Identifying no-harm incidents in home healthcare: a cohort study using trigger tool methodology

Lindblad, Marléne; Unbeck, Maria; Nilsson, Lena; Schildmeijer, Kristina; Ekstedt, Mirjam

doi:10.1186/s12913-020-05139-z

Cited by 10 publications

(15 citation statements)

References 37 publications

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“…Trigger tool-based methods have been adapted to many clinical contexts and translated to different languages. There are modified trigger tools for emergency department [17], surgery [18], paediatrics [19,20], geriatric patients [10], home healthcare [21,22], and for discovering medication errors [11]. GTT has been translated and modified to be used in different countries, for example Italy [23], Brazil [24], Portugal [25], China [10], Germany [18], Switzerland [9], Finland [26], Sweden [27], Norway [28] and Denmark [16].…”

Section: B) Use Of Trigger Tools In Different Settingsmentioning

confidence: 99%

Estonian adverse events study for multimorbid patients using Estonian Trigger Tool (MUPETT—MUltimorbid Patients—Estonian Trigger Tool). Development of Estonian trigger tool for multimorbid patients. A study protocol for mixed-methods study

et al. 2023

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Introduction It is widely recognized that providing healthcare may produce harm to the patient. Different approaches have been developed to measure the burden of adverse events (AEs) to plan and measure the effects of interventions. One of the most widely used instruments is the Trigger Tool, which has previously been modified to be used on various settings and translated into many languages. Multimorbidity complicates care and may increase the number of AEs patients experience. Currently there is no instrument designed to measure AEs in multimorbid patients. In Estonia, there is currently no validated instrument to measure the burden of AEs. Aims The aim of this study will be evaluating the characteristics and ocurrence of AEs in multimorbid patients in hospitalised internal medicine patients of Estonia, and describes the development of a trigger tool for this purpose. Methods and analysis We will search for the evidence on measuring AEs in the population of multimorbid patients focusing on trigger tools, and synthesize the data. Data collection of the triggers from the literature will be followed by translating triggers from English to Estonian. An expert multidisciplinary panel will select the suitable triggers for this population. Trigger tool will be pre-tested to assess agreement among professionals and usability of the tool. Validation will be done using 90 medical records. A cross-sectional study in internal medicine departments of two Estonian tertiary care hospitals will be performed to identify the frequency and characteristics of AEs in 960 medical records. We will also provide preventability potential and influencing factors. Dissemination Results will be disseminated to healthcare providers and stakeholders at national and international conferences, and as a doctoral medical thesis.

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Section: B) Use Of Trigger Tools In Different Settingsmentioning

confidence: 99%

Estonian adverse events study for multimorbid patients using Estonian Trigger Tool (MUPETT—MUltimorbid Patients—Estonian Trigger Tool). Development of Estonian trigger tool for multimorbid patients. A study protocol for mixed-methods study

et al. 2023

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“…Open access on safety in medication management and prevention of falls. [7][8][9][10][11] A large research gap remains on the broader safety perspective, encompassing the older person's behaviour and lifestyle, the social and physical home environment, and provision of both medical healthcare and social care, which have been identified as important domains of safety in home care. 4 12 13 A literature review on home care in European countries showed that there is limited information on how practical care models are related to outcomes such as safety in home care and that information about home care services is skewed, both within and across countries.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

‘We just have to make it work’: a qualitative study on assistant nurses’ experiences of patient safety performance in home care services using forum play scenarios

et al. 2022

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ObjectiveSafety is essential to support independent living among the rising number of people with long-term healthcare and social care needs. Safety performance in home care leans heavily on the capacity of unlicensed staff to respond to problems and changes in the older patients’ functioning and health. The aim of this study is to explore assistant nurses’ adaptive responses to everyday work to ensure safe care in the home care context.DesignA qualitative approach using the drama-based learning and reflection technique forum play with subsequent group interviews. The audio-recorded interviews were transcribed and analysed with thematic analysis.SettingHome care services organisations providing care to older people in their private homes in two municipalities in southern Sweden.ParticipantsPurposeful sampling of 24 assistant nurses and three managers from municipal home care services and a local geriatric hospital clinic.ResultsHome care workers’ adaptive responses to provide safe home care were driven by an ambition to ‘make it work in the best interests of the person’ by adjusting to and accommodating care recipient needs and making autonomous decisions that expanded the room for manoeuvrability, while weighing risks of a trade-off between care standards and the benefits for the community-dwelling older people’s independent living. Adaptations to ensure information transfer and knowledge acquisition across disciplines and borders required reciprocity.ConclusionsSafety performance in home care service is dependent on the staff closest to the older people, who deal with safety risks and ethical dilemmas on a day-to-day basis and their access to information, competence, and resources that fit the demands. A proactive leadership characterised by mutual trust and adequate support for decision making is suggested. Managers and decision-makers across healthcare and social care need to consider how they can develop interprofessional collaborations and adaptive routines supporting safety from a broader perspective.

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“…Detailed event presentation; sorted by column total. References [12,22,24,36,37] Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.…”

Section: Supplementary Materialsmentioning

confidence: 99%

“…Putting an additional focus on no-harm incidents provides valuable information on areas for improvement and learning from how to anticipate and reduce emerging risks before patient harm occurs. Investigating AEs and no-harm incidents is important to gain knowledge and understanding of how to improve patient safety [ 12 ]. Therefore, the information on no-harm incidents provides an additional perspective on patient safety during care services and the opportunity to improve areas at risk for patient harm [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Occurrence of No-Harm Incidents and Adverse Events in Hospitalized Patients with Ischemic Stroke or TIA: A Cohort Study Using Trigger Tool Methodology

Nowak

Schwendimann

Lyrer

et al. 2022

IJERPH

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Adverse events (AEs)—healthcare caused events leading to patient harm or even death—are common in healthcare. Although it is a frequently investigated topic, systematic knowledge on this phenomenon in stroke patients is limited. To determine cumulative incidence of no-harm incidents and AEs, including their severity and preventability, a cohort study using trigger tool methodology for retrospective record review was designed. The study was carried out in a stroke center at a university hospital in the German speaking part of Switzerland. Electronic records from 150 randomly selected patient admissions for transient ischemic attack (TIA) or ischemic stroke, with or without acute recanalization therapy, were used. In total, 170 events (108 AEs and 62 no-harm incidents) were identified, affecting 83 patients (55.3%; 95% CI 47 to 63.4), corresponding to an event rate of 113 events/100 admissions or 142 events/1000 patient days. The three most frequent AEs were ischemic strokes (n = 12, 7.1%), urinary tract infections (n = 11, 6.5%) and phlebitis (n = 10, 5.9%). The most frequent no-harm incidents were medication events (n = 37, 21.8%). Preventability ranged from 12.5% for allergic reactions to 100% for medication events and pressure ulcers. Most of the events found (142; 83.5%; 95% CI 76.9 to 88.6) occurred throughout the whole stroke care. The remaining 28 events (16.5%; 95% CI 11.4 to 23.1) were detected during stroke care but were related to care outside the stroke pathway. Trigger tool methodology allows detection of AEs and no-harm incidents, showing a frequent occurrence of both event types in stroke and TIA patients. Further investigations into events’ relationships with organizational systems and processes will be needed, first to achieve a better understanding of these events’ underlying mechanisms and risk factors, then to determine efforts needed to improve patient safety.

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Identifying no-harm incidents in home healthcare: a cohort study using trigger tool methodology

Cited by 10 publications

References 37 publications

Estonian adverse events study for multimorbid patients using Estonian Trigger Tool (MUPETT—MUltimorbid Patients—Estonian Trigger Tool). Development of Estonian trigger tool for multimorbid patients. A study protocol for mixed-methods study

Estonian adverse events study for multimorbid patients using Estonian Trigger Tool (MUPETT—MUltimorbid Patients—Estonian Trigger Tool). Development of Estonian trigger tool for multimorbid patients. A study protocol for mixed-methods study

‘We just have to make it work’: a qualitative study on assistant nurses’ experiences of patient safety performance in home care services using forum play scenarios

Occurrence of No-Harm Incidents and Adverse Events in Hospitalized Patients with Ischemic Stroke or TIA: A Cohort Study Using Trigger Tool Methodology

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