Home care: more than just a visiting nurse

Romagnoli KM, Handler SM, Hochheiser H.  Home care: more than just a visiting nurse.  BMJ Quality & Safety. doi:10.1136/bmjqs-2013-002339.  Aug. 2013 PMID: 23940375 [PubMed in process]

When patients leave the hospital and return home with home nursing care, they go from highly supportive medical environments with potentially many physicians, nurses, aides and other professionals, to non-medical environments with formal and informal caregiver support frequently supplemented by visits from home care nurses. Patients and caregivers must struggle to absorb confusing and potentially contradictory information imparted both by multiple clinicians prior to discharge from the hospital and by home care nurses. Providers, for their part, often have incomplete understandings of home environments and patient and caregiver capabilities. Despite these difficulties, patients are largely left to themselves, expected to be engaged in their care sufficiently to own and manage their medical conditions. It is a daunting task.

Patient safety at home is as important as patient safety in hospitals. Unsafe conditions in the home can lead to unnecessary or avoidable hospitalisations.1 Home care decreases costs, improves health outcomes, and reduces hospital stays.2–8 Despite these benefits, problems exist. Around 13% of patients enrolled in home care experience an adverse event.9 ,10 The largest proportion of adverse events that occur among home care patients are related to medications, with 20–33% experiencing a medication problem or adverse drug event.11 ,12 Research has found that home care personnel and informal caregivers may play a role in a substantial subset of adverse events that result in hospitalisation,13 although further investigation is needed to understand the nature of the interaction. Insufficient attention to effective communication during transitional care from hospital to home may be one of the factors contributing to these patterns.1 ,14

Relatively little attention has been paid to the underlying causes of these adverse events and how they might be prevented. Our literature search revealed a limited number of published manuscripts in this domain compared to other settings. To prevent hospital readmissions, improve patient outcomes and save money, more attention must be paid to home care safety.

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