Thank you for the opportunity to comment on the proposed changes to 18VAC90-25-15. Identification; accuracy of records and 18VAC90-60-20. Identification; accuracy of records.

We recognize that there are somewhat unique safety concerns (related to potential for stalking, etc.) that are inherent in human services and medical care and we support reasonable efforts to ensure safety of all workers.  However, we do not believe removing staff identification badges is a sound approach, particularly in long-term care settings such as nursing homes and assisted living facilities.  We are not necessarily in agreement with the agency’s comment that “It seems likely though, that most employers would prefer to have a form of name (first name and last initial for example) on the badge so that patients or family members could correctly identify an aide.”  At any rate, this is not an issue that should be optional - left to facility/staff preference.  Considering the vulnerability of the population, the intimate nature of the care they must often rely upon, the potential for the care staff to be ‘non-identified’ is unacceptable.  Some form of name identification is critical to accountability and to protection of care recipients.  Furthermore, if left as an option, staff that are most problematic would be most likely to opt for anonymity, making it difficult or impossible to address and resolve care problems, potential abuse, etc. 

The need to maximize accountability is underscored by recent reports from the U.S. Department of Health and Human Services Office of Inspector General (OIG) that revealed problems with care in nursing facilities. The OIG found that nearly 1 in 3 individuals who went to a Skilled Nursing Facility (in 2011) suffered harm that could have been prevented.  Contributing factors to resident harm included substandard treatment, inadequate resident monitoring, and failing to provide treatments.  One report found that 1 in 5 Emergency Room visits by residents in a nursing home were due to incidents of abuse.  If the ability of patients, families, ombudsmen, care supervisors and other problem-solver/patient advocates is thwarted by inability to track care issues to specific staff, the patient safety net and the potential to prevent abuse and minimize harm is seriously weakened.

Recommendation:

In the interest of patient/resident safety and good care, please do not allow providers to form their own policies that would allow legal removal of any element of a name / unique identifier on staff name badges.  For example, by adding to the last sentence of 18VAC90-25-15 (A). Identification; accuracy of records -“Name identification on a badge shall follow the policy of the facility, in which the nurse aide is employed.  The policy of the facility shall require, at minimum, the use of first name and last initial, or first initial and last name. 

For 18VAC90-60-20. Identification; accuracy of records, please do not allow assisted living facilities to form their own policies that would allow legal removal of any element of a name / unique identifier on staff name badges should the facility desire. This could be accomplished, for example by adding a sentence after Name identification on a badge shall follow the policy of the assisted living facility in which the medication aide is employed.  The policy of the facility shall require, at minimum, the use of first name and last initial or first initial and last name. 

 In conclusion, while we appreciate where the Virginia Nurses’ Association is coming from in the concern to protect the safety of staff, this must not be accomplished in a way that puts at risk the care recipients, who are typically the most vulnerable in the equation.  Some compromise (e.g., requiring I.D. badges with first name and last initial) is essential to promoting accountability and ensuring at least a modicum or protection and comfort for patients, who should not be expected to put their care and/or very survival in the hands of unnamed strangers.     pe over this text and enter your comments here. You are limited to approximately 3000 words.