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Approach to Improving Safety
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Search results for "Health Care Executives and Administrators"

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Journal Article > Study

Medicines management, medication errors and adverse medication events in older people referred to a community nursing service: a retrospective observational study.

Elliott RA, Lee CY, Beanland C, Vakil K, Goeman D. Drugs Real World Outcomes. 2016;3:13-24.

Medication management is known to be especially high-risk for older adults. This study of older patients receiving home care services found polypharmacy, insufficient medication communication, and frequent errors in self-administration. These results emphasize the need to improve medication safety for older adults in community settings.

Journal Article > Review

Safety risks associated with physical interactions between patients and caregivers during treatment and care delivery in home care settings: a systematic review.

Hignett S, Edmunds Otter M, Keen C. Int J Nurs Stud. 2016;59:1-14.

Adverse events are thought to be common in patients receiving home health care. This systematic review defined home care safety risks for both patients and caregivers, including awkward working positions, social distractions, abuse and violence, and other issues that are relatively unique to this care setting.

Newspaper/Magazine Article

Unverified patient-reported error: a false alarm can have real consequences.

ISMP Medication Safety Alert! Acute Care Edition. November 20, 2014;19:1-3.

Reviewing an incident involving a patient who reported an error with home infusion of chemotherapy which was later determined to be a false alarm, this newsletter article outlines actions that could have been taken to prevent wasted resources and anxiety for the patient and health care providers.

Newspaper/Magazine Article

ISMP Canada identifies themes associated with fatal medication events in the home.

ISMP Medication Safety Alert! Acute Care Edition. February 27, 2014;19:1-4.

Summarizing results from a Canadian study to determine factors associated with fatal medication errors in the home, this newsletter article describes how patients and nonprofessional caregivers lacked understanding about their medication, such as potential adverse effects and signs of toxicity, which increased risk of harm.

Journal Article > Study

Safety for home care: the use of Internet video calls to double-check interventions.

Bradford N, Armfield NR, Young J, Ehmer M, Smith AC. J Telemed Telecare. 2012;18:434-437.

Home care nurses successfully used mobile Internet video calls to double-check medication administrations and ventilator settings within patients' homes.

Journal Article > Study

Patient safety incidents in hospice care: observations from interdisciplinary case conferences.

Oliver DP, Demiris G, Wittenberg-Lyles E, Gage A, Dewsnap-Dreisinger ML, Luetkemeyer J. J Palliat Med. 2013;16:1561-1567.

The number of patients receiving home hospice services is growing, and this descriptive study found that medication errors and falls appear to be among the prominent patient safety concerns in such patients.

Journal Article > Review

Safety in home care: a mapping review of the international literature.

Harrison MB, Keeping-Burke L, Godfrey CM, et al. Int J Evid Based Healthc. 2013;11:148-160.

This review found that there is little descriptive research to determine the prevalence of adverse events in home care and limited interventional research to evaluate risk reduction strategies.

Journal Article > Study

Assessing adverse events among home care clients in three Canadian provinces using chart review.

Blais R, Sears NA, Doran D, Baker GR, Macdonald M, Mitchell L, Thalès S. BMJ Qual Saf. 2013;22:989-997.

Adverse events are thought to be common in patients receiving home health care, but few high-quality studies address this issue. This prospective cohort study found that 1 in 10 home care patients experienced an adverse event each year, and more than half of these events were considered preventable.

Journal Article > Review

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

Macdonald MT, Lang A, Storch J, et al. BMC Health Serv Res. 2013;13:191.

This study found that the World Health Organization's International Classification for Patient Safety generally applies to the home care setting, but it overlooks some critical aspects of safety that are unique to this environment.

Journal Article > Study

Medication administration errors for older people in long-term residential care.

Szczepura A, Wild D, Nelson S. BMC Geriatr. 2011;11:82.

Data from a barcode medication administration (BCMA) system revealed that over a 3-month period, half of the residents of long-term care facilities were exposed to potentially serious medication errors. The BCMA system appeared to be very effective at intercepting these errors.

Journal Article > Study

Patient safety culture in home care: experiences of home-care nurses.

Berland A, Holm AL, Gundersen D, Bentsen SB. J Nurs Manag. 2012;20:794-801.

Adverse events are common among patients receiving home care. In this focus group study, home-care nurses identified poor management support as a major barrier to their ability to provide safer care.

Journal Article > Commentary

Chemotherapy in home care: one team's performance improvement journey toward reducing medication errors.

Ewen BM, Combs R, Popelas C, Faraone GM. Home Healthc Nurse. 2012;30:28-37.

This commentary describes how a medication administration error launched one organization's efforts to improve patient safety statewide.

Journal Article > Study

Safer care at home: use of simulation training to improve standards.

Unsworth J, Tuffnell C, Platt A. Br J Community Nurs. 2011;16:334-339.

This pilot project used simulated patient scenarios to educate nurses around triage and management of home care patients, focusing on clinical decision-making for acute problems.

Book/Report

The Role of Human Factors in Home Health Care: Workshop Summary.

Olson S. Committee on the Role of Human Factors in Home Healthcare, National Research Council. Washington, DC: National Academies Press; 2010.

This publication summarizes content from a 2009 AHRQ-funded workshop that explored the effect of behavior and human factors on home health care quality and safety.

Journal Article > Commentary

HomeNet: ensuring patient safety with medical device use in the home.

Kaufman D, Weick-Brady M. Home Healthc Nurse. 2009;27:300-307.

This article surveys the main concerns in using medical devices at home and focuses on two initiatives by the US Center for Devices and Radiologic Health that help home health care workers report medical device failures and near misses.

Journal Article > Commentary

Safety in home care: a broadened perspective of patient safety.

Lang A, Edwards N, Fleiszer A. Int J Qual Health Care. 2008;20:130-135.

This commentary addresses the trend to provide more complex care in the home and discusses the research gap regarding safety in this environment.

Journal Article > Study

Delineation of risk through the exploration of a culture of safety in community home health.

Stevenson L, McRae C, Mughal WA. Home Health Care Manag Pract. 2007;19:460-463.

This study developed a chart review tool to better assess the risks facing community-based patients and discovered that the most frequent risks identified were mobility, fall prevention, and medication safety.

Journal Article > Study

Caregiver perspectives on safety in home dementia care.

Lach HW, Chang YP. West J Nurs Res. 2007;29:993-1014.

This focus group study discusses the safety problems and management strategies that affect caregivers of patients with dementia.

Special or Theme Issue

Improving Patient Safety.

Home Healthc Nurse. 2007;25:145-224.

This special issue includes articles that discuss the safety of home-based medical care.

Journal Article > Study

Managing the care of patients discharged from home health: a quiet threat to patient safety?

Flynn L. Home Healthc Nurse. 2007;25:184-190.

The author found that nurses have varying degrees of confidence in their patients' ability to manage their own care safely after discharge from home health services.

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