Safety risks associated with physical interactions between patients and caregivers during treatment and care delivery in Home Care settings: A systematic review

Abstract

Additional Information:• This paper was accepted for publication in the journal International Jour- Review methods:The included references (n=42) were critically appraised using a modified version of Downs and Black checklist and the Mixed Methods Appraisal Tool. Results:The risk factors are reported using the modified model of human factors of health care in the home to represent the roles of both patients and caregivers in the system. The results are grouped as environment (health policy, physical and social), artefacts (equipment and technology), tasks (procedures and work schedules) and care recipient/provider. These include permanent and temporary building design and access, communication and lone working, provision of equipment and consumables, and clinical tasks. The topics with strong evidence from at least 2 papers relate to risks associated with awkward working positions, social environment issues (additional tasks and distractions), abuse and violence, inadequate team (peer) support, problems with workload planning, needle stick injuries and physical workload (moving and handling patients). Conclusions:As home care increases, there is a need to ensure the safety of both patients and caregivers with an understanding of the physical interactions and tasks to manage safety risks and plan safer care delivery systems. KeywordsHome care services, moving and lifting patients, patient safety, occupational health, community health services HighlightsWhat is already known:• Providing care and treatment at a patient's home presents risks to both caregivers and patients whether care is delivered from one or multiple organisation(s).• There are different models of home care, including the hospital in the home, patient-centred medical home, home first policies and aging-in-place • Care tasks are categorised as basic care, including personal hygiene, mobilisation, nutrition and social company, and advanced care, including medication administration, tube feeding, and operating home care technology (e.g. ventilator, electric wheelchair) What this paper adds• Risk factors for the environment of care are associated with health policies, physical location and social environment.• The risks include permanent and temporary building design and access, communication and lone working, provision of equipment and consumables and clinical tasks.• As home care increases, there is a need to ensure the safety of both patients and caregivers with an understanding of the physical interactions and tasks to manage risks and plan safer care delivery systems.

“I see myself as part of the team” – family caregivers’ contribution to safety in advanced home care

“…Various contributing and interdependent human factors have an impact on patient safety in home care. The individual characteristics of the patients and their caregivers, the nature of health care tasks, the home and social environment, medical devices and new technology are major components [ 14 , 15 ]. The home care setting, for example, has distinctive characteristics that are very different from institutional environments and that have an impact on patient safety.…”

“…The home care setting, for example, has distinctive characteristics that are very different from institutional environments and that have an impact on patient safety. Home care nurses work in isolation and their role is rather that of a guest in the family’s home [ 15 , 16 ]. The unique nature of each individual home contributes to home care being viewed as unregulated and uncontrolled [ 17 ].…”

Human Factors for Dementia: Evidence-Based Design

“…These may include the hospital in the home, patient-centred medical home, home first policies and aging-in-place. Hignett, Edmunds-Otter & Keen [18] summa-rised the state of science for physical interactions (context for design) with the results grouped as environment (health policy, physical and social), artefacts (equipment and technology), tasks (procedures and work schedules) and care recipient/provider. This included permanent and temporary building design and access, communication and lone working, provision of equipment and consumables, and clinical tasks.…”

The effect of educational intervention by nurses on home environmental risk factors for falls

“…Although some studies focus on modification of the home environment to prevent falls, this is a critically neglected area of research. In their systematic review, Hignett, Edmuns Otter, Keen (2016) conclude that as homecare becomes more common, there is a need to ensure the safety of both patients and caregivers through increased understanding of the physical interactions and tasks entailed in managing safety risks and planning safer care delivery systems. Prevention-of-falls programs aim to increase functional capacity, decrease the number of falls, prevent falls, and decrease fall-dependent injuries.…”