National Immunization Awareness Month – Are Adults Currently Immunized?

by Shari Levine, MPH, Information Director for Infectious Disease, Vermont Department of HealthNIPHIC

Shari LevineVaccines – for you, me and everybody.

What comes to mind when you think of vaccines? I think of babies, toddlers and pre-teens with their heads shaking NOOO when it’s time for a shot. Next to those kids are their parents and pediatricians enthusiastically nodding yes to prevention.

Adults also need vaccines to protect against several serious and sometimes deadly diseases. Every year thousands of adults in the U.S. become seriously ill and are hospitalized because of diseases that vaccines can help to prevent. Don’t wait for an outbreak to get yourself protected. Take the initiative now, and enjoy the benefits of prevention in the future.

Which vaccines do you need? 116482902

The specific vaccines you need as an adult are determined by your age, job, lifestyle, health conditions, where you travel, and which vaccines you’ve had in the past. Throughout your adult life, vaccines are recommended for:

  • Seasonal influenza (flu) (for all adults)
  • Pertussis (whooping cough) (for all adults who have not previously received the Tdap vaccine and for women during each pregnancy)
  • Tetanus and diphtheria (every 10 years following Tdap vaccine)
  • Shingles (for adults 60 years and older)
  • Pneumococcal disease (for adults 65 years and older and adults younger than 65 who have specific health conditions)

Other vaccinations you may need include those that protect against human papillomavirus (which can cause certain cancers), meningococcal disease, hepatitis B, hepatitis A, chickenpox, measles, mumps, and rubella. Call your health care provider to check your immunization records and find out what you may need.

Why should adults be vaccinated?

Most people live in a community, and spend time in close connection with family, friends and colleagues. This allows us to share more than just meals and companionship – we also share germs. Vaccines help to create an invisible barrier around your body that keeps germs from making you sick, or lessens the severity of illness if you do get sick.

What are the benefits?

The Centers for Disease Control and Prevention (CDC) collects data to evaluate the effectiveness of vaccines. Based on information gathered each year from every U.S. state, we know the following:

  • Hepatitis B vaccine lowers your risk of liver cancer.
  • Human papillomavirus (HPV) vaccine lowers your risk of cervical cancer.
  • Flu vaccine lowers your risk of flu-related heart attacks or other flu-related complications from existing health conditions like diabetes and chronic lung disease.
  • Tdap vaccine protects pregnant women and their newborns from whooping cough (pertussis).

vaccineAre vaccines safe?

Contradictory information is written in the media about the safety of vaccines, but scientific research is consistently telling us that vaccines are safe and effective. Every vaccine must go through years of testing before the Food and Drug Administration (FDA) licenses it for use. Both the CDC and FDA continue to track the safety of all licensed vaccines as long as they are recommended for use by Americans. Like all medications, some people will have side effects that are usually mild and go away in a few days. The most common side effects include soreness, redness, or swelling where the shot was given. Severe side effects – such as an allergic reaction – are very rare.

What if I have a chronic health condition?

People who have asthma, chronic obstructive pulmonary disease (COPD), diabetes and/or heart disease are at higher risk of developing serious complications from vaccine preventable diseases such as influenza and pneumonia.

What could happen if you don’t get vaccinated?

  • Each year, an average of 226,000 people is hospitalized due to influenza.
  • About 900,000 people get pneumococcal pneumonia every year, leading to as many as 400,000 hospitalizations and 19,000 deaths.
  • 850,000 to 2.2 million people suffer from chronic hepatitis B, with complications such as liver cancer.
  • In the U.S., HPV causes about 17,000 cancers in women and about 9,000 cancers in men each year. About 4,000 women die each year from cervical cancer.

Where can you get vaccinated?

Vaccines are given at low or no cost in health care provider offices, clinics and pharmacies around the country. Most insurance companies and Medicare will cover vaccination costs. The CDC recommends that you speak with your health care provider about your immunization records, and then get updated on any missing vaccines.

If you are traveling internationally, the CDC encourages you to be sure you’re up to date on all routine vaccinations, and to check on which vaccines are recommended for the places that you will be visiting. Check the travel website to find out which vaccines are recommended based on your destination.

August is National Immunization Awareness Month, which is sponsored by the National Public Health Information Coalition (NPHIC). The goal is to raise awareness about the importance of vaccinations and to encourage people to make sure they’re fully vaccinated.

Don’t Forget!

HHQI’s Immunization & Infection Prevention BPIP 2017 Updated version to be released in September.

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Guilt – The Caregiver Nemesis

by Jane Marks, Certified Dementia Practitioner, Speaker, Trainer

July 2017_Jane MarksDo you recall the children’s movie that was a big hit a couple of years ago that had the theme song with the line, “Let it go, let it go.”? Yes, the one EVERYONE was singing and that you could not get out of your head for the rest of the day after hearing it. It is now, most likely, running through you mind at this brief suggestion. Good. Hold that thought.

You see, I have been thinking about guilt. I often feel guilty. It is one of my greatest talents. I have often commented that if only someone would pay me for feeling guilty and for needless worrying, I would be a bazillionaire. As a caregiver, these two – guilt and worry – seem to be boundless and unending. It was for me as I traveled my journey as a caregiver, and it seems so for most of the caregivers with whom I interact.

In the past few months, I have read two articles on caregiving that did not give me the insight or help that I had hoped, but did give me confirmation on how challenging these two emotions can be for caregivers. In one, the author called caregiving “a crucible”. That word does not have a positive connotation for me, but I decided to look up the definition to be certain. I equate the word with the play written by Arthur Miller (once married to Marilyn Monroe, for you trivia fans out there) about the Salem witch trials.  A more general definition that I found is, “a place or occasion of severe test or trial.” That certainly describes caregiving as I know it. The second article listed the top ten emotions to be mindful of if you are a caregiver. What was the number one emotion on that list? You guessed it, our friend guilt.

CareAs I pondered the crucible comparison, it occurred to me that the emotional burden of caregiving might be the greatest burden we carry as caregivers. It may very well be our number one nemesis. Yes, caregiving can be a test or trial that is physically exhausting and financially burdensome, but the emotional burden is the one that seems nearly impossible to manage. One may find ways to get some physical rest – a family member or a neighbor might give you a time of respite. Maybe you can afford to hire some help. If funds are scarce, it may be possible to sell property or valuables. Some families may choose to take advantage of a reverse mortgage to deal with the financial burden. I am not implying these challenges are easy. In fact, these very actions themselves may induce guilt. Different families have different solutions for those physical and financial challenges but guilt seems to be a universal commonality. In my nearly 20 years of working with caregivers and learning from them, there does not seem to be a concrete method, a specific formula, to ease that particular burden.

Guilt is also an emotion that – even when our caregiving task is over – hangs on with a vengeance. Several months ago, I listened to a United States Senator speak about her caregiving journey with both her parents. Both had dementia and both had passed away within the last year. She described how her family dealt with the early recognition that something was wrong, then how, later, they made the decision that her parents could no longer remain in their home. She shared details of their last days. In a broken voice she said, “I still worry that I did not do enough – that I could have, or should have done something more.”

Guilt may also be the reason some caregivers have difficulty setting boundaries. Terry is a good example. I met Terry at a caregiving event. As she began to tell me her story, her face, her tone of voice, as well as her body language indicated how frustrated and tired she was. I tried to listen objectively. It sounded as though Terry’s mother was quite demanding and manipulative. Her medical issues were not life threatening, she had financial means, and lived in a well-respected assisted living facility. Yet Terry was spending many hours running errands and trying to appease her Mother’s constant demands and complaints. In her caregiving quest to do her best, Terry did not seem to recognize that her mother was being unreasonable. She finally said, “My husband is furious. He says I care more about my mom than I do about our marriage. I am really afraid he is going to leave me.”

I advised Terry to set some boundaries. I suggested she weigh each demand and complaint as to how serious and immediate the need was, and then balance that with her own needs. She should not cancel dinner plans out with her husband in order to go pick up some ibuprofen for her mother as she stated she had done just a few days earlier. Those kinds of demands could wait until the next morning and in fact, I pointed out that the assisted living facility probably had some ibuprofen on hand. I suggested Terry set aside one day each week to do the errands for her mother and to be very clear with her mother about that schedule. I also suggested she urge her mother to ask the assisted living staff for more assistance (like when she needed ibuprofen). These suggestions may sound obvious, but Terry was unable to see on her own that those kinds of boundaries would be helpful. Her guilt was blocking her from thinking clearly.

Recently, I presented at a caregiver conference in another state. After my presentation, among the many that came up to ask questions or to comment was Shirley. She shared that she was caring for her 94 year old father. She told me a bit about their situation and asked for some advice about a particular challenge with her father. I offered some suggestions but as I looked into her eyes I was compelled to ask, “And are you taking care of yourself Shirley?”

Her eyes filled with tears and she responded, “Not really. In fact, I feel guilty for coming here today instead of being with my father.”

My heart ached for her. “Shirley, don’t you think you are doing the very best you can to care for your father?” I asked.

“Probably not,” she answered with a shake of her head and a tear on her cheek.

I reached out and embraced her as I said, “Shirley, you came here today. You arranged for someone you trust to stay with your father. You listened and took notes as experts offered advice on caregiving, pointers on how to provide better care, as well as information on local resources. That shows me you are trying your best and one simply cannot do better than one’s best! I hope you will remember that.” Shirley smiled and hugged me back.

I believe no family caregiver wakes up and says, “I am determined that today I am going to be the worst caregiver I can possibly be!” Yes, there are days when we fail miserably. Our temper, our exhaustion, our lack of knowledge, even our simple humanness will cause us to mess up sometimes. None of us will do it perfectly all the time, but each of us is doing the very best we can at any given moment.

In many caregiving situations, you are battling a condition or illness that is not curable. Yes, Dad may rehabilitate from that stroke but he may never recover completely. The autistic child may improve and develop life skills with work and proper therapy, but may never be completely independent. Those with Alzheimer’s, ALS, COPD, renal failure, or terminal cancer will only worsen overtime. Yet, I think, somewhere deep down, we think we can fix it. But we can’t turn back the clock, we cannot stop the aging process, nor can we cure illness. It is important for caregivers to realize we are only the umbrella. We cannot stop the rain. We are merely a person trying to provide comfort, care, and love to someone who is succumbing to an illness or a condition over which we have little or no control. What we can control is how we take care of ourselves.

I am sure I did not completely assuage Shirley’s guilt. I wish I had that magic powers to erase a tired caregiver’s guilt. I also pointed out to Shirley that if she wanted to be able to provide care for her father as long as he may need it, it was imperative that she take care of herself. She need not feel guilty about that. I do know, as a reader and a writer, that words have power. It is why we become so upset with some of the things we read on social media, most particularly those political posts! Seriously, we know how words can hurt and how words can make us feel better. When someone tells us, “Good job!” or “I truly appreciate you,” it sticks with us for a while and buoys our mood and spirit. We all recall those times when someone has said something hurtful or mean. It sticks in our craw and causes us to lose sleep. When the person with dementia for whom we care asks, “Who are you?” or says, “I hate you!”, we know the pain in our heart and soul those words can render.

I hope the words written here will help you. I hope you realize that someone does appreciate your role as a caregiver and understands the many emotions you feel. You are not alone on the emotional roller coaster of caregiving.

I want to share just a few more words, by someone wiser than I, that may help you. Maureen Johnson, a New York Times best-selling author, has said, “Guilt is a weight that will crush you, whether you deserve it or not.” This weight, this guilt, will not help you be a better caregiver. It will contribute to your exhaustion and your feelings of hopelessness. Other than that, guilt is useless. I will say it one more time – you do not deserve the heavy weight of guilt because you are doing the best you can. The mere fact that you are reading this post tells me you are seeking ways to be a better caregiver. You are giving of your time and your heart to try to ease life for someone else. You can’t do better than that.

heartA few weeks ago, I heard this quote from Buddha. I think it may be my current favorite. No matter your religious or philosophical beliefs, these are good words to live by, especially if you are a caregiver. “In the end there are only three things that matter: how much you loved; how gently you lived; and how gracefully you let go of things not meant for you.” So, this guilt thing, just let it go.

You can follow Jane’s blogs and articles on and Sandwich Caring on Facebook.


Nurses can earn 3 hours of free CEs by going to HHQI University and completing the Meeting the Needs of Caregivers and Care Receivers course. This course includes watching two excellent webinars:

  • “Alzheimer’s Disease:  A New Way of Understanding for the Home Care Worker” by Jane Marks
  • “The Universal Language of Caregiving: What We Need to Know Now” by Kim Linder








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The Struggles and Rewards of Being a Caregiver to a Loved One with Alzheimer’s

by Misty Kevech, RN, MS, HHQI RN Project Coordinator

June is the National Alzheimer’s and Brain Awareness Month. The Alzheimer’s Association also celebrates June 21st as the “Longest Day” which is about love – “Love for all those affected by Alzheimer’s disease.” Alzheimer’s is the most common form of dementia.

A study just released in May by the Centers for Disease Control and Prevention (CDC) indicates that the incidence of Alzheimer’s disease is rising as well as the death rates (55% increase). The large Baby Boomer generation is one of the reasons for the increase in disease, because age is the greatest risk factor for Alzheimer’s. Additionally, the burden of caregiving falls heavily on loved ones.

As healthcare clinicians, we provide or coordinate care for patients with dementia. Many of us also are either a caregiver or know someone personally that is caring for their loved one with dementia. It hits close to home, but we really don’t know the struggles or the joys of caregiving for a person with dementia until we have walked in those shoes.

I had the pleasure of visiting with a nurse of 36 years to discuss her story of caregiving. While she was happy to share her story, she and her family wished to remain anonymous. For the sake of the story, I will refer to the nurse as Sara and to her mother as Marie.

Marie began to develop signs of dementia at about the age of 65. The disease began at a slow progression until the age of 78 when it became clear she could not be alone all day. Marie’s sister moved in to help care for her for two years prior to Marie’s husband’s death, and she stayed on for several more years. Sara and her brother worked together to make it work.

Eventually, Sara moved in with her mother when her aunt relocated to another state and enlisted the help of private caregivers and outside agencies to supplement care. In 2011, Marie developed some serious health issues which advanced her dementia, and her physician said she could no longer be left alone. Later that year, Sara had made the decision to quit her job so that she could care for her mother full-time until they had her PDA Waiver in place, noting that the cost of private caregiving is quite expensive. Sara and her brother enrolled their mother in adult daycare in an effort to provide their mom with socialization and functional activities in a safe environment which allowed some respite for the family. Marie was always happy when she returned home from the daycare, even if she couldn’t say what her day was like.

There was still a huge burden on the family in coordinating Marie’s care, locating and enrolling her into the adult day care, determining how and when to use caregivers in the home, as well as managing her finances and medical conditions. In Fall  2012, the PDA Waiver was finalized and the family began using the adult daycare and caregiving agency for Marie on a more regular basis. Unfortunately, in early 2013 Marie had another serious illness and was frequently hospitalized. This led to another sharp decline in her mental status. When these types of declines occur, there is no return to a baseline. Nevertheless, Sara decided to return to work part-time that Fall. A year later, the medical problems exacerbated, and Sara was often called away from her job when her mother would become ill at daycare and be sent to the emergency department. As Marie’s dementia and health continued to decline, she was no longer a candidate for daycare, and the painful decision to place her in a nursing home was made. She is now very settled in the dementia care unit of a local skilled facility, and her family members visit frequently.

The emotions of caregiving ranged from anger to sadness to depression. The sadness Sara and her brother experienced included the feeling of losing the mother they loved and enjoyed being around. Turning a loved one’s care over to strangers is also a very difficult thing to endure. Looking back, Sara definitely agrees that she did have symptoms of depression while she was caring for her mom, but she didn’t worry about herself because her focus was always centered on caring for her mom. She missed her own physician appointments and didn’t address any of her own health needs. We know this often happens with caregivers but don’t think it will happen to us, especially since we are healthcare clinicians.

One of the surprising aspects of Marie’s disease was the toll that medical complications took on the progress of the dementia. The result of that lengthy 2011 medical hospitalization was clostridium difficile (C.Diff) infections which led to sepsis. Marie’s memory significantly declined during those months of infection and never returned. Caregiving needs increased during this time, but because she was contagious, external caregivers were remiss to continue their services.

In some ways, as the cognitive status declined, some aspects of care became easier. No more fighting over what clothes to wear, or where this goes, or how to use that. Sara’s mother not only listened to what she said, but looked to her for any suggestions and for all the answers that her mind could not provide. Marie’s sleep patterns were fairly good, but for safety reasons, it became necessary to sleep with her, which resulted in Sara not getting a good night of sleep for years. But that was ok – it was all for her mother and it was what she wanted to do, not what she had to do.

This past fall, after recurrent urinary tract infections (UTIs), Marie’s care became too much and a decision was made to place her with the help of an excellent social worker. One of the reason’s the social worker was so attuned to the needs of people with dementia is that she was caring for her own mother with the disease. It was the right thing to do, and the right time.

Sara’s father told her before he died, “Don’t lose your mother.” Her aunt told her that no one should ever pressure their children to promise never to put their loved one in a nursing home. She understood what a hard decision it is for family to make and felt that the burden of breaking a promise just compounded that tough situation.

Sara’s mother is now in a dementia care unit in that nursing home, and she seems happy there. While her functional status has declined, she is surprisingly well cared for and safe. Marie is followed by a geriatrician who has completely stabilized her medical condition of recurrent UTIs.

Sara is now working full-time and is enjoying her work in home health care. She is getting her life back in order and regularly visits her mom. One thing she has found is that there are always little things related to her mother’s care that she needs to handle as she remains her mother’s primary caretaker. Marie enjoys manicures, pedicures, facials, walks, being read to, and laughing at everything, even if neither knows what they are laughing about!

I asked Sara what she thought was the best part of caring for her mother. She said, “It has been my honor to care for my mother, and to pay her back for everything that I put her through when I was growing up. It has made me appreciate how caring for someone so disabled can actually bring one great joy and peace of mind and heart. I felt strongly that I was meant to care for her, and that I should not run from it, but embrace it. I do not regret it for one minute and feel so grateful she is still here. I am so thankful that we are able to have our moments of recognition and happiness together for what is left of her years on earth.”

HHQI wants to thank Sara and her family for their willingness to openly share their story. We also want to thank everyone who shoulders the tough but rewarding role of being a caregiver for their loved ones. We hope that this story will help you to support patient families who are caregivers, as well as yourself or someone in your family that serves as a caregiver.

HHQI University has a course, Meeting the Needs of Caregivers and Care-Receivers, which includes excellent webinars related to Alzheimer’s disease and caregiving. Three hours of nursing CEs are available for successfully completing this course.


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5 Tips and Tricks for Managing Your Medications This Summer

by Michaela E. Leffler, Pharm.D., BCPS, BCGP, Assistant Professor, Pharmacy Practice Department, University of Charleston School of Pharmacy, Charleston, WV

As the busy summer months are approaching, keeping your health and well-being as a top priority is as important as ever. Between spending time outdoors, enjoying the warm weather, and grilling out with family and friends, the last thing anyone wants to worry about is health problems due to mismanaged medications. So here are a few tips and tricks to make managing your medications and health conditions easy with only a small time commitment. By following these simple suggestions, I hope you can keep your body in tip-top shape so you have time and energy to make many wonderful memories this summer!

  1. Use a Pill Box

As a pharmacist, one of the most difficult things I see patients struggle with is figuring out how to take all the medications they are prescribed. Remembering to take medications on time and at the right time can be very difficult when managing multiple medications that sometimes need to be taken more than once per day. One of the most useful tools, and one that I recommend to all my patients, is a multiple compartment pill box. I recommend a pill box that has a section for morning and night medications on every day of the week. If you take some medications in the afternoon, they even sell pill boxes that have three sections for each day of the week. Spend some time every weekend filling your box with the appropriate medications in the morning, afternoon or evening boxes. If you are the type of person that travels around town on a regular basis, get a small individual pill box that will easily fit in your hand bag, wallet or pocket. This way you can take your pills out of your weekly pill box and take them with you on the go. Pill boxes eliminate the need to open multiple pill bottles a day and will put an end to the “Did I remember to take my pills this morning?” question. These pill boxes can be found online by searching for “three times a day pill organizer”, or you can find them at your local pharmacy.

  1. Get into a Routine

Working a designated time to take medications into your daily routine is a great way to reduce the number of medication doses that are forgotten. One way to do this is to associate taking medications with a certain task that you complete at around the same time each day. Some examples include times such as when you are eating meals, brushing your teeth or feeding pets. Additionally, if you find yourself leaving the house for the afternoon or evening, find a way to remind yourself to take your next dose of medications with you. You can do this by storing medications in an area you will pass on the way out of the door or by leaving yourself a reminder note. Medications that are only taken once weekly or once monthly, such as some medications prescribed to increase bone density, can be associated with an event that usually happens once a week  Some examples of these types of activities include going to a church service, grocery shopping or a recurring gathering such as a club or workout class. Another helpful tool in creating a routine is setting alarms to help you remember to take medications. Set alarms on a device such as your cellphone to remind you to take medications at the same times each day.

  1. Know Your Meds & Ask Questions

Try your best to know your medications. I have encountered many patients who blindly take their medications simply because their doctor says that they should. I encourage every person who takes a medication to approach their health, wellbeing, and medical care from a team approach in which the patient, nurse, pharmacist, and physician work together with a common goal. As the patient, your job is to know your medications by name and strength. Also know what the medication is used to treat, how you need to take it, and a few of the major side effects that the medication can cause. If you are left feeling confused after a doctor’s visit or a trip to the pharmacy, then pick up the phone and call. Ask all the questions you need to be answered. Your healthcare professionals are there to help you understand your healthcare and medications better. As a pharmacist, I know that I truly enjoy teaching patients about their medications when they express genuine interest and want to know how to best take care of themselves.

  1. Record Measurements

Some medications and disease states require frequent monitoring to appropriately adjust medication doses and regimens. It is very helpful when patients complete regular monitoring at home and write down results to bring to office visits. For example, when taking medications for high blood pressure, it is useful to have daily blood pressure readings logged or when taking medications for diabetes it is helpful to have consistently timed daily blood glucose readings. There are many other scenarios in which it is helpful for patients to monitor at home so that the physician, pharmacist, nurse, or other health care professional can tailor the medication regimen to the patient. Next time you go to an appointment, be sure to ask your health care professionals how you can help them monitor from home!

  1. Listen to Your Body

A final bit of advice is to make sure you always listen to your body. It is easy to ignore signs and symptoms of poor health when life is busy, but it is often true that the longer you wait the more potential damage done to the body. If something does not feel right, pick up the phone and make an appointment today. Don’t wait!

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Happy Nurses Week!

by Misty Kevech, RN, MS, HHQI RN Project Coordinator

National Nurses Week begins each year on May 6 and ends on May 12, Florence Nightingale’s birthday. The American Nurses Association’s (ANA) theme this year is “Nursing: The Balance of Mind, Body, and Spirit.

The ANA’s theme hopes to encourage nurses to expand their learning to increase their resilience and reignite their nursing heart and soul. It also aims to help nurses identify and manage compassion fatigue, moral distress and burnout.

Below are a few questions for you to think about:

  • What inspired you to become a nurse?
    • Many nurses state to help other people, but what was your motivation?
  • What are the two most difficult challenges you have with your nursing role now?
    • Okay, getting it down to two is hard.
  • Is there something you could do to try to address one or even a part of one of the hardest challenges you have?
    • This takes thought and perseverance. When you have a difficult situation for a patient, you get creative and keep adapting. Apply that principle to yourself.
    • Consider writing down issues and ideas.
  • How do you handle the frequent high stress level?
    • Think about both positives (e.g., take a walk, do something fun) and negatives (e.g., snack, vent at home)
  • So what do you do for fun for yourself? Not your family, but for YOU?
    • Hopefully you don’t have to think about this too long.
    • What makes you feel good?
  • What is something that you can do to improve YOUR health (not your patient’s health)?
    • Make this something simple and share with a co-worker to keep yourself accountable.
    • Think SMART Goals (like we teach our patients):
      • Specific (simple, sensible, significant).
      • Measurable (meaningful, motivating).
      • Achievable (agreed, attainable).
      • Relevant (reasonable, realistic and resourced, results-based).
      • Time bound (time-based, time limited, time/cost limited, timely, time-sensitive). (

Celebrate this year’s National Nurses Week thinking about yourself as a nurse and a person. Develop a plan to keep your mind, body, and spirit health and well!

The Home Health Quality Improvement (HHQI) National Campaign thanks you for the great work you do every day for patients across this country and the role you are playing with healthcare quality improvement.

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Bridging Health Equities Across Communities Begins with You

by Misty Kevech, RN, MS, HHQI RN Project Coordinator

April is National Minority Health Month and this year’s theme is “Bridging Health Equities Across Communities.” The Office of Minority Health (OMH) selected this theme in an effort to promote awareness on issues impacting health disparities and health equity.

The U.S. Department of Health and Human Services (HHS) continues to track and support strategies to improve health equity across all healthcare settings and in the community. The original National Quality Strategy was published in March 2011 by Agency for Healthcare Research and Quality (AHRQ) & HHS. There are three overarching aims that build upon the Institutes for Healthcare Improvement’s Triple Aim®.

  • Better Care: Improve the overall quality of healthcare by making it more patient-centered, reliable, accessible, and safe.
  • Healthy People/Healthy Communities: Improve the health of the U.S. population by supporting proven interventions to address behavioral, social and, environmental determinants of health in addition to delivering higher-quality care.
  • Affordable Care: Reduce the cost of quality healthcare for individuals, families, employers, and government.

(AHRQ, 2017)

AHRQ’s 2015 National Healthcare Quality and Disparities Report and 5th Anniversary Update on the National Quality Strategy report indicates progress is being made, but disparities persist.

HHQI’s Underserved Population (UP) Network focuses on the following groups:

  • Health Disparities (e.g., racial/ethnic, socioeconomic status, health literacy, etc.)
  • Small Home Health Agencies
  • Underserved Populations (e.g., regions, urban vs. rural, etc.)
  • Dual-Eligible Patients (eligible for Medicare & Medicaid)

HHQI provides home health and other healthcare organizations a variety of education, information, tools, resources, and networking opportunities.

Join the movement to Bridging Health Equities Across Communities and join the Education & Networking Opportunities email list.

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Patient Safety – It’s what we do!

by Tina Hilmas, RN, BSN, Project Manager, Center for Patient Safety

Patient Safety Awareness Week is coming up March 12-18 and I’m always excited during this time of the year. You see, patient safety seems so simple yet is so complex and I could literally spend hours talking about it. But what I’d really like to do is intrigue you into becoming as excited about patient safety and patient safety culture as I am. The analogy that comes to mind for me is that of an onion. When you peel away the layers of an onion, you are left with the heart of the onion, or rather the core. The same is true with patient safety. As you begin to peel away the actions of an organization and look underneath at the rationales for those actions, you find the underlying beliefs of an organization, the foundation, the culture regarding Patient Safety and that is where a journey of patient safety must begin.

As a nurse, it seems like patient safety should be ingrained into our daily actions. After all, aren’t nurses supposed to promote, advocate for and protect the rights, health and safety of our patients? But can we honestly say that we have always, in every situation, put the safety of the patient first? How about that day where you were being called for one start of care after another? Or that day when you’d been on call, received multiple calls throughout the night, and began seeing patients the next day with little to no sleep? Were your first thoughts truly of patient safety or more on just how you could keep your head above water with all the visits you needed to complete? More importantly, does your organization have built in safety guards to help protect the safety of your patients?  Does your organization promote a strong patient safety culture?

You see, patient safety is more than just the National Patient Safety Goals (NSPG) of the year. Patient safety is a combination of technical change and adaptive change and it never stops. It’s not something that is “achieved” rather it is an aspect of your organization’s culture and therefore ongoing. Culture, as it pertains to an organization, is defined as a way of thinking, behaving, or working. Safety culture can be defined as the following:

“The safety culture of an organization is the product of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine the commitment to, and the style and proficiency of, an organization’s health and safety management.” (Health and Safety Commission Advisory Committee on the Safety of Nuclear Installations, 1993; adapted by AHRQ)

So to break it up, the technical change aspect is focused on those NPSG’s – developing processes and policies for fall prevention, medication education and identification of the patient. The adaptive component of culture is the leadership component, the systems component and looking deeply at human factors engineering. Some nurses have called this the “touchy-feely” part of nursing because it deals not only with processes, but also the on-going evaluation of the organization’s behavior, from leadership all the way down to the home health aide, in regards to a specific item, the heart of the onion – patient safety culture.

So where do we begin this journey? Evaluate your organization’s culture, not just employee engagement, to actually look at how the employees within your organization feel about the organization’s commitment to safety. Look at your processes and what happens when a mistake is made. Is there an investigation or Root Cause Analysis of the event including not just the outcome of the mistake, but review of the system, including policies, and contributing factors? Is there a tendency to discipline or maybe terminate the employee responsible for the mistake with the reason being, if you eliminate the person responsible then the problem is solved? Do the employees in your organization feel comfortable admitting to near mistakes, mistakes that resulted in no harm, or pointing out unsafe conditions? If so, keep up the awesome job! If not, ask why? Is it because of the culture? Does everyone just keep their head down and try to sweep mistakes that didn’t result in harm under the rug? Surveys, such as the Survey on Patient Safety, can help leaders visualize where their organization is on the culture scale. It also allows for identifying a starting point for change.

When trying to change there are multiple frameworks that can be reviewed because change is hard and threatening. In organizations that have success in promoting a strong patient safety culture, there is one factor in common, it all starts with leadership. The leaders have to show that patient safety is a priority and part of the mission of their organization. The leaders should engage with their personnel on a daily basis and they should incorporate patient safety as part of their daily routine. Patient safety will only become a priority when it is incorporated and embedded into everyone’s daily routines.

But in focusing on patient safety, leaders shouldn’t lose sight of their most valuable asset – their employees. Employees need to feel supported and invested in by their leaders. This is where leaders and organizations should ensure they have a strong Employee Assistance Program, but maybe should also look into other supportive programs such as Second Victims. This program trains the staff on how to support a fellow employee who may have been involved in an adverse event. In home care and hospice, this is something that could help not just if an adverse event occurs, but also if a long-term patient expires. Even if it was expected in hospice and home care, relationships develop between the health care team and the patient; a Second Victims Program can help to provide the support needed to those involved in the care of a long-term patient who passes.

So hopefully, I’ve helped you to see why I’m so passionate about Patient Safety.  It isn’t just the technical or the top layer of the onion, but the whole onion, the heart and core that I enjoy dealing with to make certain it is strong, healthy and sweet.

Don’t Miss HHQI’s Next Underserved Populations (UP) Network Webinar

Patient Safety: All in a Day’s Work! – Thursday, April 20, 2017,  2:00 p.m. ET

Ready to learn more about patient safety? Join Ms. Tina Hilmas, RN, BSN and the HHQI team for the next Underserved Populations (UP) Network webinar. During this webinar, you will learn how to begin preparing a Quality Assurance & Performance Improvement (QAPI) plan related to patient safety that will be required by all home health agencies. This will be a 2-hour interactive event that will include work on a QAPI plan. Register Here

About Our Guest Blogger – Tina Hilmas, RN, BSN

Ms. Hilmas has spent more than 20 years in the nursing profession both within hospital walls and outside in the home care arena. Her current work includes collaborating on quality improvement projects that include incorporating a strong patient safety culture. She also reviews patient safety events reported to the Center to analyze for trends and causal factors to assist organizations with changing their culture and improving patient safety.

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