Understanding patient safety in home care

Mention patient safety and most people think of acute care. Patient safety conjures thoughts of patients in stretchers and hospital beds as busy doctors and nurses rush around tending to the ill and reassuring anxious family members.

No doubt great strides have been made in recent years with respect to patient safety issues in acute care. Issues such as infection prevention and control, medication safety, surgical incidents, and falls have become mainstream and have captured the attention of both policy makers and the general public.

There is, however, a need for greater understanding and appreciation for patient safety issues in home care where the provision of care differs from acute care environments in many ways. These include the physical context and variability of home environments, the very crucial role of informal caregivers (including family members, friends and others who provide unpaid assistance), and the varying characteristics and needs of the clients.

Informal caregivers may provide up to 75 per cent of the care needed in the home, and they, like the home care clients they are helping, may have differing perspectives of care needs. As such, the concept of safety may vary between clients, informal care providers and formal care providers. What’s more is that the safety of the informal care providers themselves are both neither understood nor adequately addressed.

Informal caregivers are often placed in situations that can cause or exacerbate abuse, and they might feel trapped in the role without adequate resources or support and endure strains on employment and income. There are currently 900,000 Canadians receiving home care, and this growing number has significant implications on the health and safety of not only these informal caregivers, but the health and safety of those for whom they care.

In 2006, the Canadian Patient Safety Institute (CPSI) collaborated with the Victorian Order of Nurses (VON) Canada and Capital Health Edmonton to prepare a background paper examining patient safety issues for Canadian home care clients. This paper, prepared by Dr. Ariella Lang and Dr. Nancy Edwards, provided an impetus for further work on home care safety and identified that there was an urgent need for patient safety research specific to home care.

Recognizing the importance of home care safety and the lack of knowledge in this area, CPSI provided a formative team grant in the spring of 2007 for the purpose of developing and supporting a team of researchers and decision-makers who could advance home care patient safety research in Canada. The hope was “to make something happen that would not otherwise occur”. Over three years, the team  examined different aspects of safety in home care, with several presentations and publications to further knowledge and evidence.

CPSI is building on this research by providing a team of researchers $1 million to identify the scope of the patient safety challenge in home care. Co-led by Dr. Diane Doran, professor at the Faculty of Nursing at the University of Toronto, and Dr. Régis Blais, professor at the Department of Health Administration at the University of Montreal, this research is funded in partnership with the Canadian Institutes of Health Research (Institute of Health Services and Policy Research, Institute of Aging,  Institute of Musculoskeletal Health and Arthritis and Institute of Circulatory and Respiratory Health); The Change Foundation and the Canadian Health Services Research Foundation.

It is also co-funded by the Nova Scotia Health Research Foundation and the Quebec Ministry of Health and Services, and supported by a number of Canadian home care organizations, patient groups, and other important stakeholders through participation in a knowledge exchange board. The 21-member team, which includes clinicians, researchers, and policy and decision makers that have expertise in patient safety and home care services, were awarded the work after a nation-wide research competition drawing some of Canada’s leading healthcare researchers.

The two-year study entitled “Safety at Home: A Pan-Canadian Home Care Safety Study” promises to greatly improve our understanding of the prevalence, magnitude and risk of patient/client safety incidents in home care settings across Canada. The five sub-projects include an integrative international literature review, an analysis of existing data sources to determine prevalence of patient/client safety incidents in home care, a chart review and analysis of incident reports, root cause analyses for falls and medication related incidents, and interviews with care recipients and providers.

“The existing literature on the safety of home care in Canada is still vague,” says Doran. “This study, which will take place across several provinces and territories in Canada, is providing evidence about the nature of safety concerns for home care clients and their families. For example, it is developing evidence about such issues as the prevalence of injurious falls, medication related events, caregiver distress and mental health related events. It also examines variation in different types of events for subpopulations of home care clients such as those with diabetes and dementia.”

The final report will be released in January of 2013 with the aim of informing change in policy, practice and behaviour in the home care service setting.
Along with its partners, CPSI is working towards a day when patient safety in home care is given the same importance as patient safety in acute care. Together, we are committed to supporting research that generates new knowledge and that contributes to improving the safety of home care services.