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Assessing adverse events among home care clients in three Canadian provinces using chart review
OBJECTIVES: The objectives of this study were to document the incidence rate and types of adverse events (AEs) among home care (HC) clients in Canada; identify factors contributing to these AEs; and determine to what extent evidence of completion of incident reports were documented in charts where A...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2013
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3888609/ https://www.ncbi.nlm.nih.gov/pubmed/23828878 http://dx.doi.org/10.1136/bmjqs-2013-002039 |
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author | Blais, Régis Sears, Nancy A Doran, Diane Baker, G Ross Macdonald, Marilyn Mitchell, Lori Thalès, Stéphane |
author_facet | Blais, Régis Sears, Nancy A Doran, Diane Baker, G Ross Macdonald, Marilyn Mitchell, Lori Thalès, Stéphane |
author_sort | Blais, Régis |
collection | PubMed |
description | OBJECTIVES: The objectives of this study were to document the incidence rate and types of adverse events (AEs) among home care (HC) clients in Canada; identify factors contributing to these AEs; and determine to what extent evidence of completion of incident reports were documented in charts where AEs were found. METHODS: This was a retrospective cohort study based on expert chart review of a random sample of 1200 charts of clients discharged in fiscal year 2009–2010 from publicly funded HC programmes in Manitoba, Quebec and Nova Scotia, Canada. RESULTS: The results show that 4.2% (95% CI 3.0% to 5.4%) of HC patients discharged in a 12-month period experienced an AE. Adjusting to account for clients with lengths of stay in HC of less than 1 year, the AE incidence rate per client-year was 10.1% (95% CI 8.4% to 11.8%); 56% of AEs were judged preventable. The most frequent AEs were injuries from falls, wound infections, psychosocial, behavioural or mental health problems and adverse outcomes from medication errors. More comorbid conditions (OR 1.15; 95% CI 1.05 to 1.26) and a lower instrumental activities of daily living score (OR 1.54; 95% CI 1.16 to 2.04) were associated with a higher risk of experiencing an AE. Clients’ decisions or actions contributed to 48.4% of AEs, informal caregivers 20.4% of AEs, and healthcare personnel 46.2% of AEs. Only 17.3% of charts with an AE contained documentation that indicated an incident report was completed, while 4.8% of charts without an AE had such documentation. CONCLUSIONS: Client safety is an important issue in HC, as it is in institutionalised care. HC includes the planned delivery of self-care by clients and care provision by family, friends and other individuals often described as ‘informal’ caregivers. As clients and these caregivers can contribute to the occurrence of AEs, their involvement in the delivery of healthcare interventions at home must be considered when planning strategies to improve HC safety. |
format | Online Article Text |
id | pubmed-3888609 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-38886092014-01-14 Assessing adverse events among home care clients in three Canadian provinces using chart review Blais, Régis Sears, Nancy A Doran, Diane Baker, G Ross Macdonald, Marilyn Mitchell, Lori Thalès, Stéphane BMJ Qual Saf Original Research OBJECTIVES: The objectives of this study were to document the incidence rate and types of adverse events (AEs) among home care (HC) clients in Canada; identify factors contributing to these AEs; and determine to what extent evidence of completion of incident reports were documented in charts where AEs were found. METHODS: This was a retrospective cohort study based on expert chart review of a random sample of 1200 charts of clients discharged in fiscal year 2009–2010 from publicly funded HC programmes in Manitoba, Quebec and Nova Scotia, Canada. RESULTS: The results show that 4.2% (95% CI 3.0% to 5.4%) of HC patients discharged in a 12-month period experienced an AE. Adjusting to account for clients with lengths of stay in HC of less than 1 year, the AE incidence rate per client-year was 10.1% (95% CI 8.4% to 11.8%); 56% of AEs were judged preventable. The most frequent AEs were injuries from falls, wound infections, psychosocial, behavioural or mental health problems and adverse outcomes from medication errors. More comorbid conditions (OR 1.15; 95% CI 1.05 to 1.26) and a lower instrumental activities of daily living score (OR 1.54; 95% CI 1.16 to 2.04) were associated with a higher risk of experiencing an AE. Clients’ decisions or actions contributed to 48.4% of AEs, informal caregivers 20.4% of AEs, and healthcare personnel 46.2% of AEs. Only 17.3% of charts with an AE contained documentation that indicated an incident report was completed, while 4.8% of charts without an AE had such documentation. CONCLUSIONS: Client safety is an important issue in HC, as it is in institutionalised care. HC includes the planned delivery of self-care by clients and care provision by family, friends and other individuals often described as ‘informal’ caregivers. As clients and these caregivers can contribute to the occurrence of AEs, their involvement in the delivery of healthcare interventions at home must be considered when planning strategies to improve HC safety. BMJ Publishing Group 2013-12 2013-07-04 /pmc/articles/PMC3888609/ /pubmed/23828878 http://dx.doi.org/10.1136/bmjqs-2013-002039 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/ |
spellingShingle | Original Research Blais, Régis Sears, Nancy A Doran, Diane Baker, G Ross Macdonald, Marilyn Mitchell, Lori Thalès, Stéphane Assessing adverse events among home care clients in three Canadian provinces using chart review |
title | Assessing adverse events among home care clients in three Canadian provinces using chart review |
title_full | Assessing adverse events among home care clients in three Canadian provinces using chart review |
title_fullStr | Assessing adverse events among home care clients in three Canadian provinces using chart review |
title_full_unstemmed | Assessing adverse events among home care clients in three Canadian provinces using chart review |
title_short | Assessing adverse events among home care clients in three Canadian provinces using chart review |
title_sort | assessing adverse events among home care clients in three canadian provinces using chart review |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3888609/ https://www.ncbi.nlm.nih.gov/pubmed/23828878 http://dx.doi.org/10.1136/bmjqs-2013-002039 |
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