New Cholesterol Management Guidelines and the Effects on Home Health Patients

by Misty Kevech, HHQI RN Project Coordinator

Heart disease is the leading cause of death in the U.S. for men and women (CDC, 2017). Every year, 735,000 Americans have a heart attack (CDC, 2017). Cardiovascular health is important to the well-being of people for primary and secondary preventation of atherosclerotic cardiovascular disease (ASCVD), which can lead to heart attacks and strokes. The CDC (2015) states, “People with high cholesterol have about twice the risk of heart disease as people with lower levels.” Your home health patients often have a high cholesterol diagnosis, but do they understand and have a plan to address the levels?

Patient Confusion & Non-Adherence

Patients are often confused over how to interpret their blood lipid panel results and to differentiate common myths from evidence-based facts. For example, many people think that heredity affects cholesterol levels, not lifestyle choices. The truth is that lifestyle modifications are recommended for everyone, no matter their cholesterol level. Yes, heredity does factor in for some patients, but there are important lifestyle changes everyone can make. Many Americans continue to not eat heart-healthy diets and are not getting enough exercise. The U.S. Department of Health and Human Services recently released the second edition of the Physical Activity Guidelines for Americans that reinforces the 150 minutes to 300 minutes/week recommendation, if physically able, but now adds that any amount of exercise is beneficial (HHS, 2018). Would exercising 5 to 10 minutes several times a day sound more reasonable to your patients?

Lipid-lowering medications are added to lifestyle modifications for people with higher levels of cholesterol or to reduce the level more quickly. Medication adherence for these medications (e.g., satins) is only at 55% (CDC, 2018). The 39.1 million people who are at high risk for an ASCVD event, but are not taking a statin, could reduce their risk of a heart attack or stroke by up to half if therapy was taken regularly (Million Hearts®, 2018). Consider using open-ended questions to ask your patients about how, when, or how they physically feel related to cholesterol medications. Some examples of questions are, “Tell me how/when you take the ___________ pill?” and “How does the pill make you feel?” Explain that there are other medications that can be ordered if there are side effects.

Home Health & Cholesterol Management

Where does cholesterol management fit into your home health visits? Patient education on cholesterol effects, lipid levels, diet, exercise, and medications are essential for cardiovascular (CV) health. Educating your patients on reducing CV risk factors, especially lifestyle management, often aligns with other chronic disease management interventions you are teaching your patients. You could use pictures or videos as visual education to show the effects of cholesterol on the CV system. Check out the American Heart Association’s Watch, Learn and Live: Cholesterol resources. HHQI’s My Questions about My Heart for My Doctor tool can be utilized to prep your patients to discuss CV concerns with their doctor, including what their lipid results mean.

A heart-healthy diet often aligns with other disease dietary recommendations and fits nicely into your patient’s care plan. Increasing exercise is also appropriate for most chronic diseases. Consider making a therapy referral to set up a safe home exercise program for your patients, if appropriate. Even older patients with chronic diseases can increase activity levels at home, even if chair-bound. Use the Exercise & Keep Your Seat patient education tool (a diabetes tool, but appropriate for all) for those who need to safely exercise from a chair. This tool is also available in other languages.

Medication teaching is part of the Home Health Conditions of Participation. As a clinician, you need to understand and be able to explain to patients the importance of taking cholesterol-lowering medications to decrease their risk of heart attacks and strokes. You must also educate patients on the common side effects with tips and tricks to address them or work with the practitioner to try alternative medications. Teach your patients to speak up and communicate their concerns about side effects. These interventions will assist with disease management of all chronic conditions.

It is important that home health clinicians to stay up to date with all evidence-based guidelines so you can teach patients the rational and guide them toward adherence with better outcomes.

Updated Cholesterol Clinical Practice Guidelines

In November 2018, the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines released the 2018 Cholesterol Clinical Practice Guidelines. The report was approved by many other leading organizations (see the report for listing). This is the first update since 2013.

The key changes include creating two classifications in the Secondary Prevention group for those patients with atherosclerotic cardiovascular disease (ASCVD) including a “very high risk” and recommendations for these groups (see below). LDL-C threshold returns to the guidelines to assist practitioners with prescribing statins and alternative therapies (see below). The ACC/AHA recommends the use of either fasting or non-fasting lipid panels for monitoring of cholesterol levels. An unusual recommendation is for insurers to consider a no co-pay for cholesterol-lowering medications that are evidence-based (A or B categories).

The report provides the Top 10 Take-Home Messages to Reduce Risk of Atherosclerotic Cardiovascular Disease Though Cholesterol Management (see pages 5-6 for more specifics for each item).

1. In all individuals, emphasize a heart-healthy lifestyle across the life course.
2. In patients with clinical ASCVD, reduce low-density lipoprotein cholesterol (LDL-C) with high-intensity statin therapy or maximally tolerated statin therapy.
3. In very high-risk ASCVD, use a LDL-C threshold of 70 mg/dL (1.8 mmol/L) to consider addition of nonstatins to statin therapy.
4. In patients with severe primary hypercholesterolemia (LDL-C level ≥190 mg/dL [≥4.9 mmol/L]), begin high-intensity statin therapy without calculating 10-year ASCVD risk.
5. In patients 40 to 75 years of age with diabetes mellitus and LDL-C ≥70 mg/dL (≥1.8 mmol/L), start moderate-intensity statin therapy without calculating 10-year ASCVD risk.
6. In adults 40 to 75 years of age evaluated for primary ASCVD prevention, have a clinician-patient risk discussion before starting statin therapy.
7. In adults 40 to 75 years of age without diabetes mellitus and with LDL-C levels ≥70 mg/dL (≥1.8 mmol/L), at a 10-year ASCVD risk of ≥7.5%, start a moderate-intensity statin if a discussion of treatment options favors statin therapy.
8. In adults 40 to 75 years of age without diabetes mellitus and 10-year risk of 7.5% to 19.9% (intermediate risk), risk-enhancing factors favor initiation of statin therapy (see No. 7).
9. In adults 40 to 75 years of age without diabetes mellitus and with LDL-C levels ≥70 mg/dL- 189 mg/dL (≥1.8-4.9 mmol/L), at a 10-year ASCVD risk of ≥7.5% to 19.9%, if a decision about statin therapy is uncertain, consider measuring CAC.
10. Assess adherence and percentage response to LDL-C–lowering medications and lifestyle changes with repeat lipid measurement 4 to 12 weeks after statin initiation or dose adjustment, repeated every 3 to 12 months as needed.

Resources

• Are You at Risk for Heart Attack or Stroke? patient video provides risk factors and signs/symptoms (HHQI)
• CVD: Reduction of Risk & Treatment through Diet & Lifestyle Changes course features a webinar by an expert on Therapeutic Lifestyle Changes including the DASH diet (HHQI)
• Cardiovascular Health Part 2: Cholesterol management & Smoking cessation Best Practice Intervention Package (BPIP) provides evidence-based practices and resources (HHQI)
• Cholesterol Management: The Good, the Bad and the Ugly course includes webinar by pharmacist with educational information and patient tips/tricks (HHQI)
• Home Health Cardiovascular Data Registry is an optional, powerful, and convenient quality improvement tool available to CMS-certified home health agencies. Using this tool will help target potential disparities in care and advance cardiovascular health improvement efforts, including the use of statin therapy for targeted populations. Learn more and register. (HHQI)
• Lifestyle Modifications Part 1 clinician video focuses on weight reduction, DASH eating plan, and sodium reduction (HHQI)
• Lifestyle Modifications Part 2 clinician video focuses on physical activity, alcohol moderation, and smoking cessation (HHQI)
• My Healthy Heart Workbook provides key information to patients to improve their cardiovascular health including cholesterol management and is available in many languages (HHQI)
• Statin Therapy for the Prevention & Treatment of CVH course features two pharmacists providing information on treatment guidelines and medication including mitigation of side effects and how to work with local pharmacist.
• Take Control of Your Cholesterol is a patient handout on cholesterol management and is available in Spanish (HHQI)
• Cholesterol and Statins Infographic provides a visual description of how cholesterol works in the body (FDA)
• High Cholesterol Tools and Training for Professionals website includes fact sheets, guidelines, tools and training, and journal articles (CDC)
• Preventing and Managing High Cholesterol website provides information about patient actions including medications (CDC)

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Safety First: Winter Driving Tips

by Misty Kevech, HHQI RN Project Coordinator

There have already been several major snow and ice storms across the country this year. Now that the heart of winter is upon us, HHQI would like to provide some driving tips to protect healthcare workers as they travel to care for their patients. Home health is similar to the unofficial motto of the U.S. Postal Service, “Neither snow nor rain nor heat nor gloom of night stays these couriers from the swift completion of their appointed rounds.” While not all parts of the U.S. will see snow or ice this winter, rain can also cause major problems for healthcare providers that need to get to their home-bound patients. In this blog we’ll address each of these problems with expert advice from the American Automobile Association (AAA). Home health agency (HHA) leaders may consider adding these tips as part of their Emergency Preparedness education.

The following are winter driving tips are from the AAA Exchange website.

• AAA recommends the following winter driving tips:
  • Avoid driving while you’re fatigued. Getting the proper amount of rest before taking on winter weather tasks reduces driving risks.
  • Never warm up a vehicle in an enclosed area, such as a garage.
  • Make certain your tires are properly inflated.
  • Never mix radial tires with other tire types.
  • Keep your gas tank at least half full to avoid gas line freeze-up.
  • If possible, avoid using your parking brake in cold, rainy and snowy weather.
  • Do not use cruise control when driving on any slippery surface (wet, ice, sand).
  • Always look and steer where you want to go.
  • Use your seat belt every time you get into your vehicle.
• Tips for long-distance winter trips:
  • Watch weather reports prior to a long-distance drive or before driving in isolated areas. Delay trips when especially bad weather is expected. If you must leave, let others know your route, destination and estimated time of arrival.
  • Always make sure your vehicle is in peak operating condition by having it inspected by a AAA Approved Auto Repair facility.
  • Keep at least half a tank of gasoline in your vehicle at all times.
  • Pack a cellular telephone with your local AAA’s telephone number, plus blankets, gloves, hats, food, water and any needed medication in your vehicle.
  • If you become snow-bound, stay with your vehicle. It provides temporary shelter and makes it easier for rescuers to locate you. Don’t try to walk in a severe storm. It’s easy to lose sight of your vehicle in blowing snow and become lost.
  • Don’t over exert yourself if you try to push or dig your vehicle out of the snow.
  • Tie a brightly colored cloth to the antenna or place a cloth at the top of a rolled up window to signal distress. At night, keep the dome light on if possible. It only uses a small amount of electricity and will make it easier for rescuers to find you.
  • Make sure the exhaust pipe isn’t clogged with snow, ice or mud. A blocked exhaust could cause deadly carbon monoxide gas to leak into the passenger compartment with the engine running.
  • Use whatever is available to insulate your body from the cold. This could include floor mats, newspapers or paper maps.
  • If possible run the engine and heater just long enough to remove the chill and to conserve gasoline.
• Tips for driving in the snow:
  • Accelerate and decelerate slowly. Applying the gas slowly to accelerate is the best method for regaining traction and avoiding skids. Don’t try to get moving in a hurry. And take time to slow down for a stoplight. Remember: It takes longer to slow down on icy roads.
  • Drive slowly. Everything takes longer on snow-covered roads. Accelerating, stopping, turning – nothing happens as quickly as on dry pavement. Give yourself time to maneuver by driving slowly.
  • The normal dry pavement following distance of three to four seconds should be increased to eight to ten seconds. This increased margin of safety will provide the longer distance needed if you have to stop.
  • Know your brakes. Whether you have anti-lock brakes or not, the best way to stop is threshold breaking. Keep the heel of your foot on the floor and use the ball of your foot to apply firm, steady pressure on the brake pedal.
  • Don’t stop if you can avoid it. There’s a big difference in the amount of inertia it takes to start moving from a full stop versus how much it takes to get moving while still rolling. If you can slow down enough to keep rolling until a traffic light changes, do it.
  • Don’t power up hills. Applying extra gas on snow-covered roads just starts your wheels spinning. Try to get a little inertia going before you reach the hill and let that inertia carry you to the top. As you reach the crest of the hill, reduce your speed and proceed downhill as slowly as possible.
  • Don’t stop going up a hill. There’s nothing worse than trying to get moving up a hill on an icy road. Get some inertia going on a flat roadway before you take on the hill.
  • Stay home. If you really don’t have to go out, don’t. Even if you can drive well in the snow, not everyone else can. Don’t tempt fate: If you don’t have somewhere you have to be, watch the snow from indoors.

The following are wet weather driving tips are from the AAA Exchange website.

• General Wet Weather Tips
  • Replace windshield wiper inserts that leave streaks or don’t clear the glass in a single swipe.
  • Make sure all headlights, taillights, brake lights and turn signals are properly functioning so other drivers will see you during downpours. Turn on your headlights whenever you drive.
  • Proper tire tread depth and inflation are imperative to maintaining good traction on wet roadways. Check tread depth with a quarter inserted upside down into the tire groove. If you can see above Washington’s head, start shopping for new tires. Check each tire’s pressure, including the spare, at least once a month… and be sure to check the pressure when the tires are cold.
• Avoid Cruise Control
  • Most modern cars feature cruise control. This feature works great in dry conditions, but when used in wet conditions, the chance of losing control of the vehicle can increase. To prevent loss of traction, the driver may need to reduce the car’s speed by lifting off the accelerator, which cannot be accomplished when cruise control is engaged.
  • When driving in wet-weather conditions, it is important to concentrate fully on every aspect of driving. Avoiding cruise control will allow the driver more options to choose from when responding to a potential loss-of-traction situation, thus maximizing your safety.
• Slow Down and Leave Room
  • Slowing down during wet weather driving can be critical to reducing a car’s chance of hydroplaning, when the tires rise up on a film of water. With as little as 1/12 inch of water on the road, tires have to displace a gallon of water per second to keep the rubber meeting the road. Drivers should reduce their speed to correspond to the amount of water on the roadway. At speeds as low as 35 mph, new tires can still lose some contact with the roadway.
  • To reduce chances of hydroplaning, drivers should slow down, avoid hard braking or turning sharply and drive in the tracks of the vehicle ahead of you. Also, it’s important for motorists to allow ample stopping distance between cars by increasing the following distance of the vehicle in front of them and beginning to slow down to stop for intersections, turns and other traffic early.
• Responding to a Skid
  • Continue to look and steer in the direction in which the driver wants the car to go.
  • Avoid slamming on the brakes as this will further upset the vehicle’s balance and make it harder to control.
  • If you feel the car begin to skid, continue to look and steer in the direction you want the car to go. Don’t panic, and avoid slamming on the brakes to maintain control.

Resources:

• How to GO on ICE and SNOW (AAA)
• GET A GRIP: A Guide to Wet-Weather Driving Techniques (AAA)
• Flood Information Sheet (FEMA)

Why Time Spent on Your Phone Can be Disastrous for Your Sleep Patterns

By guest blogger: Sarah Johnson – sjohnson@tuck.com 

Working night shifts or staying up late can be a nightmare for your internal clock, but there’s something else that might make your hopes of getting rest even worse — the iPhone or Android you use to pass the evening when there’s nothing else to do.

The light shining on you from your smartphone is hitting you with blue-ish lighting that research has since revealed can have devastating effects on your ability to sleep normally. It’s unfortunate that long-lasting, environment-friendly lighting has such a serious downside, ranging from sleep problems to potential health risks.

Read on to learn about the negative consequences of staying on your phone late at night.

Blue Light Is Great For Everything but Your Sleep Patterns

Blue lighting’s reputation was exclusively linked to how great it is for energy savings. For example, residential LED lights burn approximately 75 percent less energy than traditional incandescent lights. It’s even estimated that by 2027, this type of lighting will save Americans more than $30 billion.

The shift in emphasis on energy and cost savings means blue lighting is a growing part of the average person’s life in one way or another. The most common exposure these days is through the TV, laptop, and smartphone. It means you get daily exposure to a light source that research shows interferes with your circadian rhythm, that is, your daily wake and sleep cycle. Studies show that it increases your alertness and suppresses the hormone melatonin. This makes it harder to fall and stay asleep.

Phone Lighting and the Night Shift Disturbing Your Sleep

Interestingly, the ability of blue light exposure to increase alertness might have short-term benefits on the job, if you’re working late at night. This might help you avoid the feelings of tiredness that come with the job. Even so, the long-term consequences could be severe. There are already studies that show night shift work can have a negative impact on overall sleep patterns. Combined with prolonged exposure to certain electronics, things could get worse.

What You Can Do to Sleep Better

There are steps you can take to improve your overall quality of sleep as best you can. When working the night shift or staying up late, consider reading a book rather than hopping on your phone. If you do decide (or need) to get on the phone, consider using blue-light-blocking glasses. The less you expose yourself to blue light, the less you have to worry about it interfering with your body and health. At home, swap blue LED lights for traditional red light bulbs in the bedroom. It’s also a good idea to cut back on use of your laptop or phone a few hours before bedtime. Lastly, practice good sleep hygiene. These are daily habits and behaviors that make it easier for you to enjoy a good night’s sleep. Getting to bed at a good hour, turning off electronics, and avoiding nighttime distractions are all examples of helpful ways of practicing good sleep hygiene.

Sleep doesn’t always come easy or naturally to night shift workers. If you happen to work late, it’s only natural to avoid zoning out or outright sleeping on the job. However, continuously sitting on your smartphone is not the best way to go about staying awake, and the potential risks just aren’t worth it.

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Celebrating Our Home Health Aides

Guest post by Loretta Goggins RN, BSN, Home Health Resources, Inc., Houston, TX

November is Home Health Aides Appreciation Month, and in honor of this special month, I’d like to take this opportunity to celebrate the home health aides on our team!

Home health aides are an integral part of our home care team, working closely with the patient, families, nurses, and therapists to provide our patients with the very best. Much of the time they are only in the home short-term, while the patient’s needs are greatest. One of the challenges of this reality is that the home health aide needs to be skilled at caring for the patient, getting to know them, and helping them be comfortable in the given situation. They gracefully manage the difficult task of providing personal care for their patients, many of whom have never needed to depend on anyone else for this help, let alone from a total stranger.

As part of the healthcare team at our home health company, our aides work with patients that have a variety of needs. They follow the care plan set up by the admitting nurse and stay in contact with the patient’s case manager, especially if there is anything unusual to report or pertinent information to share.

Our home health aides strive to be the best that they can be in their role. They are always eager to gain more knowledge in order to improve themselves and the care they provide. This past summer we began taking advantage of the learning opportunities available to us through HHQI University. These classes are tailored specifically to the population that our home health aides serve. We have participated in courses to learn about the skills of skin observation, caring for the diabetic patient, and protecting our patients/ourselves during the flu/pneumonia season. Even our most “seasoned” home health aides have enthusiastically welcomed the additional education and have found these sessions valuable.

By just visiting with our home health aides, it’s easy to understand why they do such a good job and why they are so well liked by our patients and their families. When I recently asked one of our aides what she liked best about her job she initially said that it was difficult to pick any one thing, saying that “it depends, because it is different when working with a variety of patients.” Then her face lit up and she said, “One of the things that I like best about my job is that I can help patients feel good about themselves. It’s different for every patient so part of what I need to do is to figure out what each patient really wants. For one patient, it is just a good shower and shampoo. For another it may be to have help putting on makeup. Another patient may really enjoy having their hair set or someone else it is to have a good shave. I try to tap into that because I know that when you look better you feel better about yourself. When you feel better about yourself, you are more likely to feel good in general.”

WOW, what insight! That sums it up! Being a good home health aide takes such commitment. It is not an easy job. Our aides travel a lot, juggle patient preferences (times to be seen and more), and they work with and around the other disciplines involved in the patient’s care. Our aides get to know the patient and their family members really well, and they are always looking out for each patient’s safety and well-being. At the heart of the matter is that the home health aides “get it.” They understand what was stated above – the importance of helping patients feel good about themselves generally instills in them a sense of hope and motivation. Those that are more motivated generally try to take better care of their health. How awesome!

Home health aides are indeed a special group of people, with a special set of skills, doing a very important job. To say that they are invaluable is an understatement. We appreciate all that they do as we serve those that are entrusted to our care.

 

 

 

Learn More About Sepsis Screening & Education – It Could Be a Life-Saver

By investing a few minutes, home care clinicians can make a world of difference

by Chris Chimenti, MSPT, ACCH, Senior Director of Clinical Innovation, HCR Home Care

What is sepsis? According to the Centers for Disease Control and Prevention (CDC), “Sepsis is the body’s extreme response to an infection. It is a life-threatening medical emergency! It happens when an infection you already have – in your skin, lungs, urinary tract, or somewhere else – triggers a chain reaction throughout your body. Without timely treatment, sepsis can rapidly lead to tissue damage, organ failure, and death”.¹

The figures are staggering:

• Over 1.6 million people are diagnosed with sepsis each year in the U.S.²
• The risk of death from sepsis increases by 8% every hour treatment is delayed.²
• The onset of sepsis occurs outside of a hospital setting in nearly 80 percent of cases.³

Nurses and therapists working in the home health care setting are uniquely positioned to detect sepsis, and detect it sooner than later with routine screening. Time is of the essence when sepsis begins… it’s an emergent event. Clinicians should educate patients who have an infection or are at risk of infection about the warning signs of sepsis. Family members and anyone involved in the care of the patient should be informed as well.

Who is at risk?

• Children < 1 year old
• Adults 65 and older
• Individuals with an impaired immune system
• Patients with chronic illnesses such as diabetes or cancer

What are the warning signs?

• Confusion or disorientation
• Rapid heart rate
• Shortness of breath
• Hyperthermia or hypothermia
• Shivering
• Sweaty or clammy skin
• Extreme pain

At HCR Home Care, sepsis screening is an integral part of our daily patient assessments. The Home Care Association (HCA) Sepsis Screening Tool⁴ is embedded in our electronic medical record (EMR) system. This standardized instrument streamlines the clinical assessment to promptly identify the critical signs and symptoms of sepsis. Upon completion of the three screening questions, the EMR automatically generates follow-up actions that align with established medical standards.

What are the three items included in the screening tool?

• Active infection or potential source of infection
• Fever, tachypnea, or tachycardia
• Organ dysfunction (e.g., altered mental status, hypotension)

Our nurses and therapists have conducted the standardized sepsis screens during every home visit over the past 12 months. During this time, over 175,000 individual screens have been performed. 141 patients presented with symptoms consistent with severe sepsis and required immediate transport to a local hospital emergency room. During the same time period, another 125 patients met criteria for sepsis and physician notification immediately followed.

At times, sepsis may not be included as a diagnosis in hospital discharge instructions. This may be due to the fact the symptoms associated with sepsis resolved during the hospital stay. According to the Sepsis Alliance, 62 percent of patients who develop sepsis are likely to be re-hospitalized in the subsequent 30 days.² Eliminating potentially avoidable hospitalizations is a critical focus in home health practice today. Awareness of sepsis can make a difference in keeping patients at home and out of the hospital.

Sepsis deserves to be understood, appreciated, and closely monitored. The condition can result from a simple scrape, urinary tract infection, or surgery. Early detection and prompt medical attention are needed to prevent the worst…amputation, organ failure, or death. Be prepared to ask yourself…“could this be sepsis?” You could just make a world of difference for your patient.

References:

¹ What is Sepsis? Accessed on 9/6/18.

² Sepsis Fact Sheet. Accessed on 9/6/18.

³ CDC: Most Sepsis Cases Start Outside A Hospital. Accessed on 9/5/18.

⁴ Stop Sepsis At Home. Accessed on 9/7/18.

 

Additional Resources:

Signs of Infection and Sepsis at Home (Great Plains QIN)

Sepsis Information Guides (Sepsis Alliance)

Stop Sepsis Tools & Resources (Home Care Association of New York – HCA)

Sepsis – It’s About TIME Infographic (sepsis.org)

September is National Disaster Preparedness Month: Social Determinants, Health Care Coalitions and Disaster Preparedness

by Barbara B. Citarella, RN, MS, CHCE, NHCP-BC, President & CEO, RBC Limited Healthcare & Management Consultants

With Hurricane Florence looming in the Atlantic Ocean, the timeliness of National Preparedness Month (NPM), which is recognized each September, is more important this year than ever before for so many people along the East Coast. This national month-long observance provides an opportunity to remind us that we all must prepare ourselves and our families now and throughout the year. This September will focus on planning, with an overarching theme: Disasters Happen. Prepare Now. Learn How. Health care providers, however, fall into a unique category, much like our emergency responders. They must take care of the community as well as their own families in a disaster. But each community is defined differently and is unique.

The distinctiveness of a community is based on many factors. These factors, many of which are social determinants, affect community resilience. Health care providers, especially home care and hospice, encounter the reality of social determinants on a daily basis. But the correlation between disaster preparedness, social determinants and resilience is relatively new.

Community health care providers (home care and hospice) see and understand the real world patients live in. While responsibility, and in some cases regulations, dictates our role in developing a patient care plan that includes disaster preparedness, it is clear that when a patient is struggling with basic everyday life needs, preparedness activities are not high on the to-do list. Activities such as stockpiling food and water may be impossible for some families who are barely getting by.

What are the social determinants that impact a community’s ability to respond survive and recover from an event?

Social determinants for resiliency are social variables such as health, education, wealth, transportation, and connectivity of a community. These differences make each community unique. As all disasters are handled at the local level, the strength of each community is what impacts the response. Hurricane Katrina helped to paint a clear picture of what happens to those most vulnerable during a disaster. For many people in New Orleans prior to Hurricane Katrina, life was a challenge. It was only when the disaster occurred that those issues presented themselves in a very stark reality.

Action reports from Katrina identified problems with communicating to people who had literacy and language barriers. Many had difficulty understanding information concerning the hurricane, including what to do and where to go. The areas of the city with the weakest economy were hit the hardest. Vulnerable populations struggled to find shelters and appropriate medical care.

Last year was a particularly difficult year for people around the country, and world, with large scale events such as three major hurricanes in the United States, wildfires, earthquakes, Ebola outbreak, the Las Vegas shooting, terrorist attacks with vehicles, floods, and monsoons.

Health care providers and emergency management personnel must have knowledge of the variables in the community, such as unemployment rates, income, population demographics, various cultures, religions, church activities, community activities, crime indicators, opioid addiction statistics, housing capabilities, and yes, even awareness and location of sex offenders. This information is necessary to prepare, respond and recover. This data also helps providers to work effectively as a team with the community emergency responders and health care coalitions. Collaboration like this is imperative to help move people in, up, down and through the impacted area as physical, mental, and social needs change.

Often in the past home care and hospice providers were not a part of the community preparedness activities. During the last few years there has been a significant change. The basis for the change comes in the form of health care coalitions. Health Care Coalitions (HCC) are groups of individual health care and response organizations in a defined geographic location that serve as multi-agency coordinating groups and support and integrate with public health and medical services activities. HCCs play a critical role in developing health care delivery system preparedness and response capabilities. Coalitions have recognized the value of community health workers especially in their ability to provide short term surge capacity as well as location and identification of vulnerable populations. Community health care providers know the geographic area well and can easily move around when roads are blocked. Additionally, their personnel are readily accepted by the community and recognized as providing needed and supportive services to those most fragile and at risk.

As an entity, health care coalitions are involved in strategic planning, operational planning and response, information sharing, resource coordination, and management. Coalitions have the capability to identify the social determinants for their specific geographic location. This is done by engaging all community providers and support groups in a collaborative effort to work together without bias for the betterment of the community. It is only through collaborative leadership that communities will be successful in preparedness, mitigation, response and recovery. All health care providers should reach out to the coalition in their location. You can access a list of all the health care coalitions in the country here.

Health care providers play an essential role in preparedness and response. Remember: Disasters Happen. Prepare Now. Learn How.  

 

Additional Emergency Preparedness Resources:

• Emergency Preparedness Rule website (CMS) includes guidance, examples, FAQs…
  • Emergency Preparedness Rule – Federal Register (CMS)
• Ready.gov
• Hurricane Information Sheet (FEMA)
• Wildfire Information Sheet (FEMA)
• Flood Information Sheet (FEMA)
• Extreme Heat Information Sheet (FEMA)
• Emergency Preparedness Basic Surveyor Training Course (CMS)
• Preparing for Winter Weather: What to Have in Case of Emergency  (MyHHQI Blog)

National Immunization Awareness Month – The Importance of Adult Vaccination

written by the Centers for Disease Control and Prevention

Vaccines provide protection for everyone!

August is National Immunization Awareness Month. As a health professional, it’s an opportune time to remind adults about getting their vaccines. Each year thousands of adults in the US get sick from diseases that could be prevented by vaccines. Unfortunately, adult vaccination rates are low.

What vaccines do adults need?

The Centers for Disease Control and Prevention (CDC) recommends several vaccines for adults based on age, health condition, occupation, lifestyle, and other risk factors.

• Seasonal influenza (flu) – for all adults
• Tdap (Tetanus, diphtheria, and pertussis)
  • For health care professionals and anyone having close contact with a baby younger than 12 months
  • Pregnant women should get a dose of Tdap during every pregnancy
  • A Td booster should be given to adults every 10 years after Tdap vaccination.
• Pneumococcal disease – for adults 65 years and older, and adults younger than 65 with certain conditions that weaken their immune system
• Shingles – for adults 50 years and older

Adults may also need vaccines to protect against human papillomavirus (HPV)— which can cause certain cancers, meningococcal disease, hepatitis A, hepatitis B, measles, mumps and rubella (MMR).

When traveling internationally, CDC recommends adults receive the recommended vaccines based on their destination.

The flu vaccine remains the best protection from flu

Most people who get the flu will have mild illness, will not need medical care or antiviral drugs, and will recover in less than two weeks. Some people, however, are more likely to get flu complications that can result in hospitalization and sometimes death. Pneumonia, bronchitis, sinus infections and ear infections are examples of flu-related complications. Vaccination can keep people from getting sick with flu, and it may also make illness milder for people who do get the flu. A 2017 study showed that flu vaccination reduced deaths, intensive care unit (ICU) admissions, ICU length of stay, and overall duration of hospitalization among hospitalized flu patients. 2017-2018 was a high severity flu season with record-breaking levels of influenza-like illness and hospitalization rates. CDC estimates that the 2017-2018 flu vaccine reduced the risk of getting sick and having to see a doctor from flu by about one-third.

Promote the new shingles vaccine for adults!

Shingles is a painful rash illness which sometimes leads to long-term nerve pain. CDC recommends adults age 50 or older get vaccinated with the new shingles vaccine, Shingrix.

There are several reasons to get vaccinated with Shingrix:

• Previous infection with chickenpox puts adults at risk for shingles.
• More than 99 percent of Americans born before 1980 have had chickenpox, even if they don’t remember it.
• About 1 in 10 people who get shingles develop nerve pain that lasts for months or years after the rash goes away. This is called postherpetic neuralgia and is the most common complication of shingles.
• Shingles may lead to other serious complications involving the eye, including blindness. Very rarely it can also lead to pneumonia, hearing problems, brain inflammation (encephalitis) or death.
• The risk of shingles and its complications increases with age.

Adults 50 years and older need two doses of Shingrix. They should receive the second dose two to six months after getting the first dose. They may have already received a different shingles vaccine called Zostavax. If they did, they still need two doses of Shingrix.

Shingrix is more than 90 percent effective at preventing shingles and long-term nerve pain. You may experience some short-term side effects because Shingrix causes a strong response in your immune system. The pain from shingles can last a lifetime, while the side effects from the shot should only last a few days.

Recommend pneumococcal disease vaccine for your older patients and coworkers

Each year in the United States, pneumococcal disease causes thousands of infections, such as meningitis, bloodstream infections, pneumonia, and ear infections. Most pneumococcal deaths in the U.S. occur in adults, yet 8 out of 10 adults with increased risk conditions remain unvaccinated. Four out of 10 adults age 65 or older are unvaccinated. The best way to prevent pneumococcal disease is to get the vaccine. Recommend pneumococcal vaccination for all adults 65 years or older and adults younger than 65 with chronic illnesses or conditions that weaken the immune system.

The importance of vaccination for people with chronic health conditions

Adults with certain chronic conditions are more likely to develop complications, including long-term illness, hospitalization and even death, from certain vaccine-preventable diseases. Here are vaccine recommendations for adults with these chronic conditions:

• Heart Disease – CDC recommends people with heart disease get a yearly flu vaccine. They should also get a pneumococcal vaccine once as an adult before 65 years of age and then two more doses at 65 years or older.
• Lung Disease – CDC recommends people with asthma, COPD, or other conditions that affect the lungs get a yearly flu vaccine. They should also receive a pneumococcal vaccine once as an adult before 65 years of age and then two more doses at 65 years or older.
• Diabetes – CDC recommends people with diabetes get a yearly flu vaccine and a hepatitis B vaccine series if they’re between the ages of 19 and 59. If they are 60 years or older, they should consult their doctor to see if they should receive hepatitis B vaccine. Pneumococcal vaccines are also recommended for people with diabetes once as an adult before 65 years of age and then two more doses at 65 years or older.

What are some recommendations for improving adult vaccination rates?

Most adults are not aware that they need vaccines. As a health care professional, a strong recommendation is a critical factor that affects whether your patients get vaccinated. CDC suggests using the SHARE method to make a strong vaccine recommendation and provide important information to help patients and coworkers make informed decisions about vaccinations:

• S: SHARE the reasons why vaccines is are an important defense against certain preventable diseases.
• H: HIGHLIGHT positive experiences with vaccines (personal or in your practice), as appropriate, to reinforce the benefits and strengthen confidence in vaccination.
• A: ADDRESS patient questions and any concerns about vaccines, including side effects, safety and vaccine effectiveness in plain and understandable language.
• R: REMIND patients that vaccines can protect them and their loved ones from serious illness and disease-related complications.
• E: EXPLAIN the potential costs of getting certain illnesses, including serious health effects, time lost (such as missing work or family obligations) and financial costs.

Did you know health care workers are at risk for exposure to serious, sometimes deadly diseases?

Health professionals who handle materials that could potentially spread infection should get the recommended and appropriate vaccines to reduce the chance of getting or spreading vaccine-preventable diseases. Health care workers can protect themselves, their patients and family members by making sure they are up-to-date with recommended vaccines.

Each year, thousands of adults needlessly suffer illness, are hospitalized, and even die as a result of vaccine-preventable diseases. As a health professional, you can increase awareness about the importance of adult immunization and encourage vaccination. Share fact sheets that can help adults understand why vaccination is so important, and which vaccines are recommended for them. CDC also has posters and flyers that can be used to encourage adult vaccination. With your help, we can improve vaccination rates and ensure that adults have the best protection against many diseases.

 

RESOURCE ALERT!

The Home Health Quality Improvement (HHQI) National Campaign provides many tools and resources to support immunizations, including:

• Immunization & Infection Best Practice Intervention Package
• 10 Common Flu Myths
• Immunization:  Your Strongest Defense (patient video)