What’s New in the
Patient Safety World
August 2018
IHI on Safety of
Care in the Home
IHI (Institute for Healthcare Improvement) just published an excellent report/monograph “No Place Like Home: Advancing the Safety of Care in the Home” (IHI 2018). It identifies some of the unique issues that apply to care in the home setting. Much is based on a previous IHI report “Patient Safety in the Home: Assessment of Issues, Challenges, and Opportunities” (Carpenter 2017).
They identify the following factors that make safe care in the home especially challenging:
- The provision of care outside the controlled environment of the health care system
- Issues with communication and care coordination among the care team, the care recipient, and the family caregiver
- The need to balance autonomy and risk
- The closeness of the link between the care recipient and those providing care
- The limited health literacy of the care recipient and the family caregiver
- Variable availability of data
- Social and physical isolation
- The variety of needs and populations
They identify risks specific to care in the home and the potential harms associated with those risks, which often have underlying causes that are interrelated:
- Adverse events related to medication and other forms of treatment
- Injuries due to physical hazards in the home (e.g., falls)
- Injuries related to equipment and technology
- Pressure injuries
- Infections
- Conditions related to poor nutrition
- Adverse effects on family caregivers
- Adverse effects on home care workers
- Potential neglect and abuse of care recipients
The report provides
recommendations, strategies, and tools for realizing five guiding principles:
- Principle 1: Self-determination and person-centered care are fundamental
to all aspects of care in the home setting.
- Principle 2: Every organization providing care in the home must
create and maintain a safety culture.
- Principle 3: A robust learning and improvement system is necessary
to achieve and sustain gains in safety.
- Principle 4: Effective team-based care and care coordination are
critical to safety in the home setting.
- Principle 5: Policies and funding models must incentivize the
provision of high-quality, coordinated care in the home and avoid
perpetuating care fragmentation related to payment.
We encourage you to go to the IHI website and download the full report(s). As usual, IHI has done an excellent job of summarizing some of the challenges in yet another healthcare setting.
We also hope you’ll go back to our August 13, 2013 Patient Safety Tip of the Week “Adverse Events in Home Care” that summarized the findings of several excellent Canadian studies on patient safety issues in the home setting.
Some of our prior columns on patient safety issues in the home:
- April 12, 2011 “Medication Issues in the Ambulatory Setting”
- May 7, 2013 “Drug Errors in the Home”
- August 13, 2013 “Adverse Events in Home Care”
- September 16, 2014 “Focus on Home Care”
- August 2016 “Home Infusion Therapy Pitfalls”
References:
IHI (Institute for Healthcare Improvement). No Place Like Home: Advancing the Safety of Care in the Home. IHI 2018
Carpenter D, Famolaro T, Hassell S, et al. Patient Safety in the Home: Assessment of Issues, Challenges, and Opportunities. Cambridge, Massachusetts: Institute for Healthcare Improvement; August 2017
http://www.ihi.org/resources/Pages/Publications/Patient-Safety-in-the-Home.aspx
http://www.patientsafetysolutions.com/