Safety In Home Care Research Articles

Nurse-Led Medication Management for Older People in Home Care: A Systematic Review of Evolving Nurse Responsibilities in Technology-assisted Care

Technology-assisted care is transforming the home care landscape for older people requiring medication management. With evolving roles and responsibilities, nurse-led interventions are shaping the future of nursing practice in home care. This review aimed to identify and describe nurse-led roles in medication management in home care for older people within the context of technology-assisted care. A systematic review employing an integrative approach was conducted on the PubMed (covering MEDLINE), Scopus, CINAHL, ProQuest, and Embase, targeting studies published in English over the past decade, from 2014 to 2024. The initial database search identified 1629 studies, which were subsequently narrowed down to 20 studies selected for data analysis and narrative research synthesis. The review findings were classified into 3 categories: “fundamental principles,” “nurses and their role identities,” and “enhanced care quality and medication safety.” Given the effectiveness of nurses as leaders in technology-assisted home care for enhancing medication management safety, it is essential to implement policies that support and improve their involvement in multidisciplinary healthcare teams. Additionally, continuous education and training focused on technology-assisted care competencies are necessary to ensure nurses are well-prepared to enhance patient safety in home care.

Application of communication technologies in ensuring patient safety in home care: Pros and cons

The Article Abstract is not available.

Trust and easy access to home care staff are associated with older adults' sense of security: a Swedish longitudinal study.

Older adults are increasingly encouraged to continue living in their own homes with support from home care services. However, few studies have focused on older adults' safety in home care. This study explored associations between the sense of security and factors related to demographic characteristics and home care services. The mixed longitudinal design was based on a retrospective national survey. The study population consisted of individuals in Sweden (aged 65+ years) granted home care services at any time between 2016 and 2020 (n=82,834-94,714). Multiple ordinal logistic regression models were fitted using the generalised estimation equation method to assess the strength of relationship between the dependent (sense of security) and independent (demographics, health and care-related factors) variables. The sense of security tended to increase between 2016 and 2020, and was significantly associated with being a woman, living outside big cities, being granted more home care services hours or being diagnosed/treated for depression (cumulative odds ratio 2-9% higher). Anxiety, poor health and living alone were most strongly associated with insecurity (cumulative odds ratio 17-64% lower). Aside from overall satisfaction with home care services, accessibility and confidence in staff influenced the sense of security most. We stress the need to promote older adults' sense of security for safe ageing in place, as mandated by Swedish law. Home care services profoundly influence older adults' sense of security. Therefore, it is vital to prioritise continuity in care, establish trust and build relationships with older adults. Given the increasing shortage of staff, integrating complementary measures, such as welfare technologies, is crucial to promoting this sense of security.

Specialized nurses' role in ensuring patient safety within the context of telehealth in home care: A scoping review.

Specialized nurses are uniquely positioned to implement innovative telehealth solutions to improve the quality and safety of home care, and this has become a focal point of contemporary healthcare research. This review aimed to identify the nature and scope of specialized nurses' roles in ensuring patient safety within the context of telehealth in home care. A scoping review of the international literature was carried out from January 1, 2013, to August 29, 2024. The review employed Levac et al.'s framework to delineate the research phenomenon and consolidate existing empirical research findings. Through a comparative analysis, the review integrated findings from selected studies, highlighting both similarities and differences related to this phenomenon, which led to the development of distinct categories. The search yielded 1127 articles, from which 23 studies met the inclusion criteria for research synthesis and subsequent reporting of results. These studies spanned specialized nurses' roles in telehealth and various fields in which specialized nurses utilized telehealth to deliver high-quality and safe home care. The findings highlighted key outcomes linked to the improvement of patient safety in home care encompassing continuity of care, confidence in care, monitoring and early intervention, medication safety, engagement and adherence, and healthcare costs. The review revealed the crucial role played by specialized nurses in harnessing telehealth in healthcare to meet the highest care standards, creating an environment that prioritizes the well-being and patient safety in home care.

„Es ist eine unserer Hauptaufgaben, die Sicherheit der Patienten zu gewährleisten.“ – Ergebnisse einer qualitativen Studie zur Gewährleistung von Sicherheit in der beatmungsspezifischen Hilfsmittelversorgung

BackgroundMaintaining safety is critical in home mechanical ventilation (HMV). It is co-determined by the availability of reliable technical aids and their correct application. Ensuring safe aid supply is part of the aid providers'́ legal mandate. However, whether and how this is achieved is largely unknown. Therefore, the tasks of technical aid providers, associated requirements and challenges with special regards to educational and safety aspects were investigated. MethodsFor this purpose, episodic interviews were conducted between July and December 2020 with a purposive sample of field representatives of eleven technical aid providers. Between one and six persons participated in each of the interviews, resulting in a total sample of 25 persons (14 field representatives without management function, ten with management function, one director). Given the conditions during the COVID-19 pandemic, six interviews took place face-to-face and five as web meetings. Interviews were analysed using qualitative content analysis. ResultsFrom the interviewees'́ perspective, the most important safety-related measure is the legally required and individually tailored initial instruction in a safe aid application. Additional safety-related tasks comprise counselling, e. g. for prescribing physicians and users (patients, relatives, nursing service employees), regular home visits, and the provision of a technical emergency service. Interviewees indicate that safety risks emerge primarily from a lack of skills and a high staff turnover among professional caregivers. This, they state, challenges building up and maintaining competencies among nursing staff. Other safety risks arise from healthcare fragmentation, lacking coordination, cooperation, and accountability of the professionals involved. Respondents address these challenges pragmatically by providing additional services, like ongoing caregiver training, care coordination and support roles. DiscussionMaintaining safety in ventilation-associated technical aid supply must be considered a crucial component of the overall HMV care processes, in which safety currently cannot be taken for granted. Field representatives of technical aid providers address the existing challenges with selective and intuitive strategies, some of which exceed their legal mandate. ConclusionImproving safety in home care can be supported by establishing Advanced Nursing Practice roles in nursing services. The systematic further development of roles and tasks of staff of technical aid providers should be clarified within an overarching discourse on viable approaches to cross-sectoral and interprofessional HMV care.

Quality and Safety of Proximity Care Centered on the Person and Their Home: A Systematic Review Protocol.

The quality and safety of health care is a priority, a requirement and a demand of health organizations and social institutions with concrete purposes of progressively providing people with a higher level of health and well-being. It is in the development of this path that home care currently represents an area of gradual investment and where health care services and the scientific community have shown interest in building circuits and instruments that can respond to needs. It is essencial that care must be centered and in close proximity to the person and their family, their context. On the other hand, in Portugal, there are already quality and safety models for the institutionalization context however it is non-existent for home care. In this sense, our objective is to identify, through a systematic review of the literature, particularly from the last 5 years, areas of quality and safety in home care.

Concept analysis of patient safety in home care: a hybrid model

BackgroundPatient safety in home care is a fundamental and complex concept in nursing. This concept includes a number of challenges in patient care. Studies have shown that there is no...

Quality and safety in home care with the Vidaza cooperation protocol

In a context of tense bed management in hospitals, the implementation of cooperation protocols between hospital services and home care providers has become necessary in recent years. The Albi hospital in the Tarn region has set itself the objective of developing care pathways in conjunction with the city in order to better structure the supply of care in the region and also to encourage exchanges between healthcare professionals. The "Vidaza (Azacitidine®) cooperation protocol for day hospital - home hospitalization" illustrates this approach in the field of oncology.

Development of a medication literacy assessment instrument (MELIA) for older people receiving home care.

To develop a consensus-based instrument [MELIA] to assess the medication literacy of older home care patients to ultimately optimize medication safety. This study was part of the project 'Study of Medication Safety in Home Care' (doMESTIC), which took place from 2016 to 2020 in Switzerland. The development process for the medication literacy assessment instrument encompassed six steps. First, a scoping literature search was conducted in the Pubmed, CINAHL, EMBASE and Cochrane Library databases as 2) a basis for the development of assessment items. This was followed by 3) a cognitive interview with home care patients and 4) the first round of a Delphi process. Then, 5) a focus group interview with home care experts was conducted before 6) the second Delphi round. The project took place between August 2020 and June 2021. With these different steps, perspectives of both patients and various home care and medication safety experts were included in the development of the assessment instrument. A detailed instrument consisting of 20 items as well as a 7-item short version were developed. The short version is intended for efficient preliminary screening to identify patients at high risk for medication management-related problems. Medication literacy in patients 65 years and older receiving professional home care is a key issue in preventing medication errors. A targeted assessment, starting with an efficient short version of MELIA, allows for prioritization of patients for interventions to optimize medication safety while ensuring their independence as much as possible. Systematic assessment of patients' medication literacy helps to provide them with targeted and individual support in their medication management to avoid medication errors and increase patient safety. The development of MELIA is a first step in providing an assessment instrument specifically for the home care setting. Patient participation was an integral part of the instrument development. The initial 23 items were optimized based on cognitive interviews with four home care patients. The next steps of the instrument development were based on feedback of health care professionals-encompassing advance practice nurses, regular nurses, pharmacists and general practitioners-during a two-step Delphi process as well as a focus group discussion.

Patient safety in home care: A multicenter cross-sectional study about medication errors and medication management of nurses.

Studies assume that up to 30% of home care recipients are exposed to a possible medication error. For the home care sector, the study situation regarding such errors is limited. The aim of the study was to find out how often medication errors occur and whether they are related to training, quality assurance measures (use of the double‐check principle (DCP)), and other structural conditions of home care services. A cross‐sectional study was conducted, comprising 485 fully trained nurses of 107 randomly selected home care services. Potential influencing factors were analyzed in a multiple logistic regression model. Of 485 fully qualified nurses, 41.6% reported medication errors within a 12‐month period, while 14.8% did not answer this question. Nurses who had attended medication training within the last 2 years compared to a longer period (frequently to rather rarely applied DCP); the odds ratio of not making medication‐related errors was 1.79[1.42–3.09] (OR 3.13; [1.88–5.20]). Years of professional experience, amount of patients per shift, and type of work contract (full/part‐time) were not statistically significantly associated with reported medication errors. Medication‐related errors occur frequently in home care. Regular training and adequate quality management measures increase patient safety. Nursing managers and other responsible individuals of home care institutions have to make sure that nursing staff take part in regular medication training and apply the DCP when they give out medication in home care.

Improving Homecare Risk Management and Patient Safety


 Background: Risk management in the domiciliary healthcare setting is a harder challenge than in a hospital environment. Many, not always predictable, variables related to the patient, the caregiver, the health professionals and the home environment make it impossible to guarantee complete safety in homecare. The first aim of the study was to verify that the Electrical Medical Devices (EMD) and medical Consumables Supplies (CS) provided to mechanically ventilated and artificially fed patients at home comply with requirements for safe homecare. 
 Methods: We conducted a Failure Modes, Effects and Criticality Analysis (FMECA) on two processes, mechanical ventilation and artificial feeding at home, and defined a local institutional list of the requirements for safe home healthcare; a checklist containing all the items in the list was administered to ventilated and artificially fed patients at home. 
 Results: The checklist was used for 92 home patients, sex M/F=52/40, mean age 59,8±22 years (range 2÷102 years). Many failures were highlighted when the checklist was applied and problems affecting AMBU resuscitator bags, tracheostomy tubes, ventilators in patients being mechanically ventilated around-the-clock and ventilator circuits were identified as the most critical potential vulnerabilities for homecare patients. 
 Conclusion: The checklist is a simple and valid tool for implementing proactive clinical risk management initiatives in homecare. Although it is impossible to guarantee complete safety in any healthcare environment, scheduling periodic checks with checklists to assess the quantitative and qualitative adequacy of EMD and CS provided to the patient could contribute to the homecare risk reduction. 

Hospital nurses' experiences of assessing health status changes in stem-cell transplanted patients in home care: A qualitative study.

To explore hospital nurses' experience assessing changes in the health status of stem-cell transplanted patients in home care (HC). Stem-cell transplanted patients in HC are treated at home instead of in hospital wards. Hospital nurses visit patients daily and play a key role in assessing the patients' health status. Previous studies on HC for stem-cell transplanted patients focus mainly on safety in HC versus hospital care. No studies regarding nurses' experience assessing patients' health status at home when patients undergo stem-cell transplantation were found. Qualitative study with an explorative design. Data were collected via 14 individual semi-structured interviews with hospital nurses working with stem-cell transplanted patients in HC. Data were analysed using systematic text condensation. The reporting of the study was guided by the COREQ checklist. Three categories emerged from the data analysis: 1) Effective communication and clinical intuition enhances the assessment of patients' general health condition; 2) It is challenging to rely on one's own judgment in remote assessment; and 3) There are key facilitators in performing remote clinical assessments. Effective communication and clinical intuition enhanced the assessment of patients' general health conditions. The lack of physical presence during remote assessments made using clinical intuition in the assessment process difficult. Experience with hematopoietic stem-cell transplantation was seen as important to facilitate accurate remote clinical assessments. Nurses with responsibility for hospital at-home telephone care should receive training in remote communication and should shadow hospital at-home nurses during in home visits to gain experience assessing patients' health status. Telehealth aspects such as videoconferencing and remote patient monitoring should be considered for more accurate remote assessment. This could potentially result in more effective assessments and reduced readmissions and could promote nurses' confidence in their assessments.

A qualitative study of what care workers do to provide patient safety at home through telecare

BackgroundIn health care, the work of keeping the patient safe and reducing the risk of harm is defined as safety work. In our digitised and technology-rich era, safety work usually involves a relationship between people and technologies. Telecare is one of the fastest-growing technology-domains in western health care systems. In the marketing of telecare, the expectation is that safety is implicit simply by the presence of technology in patients’ homes. Whilst both researchers and health authorities are concerned with developing cost-benefit analyses and measuring effects, there is a lack of attention to the daily work needed to ensure that technologies contribute to patient safety.This paper aims to describe how patient safety in home care is addressed through and with telecare. We base our exploration on the social alarm, an established technology that care workers are expected to handle as an integrated part of their ordinary work.MethodsThe study has a qualitative explorative design where we draw on empirical data from three case studies, involving five Norwegian municipalities that use social alarm systems in home care services. We analyse observations of practice and interviews with the actors involved, following King’s outline of template analysis.ResultsWe identified three co-existing work processes that contributed to patient safety: “Aligning people and technologies”; “Being alert and staying calm”; and “Coordinating activities based on people and technology”. Attention to these work processes exposes safety practices, and how safety is constructed in relational practices involving multiple people and technologies.ConclusionsWe conclude that the three work processes identified are essential if the safety alarm is to function for the end user’s safety. The safety of home-dwelling patients is reliant on the person-technology interface. The efforts of care workers and their interface with technology are a central feature of creating safety in a patient’s home, and in doing so, they utilise a repertoire of skills and knowledge.

Research on safety in home care for older adults: A bibliometric analysis.

AimThis study aimed to describe and visualize the current research state and collaborative networks in home care safety for older adults over the past 11 years to analyse the gaps of research and future research trends.BackgroundThe amount of research on safety in home care for older adults is increasing. It is necessary to understand the status of development and main research topics and identify the main contributors and their relationships.MethodsA total of 2,631 publications were retrieved from the Web of Science. The external characteristics of the publications were summarized with the Web of Science and Histcite. Collaborative networks and keywords were analysed and visually displayed using analysis tools.ResultsThe number of articles increased over the years. Articles were identified from 79 countries, 3,630 institutions, 647 journals and 11,691 authors, and complex cooperative relations among them and five research topics were identified.ConclusionResearch on home care safety for older adults is developing steadily, and this field may be understood to a greater extent in the future. Countries, institutions and scholars need to cooperate more in this research field.Implications for Nursing ManagementThis study contributes important information for understanding achievements in the research field of home care safety and provides insights into future research.

Integrative review: Patient safety among older people with diabetes in home care services.

To identify diabetes specific patient safety domains that need to be addressed to improve home care of older people; to assess research from primary studies to review evidence on patient safety in home care services for older people with diabetes. An integrative review. Domains for patient safety in diabetes home care settings were identified by conducting two searches. We performed searches in: CINAHL, Medline, Embase, and Cochrane Library for the years 2000-2017. The first search identified frameworks or models on patient safety in home care services published up to October 2017. The second search identified primary studies about older people with diabetes in the home care setting published between 2000-2017. Data from the 21 articles populated and refined 13 predetermined domains of patient safety in diabetes home care. These were used to explore how the domains interact to either increase or reduce risk. The domains constitute a model of associations between aspects of diabetes home care and adverse events. The results highlight a knowledge gap in safety for older persons with diabetes, influenced by e.g. hypoglycaemia, falls, pain, foot ulcers, cognitive impairment, depression, and polypharmacy. Moreover, providers' inadequate diabetes-specific knowledge and assessment skills contribute to the risk of adverse events. Older persons with diabetes in home care are at risk of adverse events due to their reduced ability to self-manage their condition, adverse medication effects, the family's ability to take responsibility or home care service's suboptimal approaches to diabetes care.

Variations in drug-related problems detected by multidisciplinary teams in Norwegian nursing homes and home nursing care

Objective: Traditionally, nursing homes have been associated with suboptimal drug therapy and drug-related problems (DRPs). In contrast, less is known about drug safety in homecare. The aim of this study was to describe and compare DRPs in older persons across two care settings: nursing homes and home nursing care.Design: Cross-sectional study using descriptive and inferential statistics.Setting: Nursing homes (n = 5) and home nursing care units (n = 8) across nine municipalities in the middle of Norway.Participants: Multidisciplinary medication reviews for 61 nursing home residents and 93 patients receiving home nursing care performed over the 2013–2014 period, were mapped and examined (N = 154).Main outcome measures: DRPs classified by a Norwegian Classification Tool.Results: In all, 740 DRPs were detected in the total sample, 227 in nursing homes and 513 in home nursing care. DRPs were significantly higher among patients receiving home-based care (Mean =5.5) compared to patients in nursing homes (Mean =3.7, p = 0.002). Among the problem categories, the need for additional drug was most frequent in nursing homes (p = 0.001), while documentation discrepancies reached the highest numbers in patients receiving home nursing care (p = 0.000). Additionally, patients in home nursing care had more problems concerning adverse reactions (p = 0.060); however, this was not statistically significant. Differences in DRP categories leading to changes in the patients’ medication lists were also discovered.Conclusions: The frequency of unclear documentation and adverse reactions found in the homecare setting is alarming. This is an important issue given the trend in aged care towards caring people in their own homes. Further research is warranted to explore how different care settings may influence the safety of pharmacotherapy for older persons.Key PointsDrug related problems are a significant cause of concern among patients receiving home nursing care as well as for patients living in nursing homes. The findings of this study showed that:•Significantly more DRPs were detected among patients receiving home nursing care than patients living in nursing homes.•While patients living in nursing homes were often undermedicated, documentation discrepancies were more frequent in home nursing care.•DRP categories leading to changes on the medication lists differed between the settings.

Everything safe? – Risk situations in advanced home care from the point of view of ventilated patients and their relatives

Background: The number of home mechanically ventilated (HMV) patients has been growing for years. However, little is known about requirements, processes and effects of advanced home care, provided in distance from clinics and doctors. To date, safety related aspects of the above mentioned issues have scarcely been examined. Aim: Users of advanced home care were asked about their experiences and about situations in which they felt safe or unsafe. The aim was to gain insights into the daily care provision, explore safety risks from the users’ point of view, and to develop new approaches to enhance patient safety in home care for the severely ill. Method: A qualitative explorative study has been carried out, based on semi-structured interviews (ventilated patients N = 21; relatives N = 15). Sampling, data collecting and data analysis were guided by principles of Grounded Theory. Results: Risk situations occur when (non-)verbal communication offers of HMV patients are overseen or misunderstood, patient- or technology related monitoring tasks are neglected, if coordination and collaboration requirements are undervalued and if negotiation processes as well as education and supervision needs are disregarded. Furthermore, nurses’ lack of competence, self-confidence and professionalism may produce risk situations. Conclusion: Listen carefully to patients and relatives can help to identify quality shortcomings in advanced home care, to prevent risk situations and to develop patient-centered safety concepts for this particular setting.

Types and patterns of safety concerns in home care: client and family caregiver perspectives.

Drawing on interviews with home care clients and their family caregivers, we sought to understand how these individuals conceptualize safety in the provision and receipt of home care, how they promote safety in the home space and how their safety concerns differ from those of home support workers. In-depth, semi-structured interviews were conducted with clients and family caregivers. The analysis included topic and analytical coding of participants' verbatim accounts. Interviews were completed in British Columbia, Canada. Totally 82 clients and 55 caregivers participated. Clients and family caregivers identified three types of safety concerns: physical, spatial and interpersonal. These concerns are largely multi-dimensional and intersectional. We present a conceptual model of client and caregiver safety concerns. We also examine the factors that intensify and mitigate safety concerns in the home. In spite of safety concerns, clients and family caregivers overwhelmingly prefer to receive care in the home setting. Spatial and physical concerns are the most salient. The financial burden of creating a safe care space should not be the client's alone to bear. The conceptualization and promotion of safety in home care must recognize the roles, responsibilities and perspectives of all of the actors involved, including workers, clients and their caregivers.

Seniors managing multiple medications: using mixed methods to view the home care safety lens.

BackgroundPatient safety is a national and international priority with medication safety earmarked as both a prevalent and high-risk area of concern. To date, medication safety research has focused overwhelmingly on institutional based care provided by paid healthcare professionals, which often has little applicability to the home care setting. This critical gap in our current understanding of medication safety in the home care sector is particularly evident with the elderly who often manage more than one chronic illness and a complex palette of medications, along with other care needs. This study addresses the medication management issues faced by seniors with chronic illnesses, their family, caregivers, and paid providers within Canadian publicly funded home care programs in Alberta (AB), Ontario (ON), Quebec (QC) and Nova Scotia (NS).MethodsInformed by a socio-ecological perspective, this study utilized Interpretive Description (ID) methodology and participatory photographic methods to capture and analyze a range of visual and textual data. Three successive phases of data collection and analysis were conducted in a concurrent, iterative fashion in eight urban and/or rural households in each province. A total of 94 participants (i.e., seniors receiving home care services, their family/caregivers, and paid providers) were interviewed individually. In addition, 69 providers took part in focus groups. Analysis was iterative and concurrent with data collection in that each interview was compared with subsequent interviews for converging as well as diverging patterns.ResultsSix patterns were identified that provide a rich portrayal of the complexity of medication management safety in home care: vulnerabilities that impact the safe management and storage of medication, sustaining adequate supports, degrees of shared accountability for care, systems of variable effectiveness, poly-literacy required to navigate the system, and systemic challenges to maintaining medication safety in the home.ConclusionsThere is a need for policy makers, health system leaders, care providers, researchers, and educators to work with home care clients and caregivers on three key messages for improvement: adapt care delivery models to the home care landscape; develop a palette of user-centered tools to support medication safety in the home; and strengthen health systems integration.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1193-5) contains supplementary material, which is available to authorized users.

Ethics and safety in home care: perspectives on home support workers.

Home support workers (HSWs) encounter unique safety issues in their provision of home care. These issues raise ethical concerns, affecting the care workers provide to seniors and other recipients. This paper is derived from a subproject of a larger Canada-wide study, Safety at Home: A Pan-Canadian Home Care Safety Study, released in June 2013 by the Canadian Patient Safety Institute. Semi-structured, face-to-face, audiotaped interviews were conducted with providers, clients and informal caregivers in British Columbia, Manitoba and New Brunswick to better understand their perceptions of patient safety in home care. Using the BC data only, we then compared our findings to findings of other BC studies focusing on safety in home care that were conducted over the past decade. Through our interviews and comparative analyses it became clear that HSWs experienced significant inequities in providing home care. Utilizing a model depicting concerns of and for HSWs developed by Craven and colleagues (2012), we were able to illustrate the physical, spatial, interpersonal and temporal concerns set in the context of system design that emphasized the ethical dilemmas of HSWs in home care. Our data suggested the necessity of adding a fifth domain, organizational (system design). In this paper, we issue a call for stronger advocacy for home care and improved collaboration and resource equity between institutional care and community care.