Safety in home care: a mapping review of the international literature

Abstract

Aim This integrative study on safety in home care provides a synopsis of evidence in the Canadian and international literature. The objectives of this study were to: (i) develop/test a comprehensive search strategy to locate the literature on harmful incidents (previously called adverse events (AEs)) in the home care environment to track emerging evidence; (ii) determine what has been documented about AEs in the home care setting; and (iii) catalogue definitions of safety in home care by analysis of reported/published definitions. Methods The review was characterised by a process of mapping and categorising existing literature in practice, health services and policy literature. Methods included a thorough search strategy determined by time/scope constraints, quality assessment of study sets relevant to design and graphic/tabular representation of the synthesis. This multi‐step, iterative process used an explicit search and retrieval strategy based on Cochrane and Joanna Briggs Institute methodologies. A modified Problem, Intervention, Comparison, Outcome template was used to design the search. To facilitate concept clarification, key definitions relevant to patient safety and AEs in home care were catalogued. Results Multiple runs on searches were performed for sensitivity and specificity using the Peer Review of Electronic Search Strategies methodology developed by the Canadian Agency for Drugs and Technologies in Health and additional other approaches. Ninety‐two research studies published from 1993 to 2010 and representing 14 countries (the majority North American) met the inclusion criteria (i.e. addressing AEs within the context of home care). Studies varied in scope from one home healthcare agency/site to nationwide investigations that involved more than five million participants. Quantitative research methods included experimental, descriptive and retrospective designs. Qualitative research methods included focus groups, interviews and consensus workshops. The nature of AEs was categorised as types of patient injury/harm related to an AE, caregiver instigated injury/harm and organisational/services/staff injury/harm. Conclusions There is an emerging evidence base about safety in home care. A predominant theme was the lack of conceptual clarity with the terms patient safety and AEs in the home care environment. An important finding was that innovative strategies/tools appear in the grey or peer‐review literature as quality initiatives with/without evaluation elements. Traditionally, we do not concentrate heavily on the grey literature, but to advance the field, it may be necessary to place more emphasis on this source. A glaring limitation was the paucity of research on the occurrence of AEs and a lack of quality of research that documents prevalence estimates/incidence rates. Interventional research to evaluate risk reduction strategies was very limited and will advance only when tracking and documentation of various AEs improves.

‘I need complete trust in nurses’ – home mechanical ventilated patients’ perceptions of safety

“…The issue of safety in home care has been recently recognised, leading to a growing body of literature on this topic, and although evidence is still limited , a broader ‘understanding of patient safety issues among home care clients is developing’ (p. 166). This understanding is based on results from an analysis which show that around 13% of the Canadian home care clients had experienced at least one adverse event .…”

Sicherheit in der häuslichen Intensivversorgung beatmeter Patienten aus Sicht professioneller Akteure

“…[3,17,20]]. Es entsteht der Eindruck, dass Versorgungskonzepte, die auf Beziehungs-und Aushandlungsarbeit sowie Partizipation familialer und informeller Helfer angelegt sind [17,21,22], in diesem Feld derzeit noch wenig verbreitet sind. Dies erstaunt umso mehr, als solche systemischen Ansätze und Konzepte aufgrund der spezifischen Bedingungen der häuslichen Intensivversorgung aus wissenschaftlicher Sicht als unverzichtbar angesehen werden, um die Bedingungen der Zusammenarbeit der formellen und informellen Helfer zielgerichtet aushandeln und die Bedarfsgerechtigkeit, Qualität und auch Sicherheit in dieser speziellen Versorgungsform gewährleisten zu können [17][18][19].…”

“…Den hohen Anforderungen, die damit verbunden sind, scheinen sie jedoch häufig nicht gerecht zu werden. Es fehlt an einer ausreichenden Zahl und an einschlägig qualifiziertem Personal [2,16,21]. Dieser Befund wird nicht erstaunen, galt die häusliche Langzeitversorgung doch insbesondere seit Einführung der gesetzlichen Pflegeversicherung als wenig prestigeträchtiges Einsatzfeld für Pflegende mit häufig geringerer Qualifizierung.…”

“…Inwieweit hier eine systematische Reform der Aus-, Fort-und Weiterbildung der Pflege Abhilfe schaffen kann und ob eines Tages auch in nennenswerter Zahl hochschulisch qualifizierte Pflegende in diesem Versorgungssetting tätig werden, bleibt abzuwarten. In jedem Fall aber wäre auch jetzt schon die Umsetzung tragfähiger Personalmix-, Einarbeitungs-und Supervisionskonzepte angezeigt [18,19,21], um die drängendsten Sicherheitsprobleme in der häuslichen Intensivversorgung adressieren zu können. Fraglich erscheint, ob und inwiefern die Masse der ambulanten Intensivpflegedienste über die geeigneten Qualifikationen und Rahmenbedingungen verfügen, um solche Personalentwicklungsmaßnahmen hinreichend umsetzen zu können [2].…”

Medication Management in Municipality-Based Healthcare

“…Medication errors in home healthcare may occur due to poor communication about medications, delays in obtaining and delivering medication, and mistakes or errors in dispensing and administration (Ellenbecker, Frazier, & Verney, 2004;Mager, 2007). In nursing homes it has been estimated that 50% of the residents have an adverse drug event every year (Harrison et al, 2013;Pepper & Towsley, 2007). This can cause an increased risk of hospitalization and suffering for patients.…”