PMID- 23828878
OWN - NLM
STAT- MEDLINE
DCOM- 20140828
LR  - 20220309
IS  - 2044-5423 (Electronic)
IS  - 2044-5415 (Print)
IS  - 2044-5415 (Linking)
VI  - 22
IP  - 12
DP  - 2013 Dec
TI  - Assessing adverse events among home care clients in three Canadian provinces 
      using chart review.
PG  - 989-97
LID - 10.1136/bmjqs-2013-002039 [doi]
AB  - 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.
FAU - Blais, Regis
AU  - Blais R
AD  - Department of Health Administration, University of Montreal, , Montreal, Quebec, 
      Canada.
FAU - Sears, Nancy A
AU  - Sears NA
FAU - Doran, Diane
AU  - Doran D
FAU - Baker, G Ross
AU  - Baker GR
FAU - Macdonald, Marilyn
AU  - Macdonald M
FAU - Mitchell, Lori
AU  - Mitchell L
FAU - Thales, Stephane
AU  - Thales S
LA  - eng
GR  - Canadian Institutes of Health Research/Canada
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20130704
PL  - England
TA  - BMJ Qual Saf
JT  - BMJ quality & safety
JID - 101546984
CIN - doi: 10.1136/bmjqs-2013-002339
MH  - Aged
MH  - Canada/epidemiology
MH  - Confidence Intervals
MH  - Home Care Services/*statistics & numerical data
MH  - Humans
MH  - Logistic Models
MH  - Medical Audit
MH  - Medical Errors/*statistics & numerical data/trends
MH  - Patient Safety
MH  - Quality of Health Care
MH  - Retrospective Studies
MH  - Wounds and Injuries/*epidemiology
PMC - PMC3888609
OTO - NOTNLM
OT  - Adverse events, epidemiology and detection
OT  - Chart review methodologies
OT  - Patient safety
EDAT- 2013/07/06 06:00
MHDA- 2014/08/29 06:00
CRDT- 2013/07/06 06:00
PHST- 2013/07/06 06:00 [entrez]
PHST- 2013/07/06 06:00 [pubmed]
PHST- 2014/08/29 06:00 [medline]
AID - bmjqs-2013-002039 [pii]
AID - 10.1136/bmjqs-2013-002039 [doi]
PST - ppublish
SO  - BMJ Qual Saf. 2013 Dec;22(12):989-97. doi: 10.1136/bmjqs-2013-002039. Epub 2013 
      Jul 4.