Adverse events experienced by homecare patients: A scoping review of the literature

Centre for Health Services and Policy Research, Queen's University, Kingston, ONT, Canada.
International Journal for Quality in Health Care (Impact Factor: 1.76). 02/2010; 22(2):115-25. DOI: 10.1093/intqhc/mzq003
Source: PubMed


The paper summarizes the results of a scoping review that focused on the occurrence of adverse events experienced by homecare patients.
The literature search covered published and grey literature between 1998 and 2007. Databases searched included: MEDLINE, EMBASE, CINAHL and EBM REVIEWS including the Cochrane Library, AGELINE, the National Patient Safety Foundation Bibliography, Agency for Healthcare Research and Quality and the Patient Safety Net bibliography.
Papers included research studies, review articles, policy papers, opinion articles and legal briefs. Inclusion criteria were: (i) homecare directed services provided in the home by healthcare professionals or caregivers; (ii) addressed a characteristic relevant to patient experienced adverse events (e.g. occurrences, rates, definitions, prevention or outcomes); and (iii) were in English. Data extraction A pool of 1007 articles was reduced to 168 after analysis. Data were charted according to six categories: definitions, rates, causes, consequences, interventions and policy.
Eight categories emerged: adverse drug events, line-related, technology-related, infections and urinary catheters, wounds, falls, studies reporting multiple rates and other. Reported overall rates of adverse events ranged from 3.5 to 15.1% with higher rates for specific types. Few intervention studies were found. Adverse events were commonly associated with communication problems. Policy suggestions included the need to improve assessments, monitoring, education, coordination and communication.
A standardized definition of adverse events in the homecare setting is needed. Prospective cohort studies are needed to improve estimates and intervention studies should be undertaken to reduce the risk that homecare patients will experience adverse events.

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    • "r . Among the possible patient safety indica tors , the authors ' decided to focus on pressure ulcers , infec tions , falls , medication errors , and medical care adverse event rates . These indicators have been identified by others as useful in evaluating quality of nursing home programs ( Hartmann , Meterko , Zhao , Palmer , & Berlowitz , 2013 ; Masotti et al . , 2010 ) . Due to the high prevalence of psychi atric illness among Veterans , high rates of psychotropic use in CLCs ( Harvey , Currie , Furman , & Mambourg , 2014 ; Gellad et al . , 2012 ) , and qualitative data suggesting that anxiety , depression , and self - injurious behaviors lessen"
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    ABSTRACT: Purpose of the study: This study compares hospitalization rates for common conditions in the Veteran Affairs (VA) Medical Foster Home (MFH) program to VA nursing homes, known as Community Living Centers (CLCs). Design and methods: We matched 817 MFH residents to 3 CLC residents selected from a pool of 325,031 CLC residents. CLC and MFH cases were matched on (a) baseline time period, (b) follow-up time period, (c) age, (d) gender, (e) race, (f) risk of mortality calculated from comorbidities, and (g) history of hospitalization for the selected condition during the baseline period. Odds ratio (OR) and related confidence interval (CI) were calculated to contrast MFH cases and matched CLC controls. Results: Compared with matched CLC cases, MFH residents were less likely to be hospitalized for adverse care events, (OR = 0.13, 95% CI = 0.03-0.53), anxiety disorders (OR = 0.52, 95% CI = 0.33-0.80), mood disorders (OR = 0.57, 95% CI = 0.42-0.79), skin infections (OR = 0.22, 95% CI = 0.10-0.51), pressure ulcers (OR = 0.22, 95% CI = 0.09-0.50) and bacterial infections other than tuberculosis or septicemia (OR = 0.54, 95% CI = 0.31-0.92). MFH cases and matched CLC controls did not differ in rates of urinary tract infections, pneumonia, septicemia, suicide/self-injury, falls, other injury besides falls, history of injury, delirium/dementia/cognitive impairments, or adverse drug events. Hospitalization rates were not higher for any conditions studied in the MFH cohort compared with the CLC cohort. Implications: MFH participants had the same or lower rates of hospitalizations for conditions examined compared with CLC controls suggesting that noninstitutional care by a nonfamilial caregiver does not increase hospitalization rates for common medical conditions.
    Full-text · Article · Sep 2015 · The Gerontologist
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    • "New falls (11%), unintended weight loss (9%), new emergency department visits (7%), and new hospital visits (8%) were the most common adverse events and outcomes reported in a third study in Canada (Doran et al. 2009). In one scoping review of adverse events experienced by home care clients, the authors reported overall rates of 3.5 –15.1% (Masotti et al. 2010). Adverse drug events, infections, wounds and falls were the types of events identified. "
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    ABSTRACT: This paper explores the policies and practices that are needed to improve the safety of home care in light of the most recent evidence about home care safety in Canada. Four areas for policy and practice change are addressed: 1) the promotion of effective communication processes in home care through cross-sector collaboration, case management and technology innovations; 2) screening for safety risk factors; 3) standardizing care processes, packaging and equipment; and 4) supporting family/caregivers and strengthening clients' ability to engage in therapeutic self-care. Evidence-based strategies for change are presented within the context of the evidence about home care safety issues. Copyright © 2014 Longwoods Publishing.
    Full-text · Article · Oct 2014 · Healthcare quarterly (Toronto, Ont.)
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    • "Adverse drug events, infections, wounds, and falls were the types of events identified. Policy suggestions from that review addressed the need for improved assessment, better monitoring, education strategies, and improved coordination and communication between partners in the provision of care [8]. In Canada, one of the first HC patient safety studies reported a 5.5% incidence rate of harmful incidents and/or adverse outcomes in a sample of 279 Winnipeg HC clients. "
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    ABSTRACT: Home care (HC) is a critical component of the ongoing restructuring of healthcare in Canada. It impacts three dimensions of healthcare delivery: primary healthcare, chronic disease management, and aging at home strategies. The purpose of our study is to investigate a significant safety dimension of HC, the occurrence of adverse events and their related outcomes. The study reports on the incidence of HC adverse events, the magnitude of the events, the types of events that occur, and the consequences experienced by HC clients in the province of Ontario. A retrospective cohort design was used, utilizing comprehensive secondary databases available for Ontario HC clients from the years 2008 and 2009. The data were derived from the Canadian Home Care Reporting System, the Hospital Discharge Abstract Database, the National Ambulatory Care Reporting System, the Ontario Mental Health Reporting System, and the Continuing Care Reporting System. Descriptive analysis was used to identify the type and frequency of the adverse events recorded and the consequences of the events. Logistic regression analysis was used to examine the association between the events and their consequences. The study found that the incident rate for adverse events for the HC clients included in the cohort was 13%. The most frequent adverse events identified in the databases were injurious falls, injuries from other than a fall, and medication-related incidents. With respect to outcomes, we determined that an injurious fall was associated with a significant increase in the odds of a client requiring long-term-care facility admission and of client death. We further determined that three types of events, delirium, sepsis, and medication-related incidents were associated directly with an increase in the odds of client death. Our study concludes that 13% of clients in homecare experience an adverse event annually. We also determined that an injurious fall was the most frequent of the adverse events and was associated with increased admission to long-term care or death. We recommend the use of tools that are presently available in Canada, such as the Resident Assessment Instrument and its Clinical Assessment Protocols, for assessing and mitigating the risk of an adverse event occurring.
    Full-text · Article · Jun 2013 · BMC Health Services Research
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