Nancy Sears1, G Ross Baker, Jan Barnsley, Sam Shortt. 1. Department of Health Sciences, St. Lawrence College, Room 33260, 100 Portsmouth Avenue, Kingston, ON, Canada K7L 5A6. nsears@sl.on.ca
Abstract
OBJECTIVE: Incidence of adverse events (AEs) among home care patients and preventability ratings were estimated. Risk factors, AE types and factors associated with AEs were identified. DESIGN: This study used a stratified, randomized sample of home care patients discharged in the fiscal year 2004/05. Trained nurse reviewers completed retrospective chart abstractions; charts for cases that were positive for screening criteria suggesting the presence of AEs were reviewed by trained physicians to determine the presence of and preventability of AEs. SETTING: Three publicly funded home care programs in Ontario, Canada. MAIN OUTCOME MEASURES: Prevalence and types of AEs; ratings of preventability. RESULTS: At least one screening criterion was positively identified in 286 (66.5%) of 430 cases. Physician reviewers identified 61 AEs in 55 (19.2%) of the 286 (12.8% of the 430) cases. The AE rate was 13.2 per 100 home care cases [95% confidence interval (CI): 10.4-16.6%, standard error 1.6%]. 32.7% (20 of 61 AEs) of the AEs were rated as having >50% probability of preventability; 6 deaths (10.9% of patients with an AE; 1.4% of all patients) occurred in AE-positive patients. The most common AEs were falls and adverse drug events. CONCLUSIONS: Providing health care through home care programs creates unintended harm to patients. The incidence rate of AEs of 13.2% suggests a significant number of home care patients experience AEs, one-third of which were considered preventable. Improvements in patient and informal caregiver education, skill development and clinical planning may be useful interventions to reduce AEs.
OBJECTIVE: Incidence of adverse events (AEs) among home care patients and preventability ratings were estimated. Risk factors, AE types and factors associated with AEs were identified. DESIGN: This study used a stratified, randomized sample of home care patients discharged in the fiscal year 2004/05. Trained nurse reviewers completed retrospective chart abstractions; charts for cases that were positive for screening criteria suggesting the presence of AEs were reviewed by trained physicians to determine the presence of and preventability of AEs. SETTING: Three publicly funded home care programs in Ontario, Canada. MAIN OUTCOME MEASURES: Prevalence and types of AEs; ratings of preventability. RESULTS: At least one screening criterion was positively identified in 286 (66.5%) of 430 cases. Physician reviewers identified 61 AEs in 55 (19.2%) of the 286 (12.8% of the 430) cases. The AE rate was 13.2 per 100 home care cases [95% confidence interval (CI): 10.4-16.6%, standard error 1.6%]. 32.7% (20 of 61 AEs) of the AEs were rated as having >50% probability of preventability; 6 deaths (10.9% of patients with an AE; 1.4% of all patients) occurred in AE-positive patients. The most common AEs were falls and adverse drug events. CONCLUSIONS: Providing health care through home care programs creates unintended harm to patients. The incidence rate of AEs of 13.2% suggests a significant number of home care patients experience AEs, one-third of which were considered preventable. Improvements in patient and informal caregiver education, skill development and clinical planning may be useful interventions to reduce AEs.
Authors: Diane Doran; John P Hirdes; Régis Blais; G Ross Baker; Jeff W Poss; Xiaoqiang Li; Donna Dill; Andrea Gruneir; George Heckman; Hélène Lacroix; Lori Mitchell; Maeve O'Beirne; Andrea Foebel; Nancy White; Gan Qian; Sang-Myong Nahm; Odilia Yim; Lisa Droppo; Corrine McIsaac Journal: Healthc Policy Date: 2013-08
Authors: Régis Blais; Nancy A Sears; Diane Doran; G Ross Baker; Marilyn Macdonald; Lori Mitchell; Stéphane Thalès Journal: BMJ Qual Saf Date: 2013-07-04 Impact factor: 7.035