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Assessing adverse events among home care clients in three Canadian provinces using chart review
  1. Régis Blais1,
  2. Nancy A Sears2,
  3. Diane Doran3,
  4. G Ross Baker4,
  5. Marilyn Macdonald5,
  6. Lori Mitchell6,
  7. Stéphane Thalès7
  1. 1Department of Health Administration, University of Montreal, Montréal, Québec, Canada
  2. 2Department of Health Sciences, St Lawrence College, Kingston, Ontario, Canada
  3. 3Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
  4. 4Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  5. 5School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
  6. 6Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
  7. 7Institut de recherche en santé publique, University of Montreal, Montréal, Quebec, Canada
  1. Correspondence to Dr Régis Blais, Department of Health Administration, University of Montreal, PO Box 6128, Station Centre-ville, Montréal, QC, Canada H3C 3J7; regis.blais{at}umontreal.ca

Abstract

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.

  • Adverse events, epidemiology and detection
  • Patient safety
  • Chart review methodologies

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/

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