES1). As stated succinctly in the executive summary on "vulnerable workplaces": "The basic precondition of a safe workplace is protection of the physical and psychological safety of the workforce. Both are conspicuously absent or considered optional in many care-delivery organizations. The prevalence of physical harm experienced by the health care workforce is striking, much higher than in other industries."

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Two articles in this June issue speak to the issue of staff safety in home care. The cover feature entitled "Opening the Door to Improve Visiting Nurse Safety: An Initiative to Collect and Analyze Protection Practices and Policies," by Ann Mathiews and Susan Salmond, provides information about findings from a survey that illuminates the importance of policies and safety protection practices. The second, which is also a CE article, is "Preparing for the Unexpected: Violence in the Home Care Environment, One Agency's Story" authored by Sarah Via Browning, Rebecca Culver Clark, and Roger E. Glick. The third safety-related article, authored by Mary Withey and Allison Breault, addresses a common risk area for older adults at home-falls. "A Home Healthcare and School of Pharmacy Partnership to Reduce Falls " is an innovative model that combines two known areas of problems-falls and polypharmacy-and seeks to prevent them and their sequelae. The home visits made to home care patients by pharmacy students and their working with home care nurse case managers is a great example of interprofessional or interdisciplinary collaboration.


This month's second CE is "Head, Neck, and Oral Cancer Update." In this article, Cindy Farris and Denise McEnroe Petitte review information about the growth of these cancers as well as how best to care for patients and their families impacted by this with the complexity of feeding tubes and numerous interventions and treatments. Family caregivers seem to have more responsibilities than ever. This month's Research Briefs is entitled "Research on Family Caregivers: Understanding Levels of Burden and How to Provide Assistance, " by Annette Cutrino and Judy Santamaria. This information provides some guidance on what matters to these caregivers and the support(s) they need.


Margaret Terry from the VNAA offers "Thinking Outside the Box: A Performance Improvement Model With 10 Best Practices to Reduce Hospitalizations." These best practices can be applied to your operations and practice to help your patients remain at home. Thank you, Margaret, and your dream team of thinkers to determine this list. As we know, Medicare continually undergoes change. This is the recently released "Fact Sheet" from Centers for Medicare & Medicaid Services (CMS, 2013) about the Jimmo v. Sebelius Settlement Agreement. (See Box 1 for the text of the agreement.)

Box 1 - Click to enlarge in new windowBox 1. Jimmo v. Sebelius Settlement Agreement Fact Sheet

We will all await the education that will come out of the Jimmo Settlement Agreement-including the specific operational, clinical, and documentation questions to understand the needed support for skilled services.

Box 1 - Click to enlarge in new windowBox 1. Jimmo v. Sebelius Settlement Agreement Fact Sheet

Home Healthcare Nurse seeks your experiences and models that support safety-both patient and clinician in the community. If you have an innovative program or model or other topics you have developed and wish to submit for peer review, please e-mail me directly at


Because June historically marks the beginning of summer and "time off," I hope you can enjoy time with family and loved ones this summer and if you need an interesting book to read during your down time, you might enjoy Brain on Fire: My Month of Madness by Susannah Cahalan (2012). In the interest of self-disclosure, I will tell you that I had encephalitis while a senior in high school. I got bitten by the wrong mosquito and went into a coma. At that time I was working as an aide at a hospital to save money for college and thought I was getting the flu.


I do not want to tell you what happens in this book, and it was not encephalitis, but it goes under the header "there is so much we do not know" and "trust our patients' instincts when they know something is wrong or 'off.'" This bright, articulate news reporter loses her well-honed skill sets and the story begins. #x2026; Let me know what you think if you read it. I have had a few requests by subscribers to identify interesting and educational health-related books, and another good summer read (if you have not already seen it or read it) is The Immortal Life of Henrietta Lacks by Rebecca Skloot (2010). This one is hard to put down too and also true!


I welcome your e-mails and thoughts and wish you and yours a good summertime with some fun and relaxation!


Join Us at IHCNO!

The inaugural conference of the International Home Care Nurses Organization (IHCNO), The Future of Health is at Home, will be held June 25-28, 2013 at Case Western Reserve University, Cleveland, Ohio. It is co-sponsored by the Frances Payne Bolton School of Nursing at Case Western Reserve University. For more information, visit




Cahalan S. (2012). Brain on Fire: My Month of Madness. Minneapolis, MN: HighBridge. [Context Link]


Centers for Medicare & Medicaid Services. (2013). Jimmo v. Sebelius settlement agreement fact sheet. Retrieved from http:// [Context Link]


Lucian Leape Institute at the National Patient Safety Foundation. (2013). Through the eyes of the workforce: Creating joy, meaning, and safer health care. Retrieved from http:// [Context Link]


Skloot R. (2010). The Immortal Life of Henrietta Lacks. New York, NY: Crown. [Context Link]