The Irish National Adverse Events Study (INAES): the frequency and nature of adverse events in Irish hospitals—a retrospective record review study

ObjectiveHome healthcare is an increasingly common part of healthcare. The patients are often aged, frail and have multiple diseases, and multiple caregivers are involved in their treatment. This study explores the origin, incidence, types and preventability of adverse events (AEs) that occur in patients receiving home healthcare.DesignA study using retrospective record review and trigger tool methodology.Setting and methodsTen teams with experience of home healthcare from nine regions across Sweden reviewed home healthcare records in a two-stage procedure using 38 predefined triggers in four modules. A random sample of records from 600 patients (aged 18 years or older) receiving home healthcare during 2015 were reviewed.Primary and secondary outcome measuresThe cumulative incidence of AEs found in patients receiving home healthcare; secondary measures were origin, types, severity of harm and preventability of the AEs.ResultsThe patients were aged 20–79 years, 280 men and 320 women. The review teams identified 356 AEs in 226 (37.7%; 95% CI 33.0 to 42.8) of the home healthcare records. Of these, 255 (71.6%; 95% CI 63.2 to 80.8) were assessed as being preventable, and most (246, 69.1%; 95% CI 60.9 to 78.2) required extra healthcare visits or led to a prolonged period of healthcare. Most of the AEs (271, 76.1%; 95% CI 67.5 to 85.6) originated in home healthcare; the rest were detected during home healthcare but were related to care outside home healthcare. The most common AEs were healthcare-associated infections, falls and pressure ulcers.ConclusionsAEs in patients receiving home healthcare are common, mostly preventable and often cause temporary harm requiring extra healthcare resources. The most frequent types of AEs must be addressed and reduced through improvements in interprofessional collaboration. This is an important area for future studies.

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Cerebellar lesions are associated with TSC2 mutations in tuberous sclerosis complex: a retrospective record review study

Developmental Medicine & Child Neurology ◽

10.1111/dmcn.13499 ◽

2017 ◽

Vol 59 (10) ◽

pp. 1071-1076 ◽

Cited By ~ 8

Author(s):

Susana Boronat ◽

Elizabeth Anne Thiele ◽

Paul Caruso

Keyword(s):

Tuberous Sclerosis ◽

Tuberous Sclerosis Complex ◽

Retrospective Record Review ◽

Cerebellar Lesions ◽

Review Study ◽

Record Review

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Development of a trigger tool to identify adverse events and no-harm incidents that affect patients admitted to home healthcare

BMJ Quality & Safety ◽

10.1136/bmjqs-2017-006755 ◽

2017 ◽

Vol 27 (7) ◽

pp. 502-511 ◽

Cited By ~ 5

Author(s):

Marléne Lindblad ◽

Kristina Schildmeijer ◽

Lena Nilsson ◽

Mirjam Ekstedt ◽

Maria Unbeck

Keyword(s):

Adverse Events ◽

Inpatient Care ◽

Severe Pain ◽

Home Healthcare ◽

Psychological Pain ◽

Predictive Values ◽

Trigger Tool ◽

Retrospective Record Review ◽

Modified Delphi ◽

Record Review

BackgroundAdverse events (AEs) and no-harm incidents are common and of great concern in healthcare. A common method for identification of AEs is retrospective record review (RRR) using predefined triggers. This method has been used frequently in inpatient care, but AEs in home healthcare have not been explored to the same extent. The aim of this study was to develop a trigger tool (TT) for the identification of both AEs and no-harm incidents affecting adult patients admitted to home healthcare in Sweden, and to describe the methodology used for this development.MethodsThe TT was developed and validated in a stepwise manner, in collaboration with experts with different skills, using (1) literature review and interviews, (2) a five-round modified Delphi process, and (3) two-stage RRRs. Ten trained teams from different sites in Sweden reviewed 600 randomly selected records.ResultsIn all, triggers were found 4031 times in 518 (86.3%) records, with a mean of 6.7 (median 4, range 1–54) triggers per record with triggers. The positive predictive values (PPVs) for AEs and no-harm incidents were 25.4% and 16.3%, respectively, resulting in a PPV of 41.7% (range 0.0%–96.1% per trigger) for the total TT when using 38 triggers. The most common triggers were unplanned contact with physician and/or registered nurse, moderate/severe pain, moderate/severe worry, anxiety, suffering, existential pain and/or psychological pain. AEs were identified in 37.7% of the patients and no-harm incidents in 29.5%.ConclusionThis study shows that adapted triggers with definitions and decision support, developed to identify AEs and no-harm incidents that affect patients admitted to home healthcare, may be a valid method for safety and quality improvement work in home healthcare.

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