Development of a trigger tool to identify adverse events and no-harm incidents that affect patients admitted to home healthcare

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

doi:10.1136/bmjqs-2017-006755

Cited by 21 publications

(33 citation statements)

References 36 publications

(28 reference statements)

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“…Falls were identified as a predictor of subsequent adverse events 62 and should trigger intervention. Like GAPcare, interventions could be brief and focused on identifying high-risk medications, functional impairment, and determining the safety of discharge.…”

Section: Discussionmentioning

confidence: 99%

GAPcare: The Geriatric Acute and Post‐Acute Fall Prevention Intervention in the Emergency Department: Preliminary Data

Goldberg

Marks

Ilegbusi

et al. 2019

J American Geriatrics Society

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OBJECTIVES We aimed to describe a new multidisciplinary team fall prevention intervention for older adults who seek care in the emergency department (ED) after having a fall, assess its feasibility and acceptability, and review lessons learned during its initiation. DESIGN Single‐blind randomized controlled pilot study. SETTING Two urban academic EDs PARTICIPANTS Adults 65 years old or older (n = 110) who presented to the ED within 7 days of a fall. INTERVENTION Participants were randomized to a usual care (UC) and an intervention (INT) arm. Participants in the INT arm received a brief medication therapy management session delivered by a pharmacist and a fall risk assessment and plan by a physical therapist (PT). INT participants received referrals to outpatient services (eg, home safety evaluation, outpatient PT). MEASUREMENTS We used participant, caregiver, and clinician surveys, as well as electronic health record review, to assess the feasibility and acceptability of the intervention. RESULTS Of the 110 participants, the median participant age was 81 years old, 67% were female, 94% were white, and 16.3% had cognitive impairment. Of the 55 in the INT arm, all but one participant received the pharmacy consult (98.2%); the PT consult was delivered to 83.6%. Median consult time was 20 minutes for pharmacy and 20 minutes for PT. ED length of stay was not increased in the INT arm: UC 5.25 hours vs INT 5.0 hours (P < .94). After receiving the Geriatric Acute and Post‐acute Fall Prevention Intervention (GAPcare), 100% of participants and 97.6% of clinicians recommended the pharmacy consult, and 95% of participants and 95.8% of clinicians recommended the PT consult. CONCLUSION These findings support the feasibility and acceptability of the GAPcare model in the ED. A future larger randomized controlled trial is planned to determine whether GAPcare can reduce recurrent falls and healthcare visits in older adults. J Am Geriatr Soc 68:198–206, 2019

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Section: Discussionmentioning

confidence: 99%

GAPcare: The Geriatric Acute and Post‐Acute Fall Prevention Intervention in the Emergency Department: Preliminary Data

Goldberg

Marks

Ilegbusi

et al. 2019

J American Geriatrics Society

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“…Our study confirms that the TT methodology can be useful for patient safety work to detecting risk areas before they cause harm to the patients. The identification of no-harm incidents and contributing causes, conducting in parallel with AEs, [19] will give complement and valuable information about brittleness in patient safety areas.…”

Section: Discussionmentioning

confidence: 99%

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

Lindblad

Unbeck

Schildmeijer

et al. 2020

Preprint

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Background Patient safety in home healthcare is largely unexplored. No-harm incidents may give valuable information about risk areas and system failures as a source for proactive patient safety work. We hypothesized that it would be feasible to retrospectively identify no-harm incidents and thus aimed to explore the cumulative incidence, preventability, types, and potential contributing causes of no-harm incidents that affected adult patients admitted to home healthcare.Methods A structured retrospective record review using a trigger tool designed for home healthcare. A random sample of 600 home healthcare records from ten different organizations across Sweden was reviewed. Results In the study, 40,735 days were reviewed. In all, 313 no-harm incidents affected 177 (29.5%) patients; of these, 198 (63.2%) no-harm incidents, in 127 (21.2%) patients, were considered preventable. The most common no-harm incident types were “fall without harm,” “deficiencies in medication management,” and “moderate pain.” The type “deficiencies in medication management” was deemed to have a preventability rate twice as high as those of “fall without harm” and “moderate pain.” The most common potential contributing cause was “deficiencies in nursing care and treatment, i.e., delayed, erroneous, omitted or incomplete treatment or care.” Conclusion This study suggests that it is feasible to identify no-harm incidents and potential contributing causes such as omission of care using record review with a trigger tool adapted to the context. No-harm incidents and potential contributing causes are valuable sources of knowledge for improving patient safety, as they highlight system failures and indicate risks before an adverse event reach the patient.

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“…The identification of both AEs and no-harm incidents in the home healthcare context was conducted at the same time when reviewing the records. Sample size calculation was based on the identification of AEs [19]. The method and the identification of AEs is described in detail elsewhere [19,20].…”

Section: Designmentioning

confidence: 99%

“…In some teams, the physicians carried out some of the primary and/or secondary reviews. In the primary review, the reviewer documented demographic data and screened for the presence of the 38 predefined triggers in each healthcare record [19]. A trigger is a word or a sentence in a record that could indicate that a no-harm incident had occurred, such as "fall" or "insufficient planning, coordination, communication, and/or information."…”

Section: Review Processmentioning

confidence: 99%

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

Lindblad

Unbeck

Nilsson

et al. 2020

BMC Health Serv Res

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Background: Patient safety in home healthcare is largely unexplored. No-harm incidents may give valuable information about risk areas and system failures as a source for proactive patient safety work. We hypothesized that it would be feasible to retrospectively identify no-harm incidents and thus aimed to explore the cumulative incidence, preventability, types, and potential contributing causes of no-harm incidents that affected adult patients admitted to home healthcare. Methods: A structured retrospective record review using a trigger tool designed for home healthcare. A random sample of 600 home healthcare records from ten different organizations across Sweden was reviewed. Results: In the study, 40,735 days were reviewed. In all, 313 no-harm incidents affected 177 (29.5%) patients; of these, 198 (63.2%) no-harm incidents, in 127 (21.2%) patients, were considered preventable. The most common noharm incident types were "fall without harm," "deficiencies in medication management," and "moderate pain." The type "deficiencies in medication management" was deemed to have a preventability rate twice as high as those of "fall without harm" and "moderate pain." The most common potential contributing cause was "deficiencies in nursing care and treatment, i.e., delayed, erroneous, omitted or incomplete treatment or care." Conclusion: This study suggests that it is feasible to identify no-harm incidents and potential contributing causes such as omission of care using record review with a trigger tool adapted to the context. No-harm incidents and potential contributing causes are valuable sources of knowledge for improving patient safety, as they highlight system failures and indicate risks before an adverse event reach the patient.

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Development of a trigger tool to identify adverse events and no-harm incidents that affect patients admitted to home healthcare

Cited by 21 publications

References 36 publications

GAPcare: The Geriatric Acute and Post‐Acute Fall Prevention Intervention in the Emergency Department: Preliminary Data

GAPcare: The Geriatric Acute and Post‐Acute Fall Prevention Intervention in the Emergency Department: Preliminary Data

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

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

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