The difficulty in assuring quality improvement and patient safety in-home health care is the number of potential emergencies and hazards that can be identified at a patient’s home. Nurses need to use guidelines to improve patient safety. Root Cause Analysis, as well as other forms of analysis, is also suggested as an intervention.
Safety Processes at Worksite
During the meeting with the Safety Officer, the following problems were discussed:
- The importance of checklists and documentation
- Family members assistance and their guidance
- Management of medication
- Fall prevention.
Although checklists are often used in settings within healthcare facilities, they are equally important for home-based quality care. Shepperd et al. (2013) emphasize the importance of discharge plans not only during the patient’s hospital stay but also after it when the patient is cared for by a nurse at home. As a nurse can provide home-based care for various patients with different (or similar) conditions, it is essential to conduct a documentation check (ensure that it is the right patient and that he/she is prescribed with the right medication or provided with correct procedures). These rules may sound prosaic, but they still can significantly decrease the chance of a human error and a subsequent adverse health effect.
As family members frequently take part in caring for or at least assisting the nurse in this care for a patient, it is necessary to explain to them how they can be involved in the care to improve the safety of a patient and avoid accidents. AHRQ (2012) suggests that patients or their family members need to provide specific information about symptoms, medical problems, and health history to the physician/nurse. As for the nurse, it is crucial to explain patients in detail what tests are/will be done, why they are necessary, and how they will be done to avoid misunderstandings that could potentially compromise treatment.
Wakefield (2008) also suggests that to improve the safety and quality of care provided to patients, there is a need for an agenda that would directly target medical professionals’ education. During the meeting, the Safety Officer indicated that while guidelines for Root Cause Analysis and Failure Mode Effects Analysis do exist, they are based on issues and problems identified in hospital-based care rather than home care. The nurse aims to ask either “Why did this happen?” or “What can happen?” depending on the issue. For example, a Root Cause Analysis of an adverse drug event could help the nurse understand that the patient was not aware of the potential complications or adverse effects that an incorrect dose of the drug could produce. Thus, it is the nurse’s responsibility to educate the patient about the drug, its side effects, and the correct dosage.
Failure Mode Effects Analysis applies to patient’s falls, adverse events that can often happen, especially with elderly and frail individuals. There is evidence that various exercise programs, such as Tai Chi or balance-retraining exercises, have a positive effect on older patients and reduce the number of falls in a clinical environment (e.g., nursing homes) (Carande-Kulis, Stevens, Florence, Beattie, & Arias, 2015). As the working environment discussed in this paper is a patient’s home, one can assume that a personal trainer or group exercise with family members would be beneficial for patients and nurses alike since they could help reduce falls and subsequent injuries.
To advocate for quality improvement processes at the clinical setting, Titler (2008) suggests that change champions are necessary as they can translate their passion for innovation to others and provide necessary information to the staff to support change. Furthermore, they can also help medical professionals adopt practices aimed at reducing the number of serious safety events when providing both hospital-based and home care.
To ensure patient safety and integrate successful processes into the working environment, Sollecito and Johnson (2013) suggest focusing on this safety, providing evidence-based management, and checking whether nurses are educated about the problem. Nurses need to ask themselves: How can I prevent it? Without evidence and analysis, safety and quality of care will be insufficient.
AHRQ. (2012). Be more involved in your health care. Web.
Carande-Kulis, V., Stevens, J. A., Florence, C. S., Beattie, B. L., & Arias, I. (2015). A cost–benefit analysis of three older adult fall prevention interventions. Journal of Safety Research, 52(2), 65-70.
Shepperd, S., Lannin, N. A., Clemson, L. M., McCluskey, A., Cameron, I. D., & Barras, S. L. (2013). Discharge planning from hospital to home. Cochrane Database Syst Rev, 1(1), 1-60.
Sollecito, W. A., & Johnson, J. K. (2013). Continuous quality improvement in health care (4th ed.). Burlington, MA: Jones & Bartlett Learning.
Titler, M. (2008). The evidence for evidence-based practice implementation. In R.G. Hughes (Ed.), Patient safety and quality: An evidence-based handbook for nurses (pp. 113-140). Rockville, MD: Agency for Healthcare Research and Quality (US).
Wakefield, M. (2008). The quality chasm series: Implications for nursing. In R.G. Hughes (Ed.), Patient safety and quality: An evidence-based handbook for nurses (pp. 47-66). Rockville, MD: Agency for Healthcare Research and Quality (US).