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

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

doi:10.1186/s12913-020-05139-z

Abstract

BackgroundPatient 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.MethodsA 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.ResultsIn 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.”ConclusionThis 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.

Highlights

As home healthcare is a growing and increasingly complex arena, there is an urgent need to expand patient safety research of home healthcare settings [1]
We found only two studies from inhospital settings using record review (RRR) for identification of no-harm incidents, [27, 28] which limits the possibilities for comparison, as does the fact that the care provided in a patient’s home environment is quite different from hospital care
In an earlier observational study of the medication management process in home healthcare, we found that deficiencies in the documentation systems made it easy to overlook or miss a prescribed dose, and such no-harm incidents were rarely documented in patient records [7]

Summary

Introduction

As home healthcare is a growing and increasingly complex arena, there is an urgent need to expand patient safety research of home healthcare settings [1]. Structured retrospective record review (RRR) using a trigger tool (TT) is a valid and thorough method for measuring the incidence of AEs, [9,10,11] and has successfully been developed and used for identifying adverse events (AEs) in different kind of specialties in in-hospital care [12,13,14]. RRR using TT has the potential to give an overview of the incidence, nature, preventability and consequences of AEs, providing an opportunity to identify risk areas and learn from past failures. TT has most commonly been used in hospital settings, a few studies used similar methodology for detecting patient safety issues in home healthcare [16,17,18]. We hypothesized that it would be feasible to retrospectively identify no-harm incidents and aimed to explore the cumulative incidence, preventability, types, and potential contributing causes of no-harm incidents that affected adult patients admitted to home healthcare

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