Assessing adverse events among home care clients in three Canadian provinces using chart review

Abstract

ObjectivesThe objectives of this study were to document the incidence rate and types of adverse events (AEs) among home care (HC) clients in Canada; identify factors contributing to these AEs; and determine to what extent evidence of completion of incident reports were documented in charts where AEs were found.MethodsThis was a retrospective cohort study based on expert chart review of a random sample of 1200 charts of clients discharged in fiscal year 2009–2010 from publicly funded HC programmes in Manitoba, Quebec and Nova Scotia, Canada.ResultsThe results show that 4.2% (95% CI 3.0% to 5.4%) of HC patients discharged in a 12-month period experienced an AE. Adjusting to account for clients with lengths of stay in HC of less than 1 year, the AE incidence rate per client-year was 10.1% (95% CI 8.4% to 11.8%); 56% of AEs were judged preventable. The most frequent AEs were injuries from falls, wound infections, psychosocial, behavioural or mental health problems and adverse outcomes from medication errors. More comorbid conditions (OR 1.15; 95% CI 1.05 to 1.26) and a lower instrumental activities of daily living score (OR 1.54; 95% CI 1.16 to 2.04) were associated with a higher risk of experiencing an AE. Clients’ decisions or actions contributed to 48.4% of AEs, informal caregivers 20.4% of AEs, and healthcare personnel 46.2% of AEs. Only 17.3% of charts with an AE contained documentation that indicated an incident report was completed, while 4.8% of charts without an AE had such documentation.ConclusionsClient safety is an important issue in HC, as it is in institutionalised care. HC includes the planned delivery of self-care by clients and care provision by family, friends and other individuals often described as ‘informal’ caregivers. As clients and these caregivers can contribute to the occurrence of AEs, their involvement in the delivery of healthcare interventions at home must be considered when planning strategies to improve HC safety.

Safety Strategies for Care in the Home

“…Two recent studies, one conducted in the USA (Madigan 2007 ) and the other in Canada , found that 13 % of home care patients experienced an adverse event. Larger estimates based on expert chart review of 1200 patients discharged in [2009][2010] in Canada showed a rate of 4.4 % adverse events (Blais et al 2013 ). The most frequent were injuries from falls, wound infections, behavioural or mental health problems and adverse outcomes from medication errors.…”

Baccalaureate nursing students’ confidence on patient safety

“…[1][2][3][4][5][6][7] As defined by the Canadian Patient Safety Institute (CPSI), patient safety is "the pursuit of the reduction and mitigation of unsafe acts within the healthcare system, as well as the use of best practices shown to lead to optimal patient outcomes". [6] In recognition of high error rates the Institute of Medicine (IOM) mandated that there be improvements to health education programs by increasing the amount of content related to safety.…”

The Risk Assessment of Adverse Events of Nursing Activities as the Element of Quality Management in Healhcare

“…It might be an event or occurrence which becomes apparent during the delivery of care services and which has a negative or potentially negative impact on patient care [3]. The same characteristic can be found in the definition proposed by The Institute of Medicine (IOM) in the USA, which indicates that an AE results in unintended harm to the patient by an act of commission or omission, rather than by the underlying disease or condition of the patient [4]. The Joint Commission [5], an independent, non-profit organization, which accredits and certifies more than 20,000 health care organizations and programs in the United States defines AE as an untoward, undesirable, and usually unanticipated event, such as the death of a patient.…”