Lynn Stevenson

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

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.

Moving to a culture of safety in community home health care

Objective Community home health care workers and their clients are faced with a mixture of occupational health and safety challenges that are not typically experienced by health care providers or patients in the acute care sector. The aim of this project was to explore the concept of safety in community home health in one health care authority in British Columbia. Methods A participatory action research approach was employed to explore staff and client safety risks in this environment. In the first phase, three focus groups were held with staff (n 5 39) and the data analysed to identify themes. These were validated by additional focus groups. In the second phase, interviews were held with staff followed by chart reviews. Finally, in phase three, an interdisciplinary working group developed a risk identification tool for staff which was subsequently piloted. The exploration focused on answering the following questions: What constitutes safety in community home health care? What are the priority areas for action in relation to safety? What type of risk identification would be most helpful to community health workers to prepare them adequately to meet their clients’ and their own safety needs? Results Risk themes identified included: poor communication, acute care staff not understanding the needs of community staff, working alone, mobility, medication concerns, lack of pre-screening of clients’ homes, and community health workers accepting a high degree of risk. Conclusions Findings suggest that typical notions of safety and risk in acute care are not easily translated into the community sector, that staff and clients’ safety concerns are intertwined, and staff require better and more timely information from acute care staff when patients are discharged home.

Researching triads in home care: perceptions of safety from home care clients, their caregivers, and providers

Home care demand in Canada has more than doubled in recent years. While research related to safety in home care is growing, it lags behind that of patient safety in institutional settings. One of the gaps in the literature is the study of the perceptions of home care triads (clients, their unpaid caregivers, and paid providers). Thus, the objectives of this qualitative study were to describe the safety challenges of home care triads and to further understand the multiple dimensions of safety that contribute to or reduce safety concerns for these triads. Findings indicate that clients, unpaid caregivers, and providers struggle in the home care system. Home care models that are client centered need to be considered to provide seamless, quality, sustainable home care.

Home Care Safety Markers: A Scoping Review

Safety in home care is a new research frontier, and one in which demand for services continues to rise. A scoping review of the home care literature on chronic obstructive pulmonary disease and congestive heart failure was thus completed to identify safety markers that could serve to develop our understanding of safety in this sector. Results generated seven safety markers: (a) Home alone; (b) A fixed agenda in a foreign language; (c) Strangers in the home; (d) The butcher, the baker, the candlestick maker; (e) Medication mania; (f) Out of pocket: The cost of caring at home; and (g) My health for yours: Declining caregiver health.

Redesigning care delivery in British Columbia.

Phase 1 of this initiative was designed to examine the current state of practice in acute care and to provide administrators with research evidence for identifying areas for improvement. Data were collected through observational research using function analysis augmented by a staff survey and interviews. Data were collected from 17 acute care sites across Vancouver Island and the Mainland of British Columbia involving four health authorities.

Delineation of Risk Through the Exploration of a Culture of Safety in Community Home Health

In one large Canadian healthcare region, there was no consistent way of identifying factors impacting safety and risk in community home healthcare. A participatory action research approach was employed to explore client safety risks in this environment. Staff identified a lack of adequate information as their primary safety concern. A novel chart review tool was developed to capture baseline information regarding client risks, including frequency, context and severity. Very little documentation regarding safety was identified in the reviewed charts. The most frequent risks identified were mobility, falls prevention and medication concerns, which is consistent with the literature.

No need to grow my resumé? Mentorship and the intersection of learning between emerging and established leaders

Active ongoing learning is a foundational expectation of every healthcare leader whether at the beginning or end of their career. In order for leaders to be nimble and responsive to the ongoing changes in the healthcare environment, they must actively engage in a multiplicity of learning activities. One way of ensuring diversity of learning is for emerging and established leaders to learn together through formal or informal mentoring. This article will explore that intersection and the value add of a reciprocal mentoring relationship where mentor and mentee roles become blurred and joint learning becomes the goal. Capabilities from the LEADS in a Caring Environment framework will be drawn upon, and a challenge is suggested for experienced leaders to go beyond resumé building and invest in emerging leaders, as ultimately it is an investment in their own learning and the future.

College Members in the EXTRA Program

The Executive Training for Research Application (EXTRA) is a fellowship program designed to train health services leaders to become better decision-makers by learning how to find, assess, and interpret research-based evidence. The target audience for the EXTRA program is mid-career nurse, physician and other health service executives currently in senior leadership and management positions. The program has five core components: 1) four away-from-home residency sessions; 2) one or several “intervention” projects at the home organization, proposed when the fellow applies to the program; 3) educational activities between residency sessions; 4) network-building opportunities between faculty and other fellows throughout the program; and 5) support and activities after the program wraps up. This is what some of our College members have to say about the program.