Communication and falls top the list of challenges

Do not use abbreviations prove to be tough habit to kick

Compliance with Goal 2 of the National Patient Safety Goals, which calls for the improvement of effective communications among caregivers, dropped to 72% in 2006 from 76.8% in 2005.

Home health is not the only health care industry that struggles with this goal, says Carol Mooney, RN, MSN, senior association director of the standards interpretation group for The Joint Commission. "The most frequent reason for noncompliance with this goal is the use of do not use abbreviations," she says.

Eliminating all do not use abbreviations is difficult because it requires a behavior change for many staff members, Mooney admits. "We all learned to use certain abbreviations in our education and throughout our years in health care, so these are habits that are hard to break," she says. Staff education and ongoing reminders are the key to successfully meeting this goal.

The second compliance challenge for home health agencies is Goal 9 of the National Patient Safety Goals, which requires agencies reduce the risk of patient harm resulting from falls. "This goal was cited in 28% of surveys," says Mooney. "Most home health agencies conduct a falls risk assessment and always look at the safety of the home environment, but this goal requires that agencies evaluate the number of falls, types of assessments, and interventions that occur to reduce falls," she explains.

Even though noncompliance with this goal was cited at a high rate, Mooney says that many agencies are addressing these issues informally. "Agencies must have policies in place to address assessment and intervention," she says. In addition to a home environment assessment, nurses should evaluate medications or impaired cognitive function that might increase risk of falls, she says.

In addition to policies that address the risk of falls, agencies should evaluate data on falls within their agencies at least once or twice each year, suggests Mooney. Unlike the patient goal related to falls in previous years, this goal requires agencies not only implement a falls reduction program, but also monitor the program's success, she says.

"Look at different populations and the different risks they may have," she says. For example, not all home health patients are elderly, she points out. "Some infusion patients are as young as 40 and your agency may also care for pediatric patients," she says. "Each of these populations has different types of risk."