1. Humphrey, Carolyn J. MS, RN, FAAN

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For those old enough to remember the television show Hill Street Blues (which aired from 1981-1987), you may recall that every morning the police unit would have a briefing prior to sending officers out for the day. The captain, initially played by the late Michael Conrad, would lean on the podium, shake his index finger at the group like a parent scolding a child and remind his colleagues to, "Be careful out there."


The police officers would then leave the station for a day of unexpected events, each one a potential life and death situation-not just for others, but for themselves. Although providing home care services may not be totally comparable to the dangers faced by police on the "beat," many visiting staff don't consider their personal safety as much as they should.


In this issue two articles provide examples of clinicians in danger and the steps both agencies and visiting staff can implement to ensure safety. In "Knock Before You Enter," author Vicki Jodway shares her experience of walking in the wrong patient's house in the middle of the night. Her message is an important one. Carrie Kruger and her colleagues from Cincinnati Children's Hospital Medical Center's pediatric home care and hospice program share frightening situations that lead the agency to revamp safety and security strategies that work!!


My heart sinks whenever I hear about a home care nurse who's been injured or killed in the line of duty. Thankfully these cases are rare, but we must learn and practice safety rules daily-not only while working but in our leisure activities as well. I've had my own personal experiences on visits. Like Vicki's case, I knocked before I entered a patient's duplex apartment where I had visited previously and had called to schedule the visit. The door was unlocked and from the top of a dark stairway a voice said, "Come on in." As I opened the door to enter, I heard a faint barking noise that was quickly becoming louder. I backed up and pulled the door toward me as, suddenly, a huge German Shepard lunged in my direction. Its glistening, razor-sharp teeth were all I could see through the small window of the door, which buckled against the weight of the snarling animal. If I hadn't closed the door by quickly pulling it toward me, I'd likely have fallen victim to its defiant ferocity.


Is all this to say that we should be so scared that we shouldn't be out there? Quite the contrary. The event with the German Shepard happened early in my home care career and I logged in many more visits over the ensuing years. But from that time on, I always wrote-Dog in Home-on the patient's record, and waited at the door until someone answered and escorted me in, if at all possible. I also always ask that a dog be put in another room during the entire visit even if the owner says they're friendly-I hope you do as well.


My main message is to be aware of your surroundings and anticipate problems so you can make smart, commonsense decisions. Remember that your nursing bag, agency equipment, and even patient records can be replaced if you feel your safety is jeopardized. If you've escaped from a dangerous situation, do not return merely to retrieve belongings. If your agency hasn't already implemented a duress phrase (as is described in the "Better Safe Than Sorry" article), the time to do so is now.


Home care is an interesting, necessary, and important healthcare delivery system. An increased awareness of your safety and that of your colleagues is what I hope you take away from reading this issue. What I'm really asking of you is to:


Be careful out there!!