With an estimated 1.4 million Canadians receiving publicly funded home care services annually, the Safety at Home: Pan-Canadian Home Care Study found that approximately 10 to 13 percent of home care clients experienced an adverse event annually and over 50 percent of those incidents are preventable. The most common types of harm noted were injuries from falls, medication-related incidents and infections.
Dr. Diane Doran (University of Toronto, Lawrence S. Bloomberg Faculty of Nursing/Nurse Researcher) and Dr. Régis Blais (Faculty of Medicine and School of Public Health, University of Montréal) co-Leads of the Safety at Home study, worked collaboratively with an interdisciplinary team of researchers and key stakeholders from across Canada to develop recommendations to improve home care safety.
“While the contents of the report focus on the aspects of home care delivery that need reform and improvement, it is important to recognize the impressive contributions of all those who are engaged in providing quality care to hundreds of thousands of Canadians,” says Dr. Doran. “The breadth and depth of the study barely scratch the surface and much work needs to be done to advance home care safety. We are now working with supporting organizations to share what we have learned and garner support and input to address risk factors identified in the study.”
The study utilized multi-faceted methodologies to provide a comprehensive understanding of the nature and burden of safety problems among Canadians who received publically-funded home care services. The methodologies used to estimate the rate of harmful incidents in Canadian home care clients were chart/incident report review and analysis of administrative data.
In the analysis of medication and fall-related incidents, four overarching themes emerged: inconsistency in the way care is planned and delivered in home care; lack of integration of home care teams and coordination across healthcare sectors; poor standardization of care processes; packaging of medication and equipment selection; and client and caregivers making risky decisions.
Focus groups and interviews with clients, caregivers and providers identified six factors that affected safety: doing what it takes to stay at home; duty creep and losses and how roles of the client and caregiver change; rationing oxygen leads to rationing living; the unacknowledged challenge of taking care to the home; system design issues that have built-in barriers to safe care; and the shared decay of health for client and caregiver.
Denise Clayton’s 11-year-old daughter has complex health issues and has relied on home care services since birth; the family has experienced caregiver fatigue first hand. “Continuity of care is so important when your child is fragile and vulnerable,” says Clayton. “You need to consistently break down barriers and use all of the resources at hand. You can’t give up. Our hope is that this study will signal changes that will provide families with the support that they really do need.”
A number of recommendations have been made to further the study’s ground-breaking work that will inform policy, practice and management, including the following:
Assign each home care client a cross-sector case manager with the authority and responsibility required to ensure the planning and delivery of a consistent quality of safe care;
Offer unpaid caregivers training, ongoing support, counseling and health assessments;
Build integrated, interdisciplinary healthcare teams, involving clients and their caregivers, to ensure continuity of care delivery across all healthcare sectors, with particular attention to clients discharged from hospital to home care.
Explore opportunities for increased collaboration between home care and institutional care;
Standardize medication packaging, equipment selection;
Implement a common electronic chart accessible by all caregivers from all sectors to standardize communication among disciplines and across sectors and expand the use of electronic reporting and communication tools.
Develop and standardize policies regarding the process and timing for risk assessment to ensure that changes in risk are flagged and followed-up. (Tools that already exist in Canada such as the Resident Assessment Instrument and its Clinical Assessment Protocols could be useful for assessing risk and guiding care.)
Lift restrictions on the supply of portable oxygen tanks for clients with Chronic Obstructive Pulmonary Disease (COPD).
Implement policies and procedures to safely manage medication in the home care setting;
Develop standard competencies for home support workers.
The $1 million Safety at Home study is the first of its kind in Canada and internationally. Additional funding of $200,000 was allocated for knowledge transfer and to develop the tools and resources necessary to help policymakers, frontline workers and families advance safety in home care.
“Work has begun with Accreditation Canada on home care standards and competencies and with the Canadian Patient Safety Institute, the Canadian Home Care Association and others to work collaboratively on knowledge translation,” says Dr. Doran. “I am hopeful that our work will effect change in the way services are delivered to ensure safety for all home care clients.”
To access the full study, click here, or visit www.patientsafetyinstitute.ca and select Research.
The Safety at Home study was funded by the Canadian Patient Safety Institute and sponsoring organizations – the Canadian Institute of Health Research (CIHR) (including the Institutes of Health Services and Policy Research (IHSPR), the Institute of Aging, and the Circulatory and Respiratory Foundation), the Canadian Foundation for Healthcare Improvement (CFHI) and the Change Foundation.