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 = 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.