scholarly journals Identifying no-harm incidents in home healthcare: a cohort study using trigger tool methodology

2020 ◽  
Author(s):  
Marléne Lindblad ◽  
Maria Unbeck ◽  
Lena Nilsson ◽  
Kristina Schildmeijer ◽  
Mirjam Ekstedt
Keyword(s):  
Patient Safety ◽  
Medication Management ◽  
Home Healthcare ◽  
Moderate Pain ◽  
Trigger Tool ◽  
System Failures ◽  
Sources Of Knowledge ◽  
Safety Work ◽  
Risk Areas ◽  
Record Review

Abstract Background Patient safety in home healthcare is largely unexplored. No-harm incidents may give valuable information about risk areas and system failures as a source for proactive patient safety work. We hypothesized that it would be feasible to retrospectively identify no-harm incidents and thus aimed to explore the cumulative incidence, preventability, types, and potential contributing causes of no-harm incidents that affected adult patients admitted to home Healthcare. Methods A structured retrospective record review using a trigger tool designed for home healthcare. A random sample of 600 home healthcare records from ten different organizations across Sweden was reviewed. Results In the study, 40,735 days were reviewed. In all, 313 no-harm incidents affected 177 (29.5%) patients; of these, 198 (63.2%) no-harm incidents, in 127 (21.2%) patients, were considered preventable. The most common no-harm incident types were “fall without harm,” “deficiencies in medication management,” and “moderate pain.” The type “deficiencies in medication management” was deemed to have a preventability rate twice as high as those of “fall without harm” and “moderate pain.” The most common potential contributing cause was “deficiencies in nursing care and treatment, i.e., delayed, erroneous, omitted or incomplete treatment or care.” Conclusion This study suggests that it is feasible to identify no-harm incidents and potential contributing causes such as omission of care using record review with a trigger tool adapted to the context. No-harm incidents and potential contributing causes are valuable sources of knowledge for improving patient safety, as they highlight system failures and indicate risks before an adverse event reach the patient.

scholarly journals Identifying no-harm incidents in home healthcare: a cohort study using trigger tool methodology

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Marléne Lindblad ◽  
Maria Unbeck ◽  
Lena Nilsson ◽  
Kristina Schildmeijer ◽  
Mirjam Ekstedt
Keyword(s):  
Patient Safety ◽  
Medication Management ◽  
Home Healthcare ◽  
Moderate Pain ◽  
Trigger Tool ◽  
System Failures ◽  
Sources Of Knowledge ◽  
Safety Work ◽  
Risk Areas ◽  
Record Review

Abstract Background Patient safety in home healthcare is largely unexplored. No-harm incidents may give valuable information about risk areas and system failures as a source for proactive patient safety work. We hypothesized that it would be feasible to retrospectively identify no-harm incidents and thus aimed to explore the cumulative incidence, preventability, types, and potential contributing causes of no-harm incidents that affected adult patients admitted to home healthcare. Methods A structured retrospective record review using a trigger tool designed for home healthcare. A random sample of 600 home healthcare records from ten different organizations across Sweden was reviewed. Results In the study, 40,735 days were reviewed. In all, 313 no-harm incidents affected 177 (29.5%) patients; of these, 198 (63.2%) no-harm incidents, in 127 (21.2%) patients, were considered preventable. The most common no-harm incident types were “fall without harm,” “deficiencies in medication management,” and “moderate pain.” The type “deficiencies in medication management” was deemed to have a preventability rate twice as high as those of “fall without harm” and “moderate pain.” The most common potential contributing cause was “deficiencies in nursing care and treatment, i.e., delayed, erroneous, omitted or incomplete treatment or care.” Conclusion This study suggests that it is feasible to identify no-harm incidents and potential contributing causes such as omission of care using record review with a trigger tool adapted to the context. No-harm incidents and potential contributing causes are valuable sources of knowledge for improving patient safety, as they highlight system failures and indicate risks before an adverse event reach the patient.

scholarly journals Identifying no-harm incidents in home healthcare: a cohort study using trigger tool methodology

2020 ◽  
Author(s):  
Marléne Lindblad ◽  
Maria Unbeck ◽  
Lena Nilsson ◽  
Kristina Schildmeijer ◽  
Mirjam Ekstedt
Keyword(s):  
Patient Safety ◽  
Medication Management ◽  
Home Healthcare ◽  
Moderate Pain ◽  
Trigger Tool ◽  
System Failures ◽  
Sources Of Knowledge ◽  
Safety Work ◽  
Risk Areas ◽  
Record Review

Abstract Background Patient safety in home healthcare is largely unexplored. No-harm incidents may give valuable information about risk areas and system failures as a source for proactive patient safety work. We hypothesized that it would be feasible to retrospectively identify no-harm incidents and thus aimed to explore the cumulative incidence, preventability, types, and potential contributing causes of no-harm incidents that affected adult patients admitted to home healthcare.Methods A structured retrospective record review using a trigger tool designed for home healthcare. A random sample of 600 home healthcare records from ten different organizations across Sweden was reviewed. Results In the study, 40,735 days were reviewed. In all, 313 no-harm incidents affected 177 (29.5%) patients; of these, 198 (63.2%) no-harm incidents, in 127 (21.2%) patients, were considered preventable. The most common no-harm incident types were “fall without harm,” “deficiencies in medication management,” and “moderate pain.” The type “deficiencies in medication management” was deemed to have a preventability rate twice as high as those of “fall without harm” and “moderate pain.” The most common potential contributing cause was “deficiencies in nursing care and treatment, i.e., delayed, erroneous, omitted or incomplete treatment or care.” Conclusion This study suggests that it is feasible to identify no-harm incidents and potential contributing causes such as omission of care using record review with a trigger tool adapted to the context. No-harm incidents and potential contributing causes are valuable sources of knowledge for improving patient safety, as they highlight system failures and indicate risks before an adverse event reach the patient.

scholarly journals Identifying no-harm incidents in home healthcare: a cohort study using trigger tool methodology

2019 ◽  
Author(s):  
Marléne Lindblad ◽  
Maria Unbeck ◽  
Lena Nilsson ◽  
Kristina Schildmeijer ◽  
Mirjam Ekstedt
Keyword(s):  
Patient Safety ◽  
Medication Management ◽  
Home Healthcare ◽  
Moderate Pain ◽  
Trigger Tool ◽  
System Failures ◽  
Retrospective Record Review ◽  
Safety Work ◽  
Risk Areas ◽  
Record Review

Abstract Background Patient safety in home healthcare is largely unexplored. No-harm incidents may give valuable information about risk areas and system failures as a source for proactive patient safety work. We hypothesized that it would be feasible to retrospectively identify no-harm incidents and thus aimed to explore the cumulative incidence, preventability, types, and potential contributing causes of no-harm incidents that affected adult patients admitted to home Healthcare. Methods A structured retrospective record review using a trigger tool designed for home healthcare. A random sample of 600 home healthcare records from ten different organizations across Sweden was reviewed. Results In the study, 40,735 days were reviewed. In all, 313 no-harm incidents affected 177 (29.5%) patients; of these, 198 (63.2%) no-harm incidents, in 127 (21.2%) patients, were considered preventable. The most common no-harm incident types were “fall without harm,” “deficiencies in medication management,” and “moderate pain.” The type“deficiencies in medication management” was deemed to have a preventability rate twice as high as those of “fall without harm” and “moderate pain.” The most common potential contributing cause was “deficiencies in nursing care and treatment, i.e., delayed, erroneous, omitted or incomplete treatment or care.” Conclusion This study suggests that it is feasible to identify no-harm incidents and potential contributing causes such as omission of care using record review with a trigger tool adapted to the context. No-harm incidents and potential contributing causes are valuable sources of knowledge for improving patient safety, as they highlight system failures and indicate risks before an adverse event reach the patient. Keywords No-harm incident, Trigger tool, Retrospective record review, Home healthcare, Patient safety

scholarly journals Adverse events in patients in home healthcare: a retrospective record review using trigger tool methodology

BMJ Open ◽  
2018 ◽  
Vol 8 (1) ◽  
pp. e019267 ◽  
Author(s):  
Kristina Görel Ingegerd Schildmeijer ◽  
Maria Unbeck ◽  
Mirjam Ekstedt ◽  
Marléne Lindblad ◽  
Lena Nilsson
Keyword(s):  
Adverse Events ◽  
Interprofessional Collaboration ◽  
Home Healthcare ◽  
Secondary Outcome ◽  
Healthcare Associated Infections ◽  
Trigger Tool ◽  
Retrospective Record Review ◽  
Future Studies ◽  
Healthcare Associated ◽  
Record Review

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.

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

2017 ◽  
Vol 27 (7) ◽  
pp. 502-511 ◽  
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.

scholarly journals Incidence of adverse events in Sweden during 2013–2016: a cohort study describing the implementation of a national trigger tool

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e020833 ◽  
Author(s):  
Lena Nilsson ◽  
Madeleine Borgstedt-Risberg ◽  
Michael Soop ◽  
Urban Nylén ◽  
Carina Ålenius ◽  
...  
Keyword(s):  
Patient Safety ◽  
Cohort Study ◽  
Adverse Events ◽  
Secondary Outcome ◽  
Trigger Tool ◽  
Retrospective Record Review ◽  
Medical Needs ◽  
Bladder Distention ◽  
National Patient ◽  
Record Review

ObjectivesTo describe the implementation of a trigger tool in Sweden and present the national incidence of adverse events (AEs) over a 4-year period during which an ongoing national patient safety initiative was terminated.DesignCohort study using retrospective record review based on a trigger tool methodology.Setting and participantsPatients ≥18 years admitted to all somatic acute care hospitals in Sweden from 2013 to 2016 were randomised into the study.Primary and secondary outcome measuresPrimary outcome measure was the incidence of AEs, and secondary measures were type of injury, severity of harm, preventability of AEs, estimated healthcare cost of AEs and incidence of AEs in patients cared for in another type of unit than the one specialised for their medical needs (‘off-site’).ResultsIn a review of 64 917 admissions, the average AE rates in 2014 (11.6%), 2015 (10.9%) and 2016 (11.4%) were significantly lower than in 2013 (13.1%). The decrease in the AE rates was seen in different age groups, in both genders and for preventable and non-preventable AEs. The decrease comprised only the least severe AEs. The types of AEs that decreased were hospital-acquired infections, urinary bladder distention and compromised vital signs. Patients cared for ‘off-site’ had 84% more preventable AEs than patients cared for in the appropriate units. The cost of increased length of stay associated with preventable AEs corresponded to 13%–14% of the total cost of somatic hospital care in Sweden.ConclusionsThe rate of AEs in Swedish somatic hospitals has decreased from 2013 to 2016. Retrospective record review can be used to monitor patient safety over time, to assess the effects of national patient safety interventions and analyse challenges to patient safety such as the increasing care of patients ‘off-site’. It was found that the economic burden of preventable AEs is high.

scholarly journals Retrospective record review in proactive patient safety work – identification of no-harm incidents

2013 ◽  
Vol 13 (1) ◽  
Author(s):  
Kristina Schildmeijer ◽  
Maria Unbeck ◽  
Olav Muren ◽  
Joep Perk ◽  
Karin Pukk Härenstam ◽  
...  
Keyword(s):  
Patient Safety ◽  
Retrospective Record Review ◽  
Safety Work ◽  
Record Review

Improving visiting nurses’ post-hospital medication management

2018 ◽  
Vol 26 (1) ◽  
pp. 65-76 ◽  
Author(s):  
Mette Kollerup ◽  
Tine Curtis ◽  
Birgitte Schantz Laursen
Keyword(s):  
Patient Safety ◽  
Local Development ◽  
Medication Management ◽  
Daily Practice ◽  
Participatory Approach ◽  
Home Healthcare ◽  
Continuous Assessment ◽  
Care Needs ◽  
Content Type ◽  
Visiting Nurses

Purpose Employing a participatory approach, the purpose of this paper is to identify possible areas for improvement in visiting nurses’ post-hospital medication management and to facilitate suggestions for changes in future practices. Design/methodology/approach Based on a previous study on visiting nurses’ post-hospital medication management, two workshops were conducted in a visiting nurse department in a Danish municipality. Findings The visiting nurses emphasised knowledge of patients’ basic needs and prioritised their performance of context-specific nursing assessments, with a preventive focus as a prerequisite for improved patient safety in post-hospital medication management. Research limitations/implications The participatory approach can increase the acceptability and feasibility of changes regarding future practices and thereby reduce the gap between official documents and daily practice. Although the local development of suggestions for changes in practices does not provide general knowledge, a subsequent detailed description of the changes in practices can promote transferability to other healthcare settings after local adjustments are made. Practical implications Flexible home healthcare, with stable relationships enabling the continuous assessment of the patient’s needs and symptoms, along with subsequent adjustments being made in care and medical treatment, might enhance patient safety in post-hospital medication management. Originality/value This paper adds to the knowledge of the need for integrated care in medication management in patients’ homes. It argues for primary healthcare professionals as “experts in complexity” and suggests a reconsideration of the purchaser-provider division of care to patients with unstable health conditions and complex care needs during the first days following hospital discharge.

scholarly journals Global Trigger Tool methodology to detect adverse events: pilot study at Academic Hospital of Udine

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
E Scarpis ◽  
S Degan ◽  
D De Corti ◽  
F Mellace ◽  
R Cocconi ◽  
...  
Keyword(s):  
Patient Safety ◽  
Adverse Events ◽  
Academic Hospital ◽  
Trigger Tool ◽  
Hospital Acquired Infections ◽  
Frequent Type ◽  
Global Trigger Tool ◽  
Clinical Records ◽  
Hospital Acquired ◽  
Over Time

Abstract Introduction Identification and measurement of adverse events (AEs) is crucial for patient safety in order to monitor them over time and to implement quality improvement programs, testing if they are effective. Global Trigger Tool (GTT) has been proposed as a low-cost method, being also the most effective to detect AEs. This study aims to describe the number of triggers, the rate and level of AEs identified by GTT and the most frequent type of AE. Methods The Italian version of the GTT was used. Ten paper-based clinical records (CRs) randomly selected every 2 weeks were reviewed from January to April 2019 by three independent reviewers (two nurses, one doctor) at the Academic Hospital of Udine. The AEs rates calculated are: AEs per 1,000 patient-days, AEs per 100 admissions, percentage of admissions with an AE. AEs were classified by harm levels according to National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP). Results CRs reviewed were 80. Mean age of the patients was 69.3±16.4, women were 37.5%. Mean hospitalisation was 16.8±15.3. Nine were the cases of re-hospitalisation within 30 days (11.3%). The total number of trigger was 156. AEs were 31, with at least one AE on 27.5% of admissions, 38.8 AEs per 100 admissions and 23 AEs per 1,000 patient-days. AEs with harm level E, F and H were respectively 5 (16.1%), 24 (77.4%) and 2 (6.5%). The most frequent type of AE were hospital acquired infections with 15 cases (48.4%). Conclusions The most frequent type of AE was the hospital acquired infections. Rates and levels of AEs were higher than other international studies, probably because of the limited number of CRs reviewed. Key messages Global Trigger Tool is an effective method to detect adverse patient safety events in order to monitor them over time. The most frequent type of adverse events was the hospital acquired infections.

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