Examining markers of safety in homecare using the international classification for patient safety

Marilyn T Macdonald,Ariella Lang,Tanya Barber,Kristine Iaboni,Susan Donaldson,Lynn Stevenson,Janet Storch

doi:10.1186/1472-6963-13-191

Abstract

BackgroundHomecare is a growth enterprise. The nature of the care provided in the home is growing in complexity. This growth has necessitated both examination and generation of evidence around patient safety in homecare. The purpose of this paper is to examine the findings of a recent scoping review of the homecare literature 2004-2011 using the World Health Organization International Classification for Patient Safety (ICPS), which was developed for use across all care settings, and discuss the utility of the ICPS in the home setting. The scoping review focused on Chronic Obstructive Pulmonary Disease (COPD), and Congestive Heart Failure (CHF); two chronic illnesses commonly managed at home and that represent frequent hospital readmissions. The scoping review identified seven safety markers for homecare: Medication mania; Home alone; A fixed agenda in a foreign language; Strangers in the home; The butcher, the baker, the candlestick maker; Out of pocket: the cost of caring at home; and My health for yours: declining caregiver health.MethodsThe safety markers from the scoping review were mapped to the 10 ICPS high-level classes that comprise 48 concepts and address the continuum of health care: Incident Type, Patient Outcomes, Patient Characteristics, Incident Characteristics, Contributing Factors/Hazards, Organizational Outcomes, Detection, Mitigating Factors, Ameliorating Actions, and Actions Taken to Reduce Risk.ResultsSafety markers identified in the scoping review of the homecare literature mapped to three of the ten ICPS classes: Incident Characteristics, Contributing Factors, and Patient Outcomes.ConclusionThe ICPS does have applicability to the homecare setting, however there were aspects of safety that were overlooked. A notable example is that the health of the caregiver is inextricably linked to the wellbeing of the patient within the homecare setting. The current concepts within the ICPS classes do not capture this, nor do they capture how care responsibilities are shared among patients, caregivers, and providers.

Highlights

The safety markers identified in the scoping review map to the highlevel classes as follows: Medication mania fits in Incident Characteristics; Home alone, A fixed agenda in a foreign language, Strangers in the home, and The butcher, the baker, the candlestick maker are Contributing Factors; and Out of pocket: the cost of caring at home and My health for yours: declining caregiver health are Patient Outcomes
In working through these three classes and their associated concepts, we discovered some lack of specificity relating to patient safety within the homecare setting, and that the clinical basis and structure of the International Classification for Patient Safety (ICPS) posed a challenge, in applying findings from the scoping review to the system
The ICPS, applicable to our findings, did not effectively allow for locating all of the safety risks we identified within the homecare setting, due in part to a lack of specificity related to the patient caregiver linkages, and to a blurring of the lines that exist between the home and health care settings and the shared responsibilities that exist among patients, caregivers, and health care providers

Summary

Introduction

Following a national roundtable discussion with researchers and decision makers, CPSI published Broadening the Patient Safety Agenda to Include Homecare [4] This foundational report identified that the context of care in the home is different than in hospitals or institutional settings and that the health of the homecare patient and caregiver is inextricably linked. The review focused on the homecare literature surrounding chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) These two chronic illnesses require a great deal of care, most of which is provided in the home by a family caregiver [8], and have the highest readmission rate to acute care of all medical conditions [9]. In light of the accumulating evidence related to safety in homecare and the absence of literature linking safety in homecare with the ICPS, this manuscript was conceived

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