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Kivimäki T, Stolt M, Katajisto J, Charalambous A, Suhonen R. National registry-based data of adverse events in Finnish long-term professional homecare in 2009-2019. J Clin Nurs 2023; 32:548-557. [PMID: 35373401 DOI: 10.1111/jocn.16312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 01/17/2023]
Abstract
AIMS AND OBJECTIVES The aim of this study was to discover the nature of the adverse events in Finnish long-term professional homecare reported by professionals, and to identify the circumstances in which adverse events occur and their consequences. BACKGROUND Adverse events are incidents causing unintended and unnecessary harm to older people at home. Safety is a basic human right and a fundamental prerequisite for independent living among older people at home. Few studies have focused on both long-term professional homecare environment and the safety of older people. DESIGN The research was a descriptive registry-based study. METHODS This study consisted of adverse events (N = 61248) in Finnish public long-term professional homecare (2009-2019). Data were described using frequencies and percentages. STROBE statement checklist was chosen for reporting the study process. RESULTS By profession, practical nurses and registered nurses reported the most of adverse events (89.8%). These were either critical incidents (78.3%) or near misses (20.0%) and concerned medicine, injuries and accidents, information flow or management. Consequences for older people were usually rated from no-harm to moderate harm. For long-term professional homecare, image harm, extra financial costs, no-harm and prolonged care for older people were among the consequences. Personnel frequently observed the older people afterwards and informed older people of adverse events, yet some of actions were unknown. CONCLUSIONS Many harmful adverse events are considered harmless for older people. Sometimes this can lead to unmet care needs or missed care. The degree of harm needs to be assessed in terms of physical, mental and social health with the HaiPro reporting system for homecare. RELEVANCE TO CLINICAL PRACTICE An understanding and a comprehensive view of the situation and holistic assessment of care needs includes safety and safety risks to increase safety and feeling of safety for older people at home.
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Affiliation(s)
- Taina Kivimäki
- Department of Nursing Science, University of Turku, Turku, Finland.,Satakunta Hospital District, Pori, Finland
| | - Minna Stolt
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Jouko Katajisto
- Department of Mathematics and Statistics, University of Turku, Turku, Finland
| | - Andreas Charalambous
- Department of Nursing Science, University of Turku, Turku, Finland.,Cyprus University of Technology, Limassol, Cyprus
| | - Riitta Suhonen
- Department of Nursing Science, University of Turku, Turku, Finland.,City of Turku, Welfare Division, Turku University Hospital, Turku, Finland
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Tase A, Vadhwana B, Buckle P, Hanna GB. Usability challenges in the use of medical devices in the home environment: A systematic review of literature. APPLIED ERGONOMICS 2022; 103:103769. [PMID: 35430424 DOI: 10.1016/j.apergo.2022.103769] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Home care medical devices are the fastest-growing segment of the medical device industry with associated safety and usability challenges. Human factor studies in the home environment present many difficulties resulting in limited knowledge of device use in this setting. This systematic review aims to identify usability challenges reported directly by end-users in the home environment. METHODS A systematic review of the literature was conducted concentrating on studies involving end user reporting. Reported challenges were grouped into a) device-user, b) device use environment and c) device-user interface challenges. RESULTS 3471 studies were screened and 202 underwent full-text review. Only twelve studies had direct involvement of end users. Multiple challenges were identified, with device-user interface problems being the most common. No effective, standardised method was found to collect patient/user feedback on usability challenges in the post-market stage, leading to a knowledge gap. CONCLUSIONS This study brought together multiple usability challenges reported by individual studies. Involvement of medical device end-users in usability studies is essential and their experiences must be effectively utilised in device design.
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Boonjindasup W, Syananondh K, Somboon P, Sritippayawan S. Pediatric Home Tracheostomy Care: The Importance of Knowledge Assessment. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223211061718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Assessment of caregiver knowledge is an essential part of home healthcare education for pediatric tracheostomy care, however, there is a paucity of evidence in long term. This study aims to determine how caregiver knowledge and misconceptions, as assessed by our knowledge test, changed over a 12-month period following our educational program and whether the test score was associated with any demographics of the caregivers and children with tracheostomy. A prospective cohort study was undertaken to evaluate the knowledge at 3 timepoints after tracheostomy education: baseline (T1), 6 months (T2), and 12 months (T3). Test scores were analyzed for trend and relationship with demographics. Items for which less than 80% caregivers gave correct responses at T1 were considered common misconceptions. Fifty-four caregivers were enrolled. Out of a maximum score of 25, the median (IQR) scores were 22 (21-23), 23 (22-24), and 23 (22-25), at T1, T2, and T3, respectively. The scores at T2 and T3 were significantly higher than at T1 ( P ≤ .01). One common misconception “how to manage when suction got less secretion than expected” was found at all timepoints. Caregivers of children with >2 comorbidities scored slightly higher than those of children with 0 to 2 comorbidities ( P = .01). In conclusion, our caregivers achieved high knowledge scores which increased over the 12-month study period potentially because of repeated assessment and practical experience. Common misconceptions and a factor associated with the knowledge were also identified. These advantages highlighted the importance of knowledge assessment for quality improvement.
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Seva RR, Tan ALS, Tejero LMS, Salvacion MLDS. Multi-dimensional readiness assessment of medical devices. THEORETICAL ISSUES IN ERGONOMICS SCIENCE 2022. [DOI: 10.1080/1463922x.2022.2064934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Rosemary Ruiz Seva
- Industrial and Systems Engineering, De La Salle University, Manila, Philippines
| | - Angela Li Sin Tan
- Defence Medical and Environmental Research Institute - DSO National Laboratories, Singapore, Singapore
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Senteio C, Murdock PJ. The Efficacy of Health Information Technology in Supporting Health Equity for Black and Hispanic Patients With Chronic Diseases: Systematic Review. J Med Internet Res 2022; 24:e22124. [PMID: 35377331 PMCID: PMC9016513 DOI: 10.2196/22124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/25/2020] [Accepted: 01/23/2022] [Indexed: 12/26/2022] Open
Abstract
Background Racial inequity persists for chronic disease outcomes amid the proliferation of health information technology (HIT) designed to support patients in following recommended chronic disease self-management behaviors (ie, medication behavior, physical activity, and dietary behavior and attending follow-up appointments). Numerous interventions that use consumer-oriented HIT to support self-management have been evaluated, and some of the related literature has focused on racial minorities who experience disparate chronic disease outcomes. However, little is known about the efficacy of these interventions. Objective This study aims to conduct a systematic review of the literature that describes the efficacy of consumer-oriented HIT interventions designed to support self-management involving African American and Hispanic patients with chronic diseases. Methods We followed an a priori protocol using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-Equity 2012 Extension guidelines for systematic reviews that focus on health equity. Themes of interest included the inclusion and exclusion criteria. We identified 7 electronic databases, created search strings, and conducted the searches. We initially screened results based on titles and abstracts and then performed full-text screening. We then resolved conflicts and extracted relevant data from the included articles. Results In total, there were 27 included articles. The mean sample size was 640 (SD 209.5), and 52% (14/27) of the articles focused on African American participants, 15% (4/27) of the articles focused on Hispanic participants, and 33% (9/27) included both. Most articles addressed 3 of the 4 self-management behaviors: medication (17/27, 63%), physical activity (17/27, 63%), and diet (16/27, 59%). Only 15% (4/27) of the studies focused on follow-up appointment attendance. All the articles investigated HIT for use at home, whereas 7% (2/27) included use in the hospital. Conclusions This study addresses a key gap in research that has not sufficiently examined what technology designs and capabilities may be effective for underserved populations in promoting health behavior in concordance with recommendations.
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Affiliation(s)
- Charles Senteio
- Department of Library and Information Science, School of Communication and Information, Rutgers University, New Brunswick, NJ, United States
| | - Paul Joseph Murdock
- Division of Health Sciences Informatics, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
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6
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Towards a Better Understanding of the Sense of Safety and Security of Community-Dwelling Older Adults. The Case of the Age-Friendly City of The Hague. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073960. [PMID: 35409643 PMCID: PMC8997810 DOI: 10.3390/ijerph19073960] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 01/27/2023]
Abstract
The sense of safety and security of older people is a widely acknowledged action domain for policy and practice in age-friendly cities. Despite an extensive body of knowledge on the matter, the theory is fragmented, and a classification is lacking. Therefore, this study investigated how older people experience the sense of safety and security in an age-friendly city. A total of four focus group sessions were organised in The Hague comprising 38 older people. Based on the outcomes of the sessions, the sense of safety and security was classified into two main domains: a sense of safety and security impacted by intentional acts and negligence (for instance, burglary and violence), and a sense of safety and security impacted by non-intentional acts (for instance, incidents, making mistakes online). Both domains manifest into three separate contexts, namely the home environment, the outdoor environment and traffic and the digital environment. In the discussions with older people on these derived domains, ideas for potential improvements and priorities were also explored, which included access to information on what older people can do themselves to improve their sense of safety and security, the enforcement of rules, and continuous efforts to develop digital skills to improve safety online.
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7
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Taylor C, Mulligan K, McGraw C. Barriers and enablers to the implementation of evidence-based practice in pressure ulcer prevention and management in an integrated community care setting: A qualitative study informed by the theoretical domains framework. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:766-779. [PMID: 33662173 DOI: 10.1111/hsc.13322] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 12/08/2020] [Accepted: 01/26/2021] [Indexed: 06/12/2023]
Abstract
Pressure ulcer reduction is a healthcare priority. Good clinical guidelines have the potential to transform pressure ulcer prevention and management practices. However, evidence suggests these guidelines are inconsistently utilised. The aim of this study was to explore health practitioners' perceived barriers and enablers to the implementation of evidence-based pressure ulcer prevention and management recommendations in an integrated community care setting. The study used a qualitative exploratory design. It took place in a community Trust in London, England. Semi-structured interviews were conducted with a purposive sample of registered nurses and allied healthcare professionals (AHPs). The Theoretical Domains Framework (TDF) informed both data collection and data analysis. Analysis followed a five-step process including deductive coding of the transcripts and inductive generation of specific belief statements. Nine nurses and four AHPs took part in the study. Six TDF domains were identified as most relevant to the implementation of best practice in pressure ulcer prevention and management: Goals, Knowledge, Skills, Beliefs about capabilities, Environmental context and resources and Social influences. All participants felt it was important to prevent pressure ulcers and were motivated to do so. Key enablers to the implementation of evidence-based practice included high levels of self-reported pressure ulcer knowledge and skills (nurses), responsive community equipment provision, the introduction of novel Pressure Ulcer Implementation Facilitator roles and integrated team working. Barriers included self-reported deficits in knowledge and skills (AHPs), worries about inspecting intimate anatomical locations (AHPs), difficulties initiating conversations with patients about risk and behaviour change, high workloads and clutter in the home. Family members and mobile working solutions were identified as both enablers and barriers. Potential routes to addressing implementation challenges are identified and recommendations made for future research.
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Affiliation(s)
| | - Kathleen Mulligan
- Centre for Health Services Research, School of Health Sciences, City, University of London, and East London NHS Foundation Trust, London, UK
| | - Caroline McGraw
- Centre for Health Services Research, School of Health Sciences, City, University of London, London, UK
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8
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Sockolow PS, Bowles KH, Topaz M, Koru G, Hellesø R, O'Connor M, Bass EJ. The Time is Now: Informatics Research Opportunities in Home Health Care. Appl Clin Inform 2021; 12:100-106. [PMID: 33598906 PMCID: PMC7889426 DOI: 10.1055/s-0040-1722222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/21/2020] [Indexed: 10/22/2022] Open
Affiliation(s)
- Paulina S. Sockolow
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, United States
| | - Kathryn H. Bowles
- Department of Biobehavioral Health Science, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, United States
| | - Maxim Topaz
- Columbia University School of Nursing, Columbia University Data Science Institute, Visiting Nurse Service of New York, New York, United States
| | - Gunes Koru
- Department of Information Systems, University of Maryland Baltimore County, Baltimore, Maryland, United States
| | - Ragnhild Hellesø
- Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Melissa O'Connor
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania, United States
| | - Ellen J. Bass
- College of Nursing and Health Professions, College of Computing and Informatics, Drexel University, Philadelphia, Pennsylvania, United States
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Tollefsen S, Førland O, Deilkås ECT, Baste V, Bondevik GT. Patient Safety Culture in Norwegian Home Health Care – a study protocol. TIDSSKRIFT FOR OMSORGSFORSKNING 2020. [DOI: 10.18261/issn.2387-5984-2020-02-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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10
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Jiang KC, Mohedas I, Biks GA, Adefris M, Tadesse Adafrie T, Bekele D, Abebe Z, Kolli A, Weiner A, Davila J, Mengstu B, Bell C, Sienko KH. Assessing the Usability of a Task-Shifting Device for Inserting Subcutaneous Contraceptive Implants for Use in Low-Income Countries. J Med Device 2020. [DOI: 10.1115/1.4046092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
Women in low- and middle-income countries (LMICs) have limited access to long-acting contraceptives. Access to long-acting contraceptives, such as subcutaneous contraceptive implants, could be increased by task-shifting implant administration from advanced to minimally trained healthcare providers. The objective of this study was to investigate the usability of a task-shifting device for administering subcutaneous contraceptive implants. Healthcare providers (n = 128) from multiple health centers in Ethiopia were trained to administer implants on an arm simulator with the traditional method and a method using the device. Participants were observed while inserting implants into the arm simulator, and procedural error rates were calculated. Observations were analyzed using an iterative inductive coding methodology. For the device-assisted method, minimally trained healthcare providers had larger procedural error rates than other professions (p = 0.002). For the traditional method, physicians had larger procedural error rates than nurses and midwives (p = 0.03). Several procedural errors were identified such as participants inserting and removing the trocar and plunger completely or inserting and/or removing the trocar too far or not enough. These findings reinforce the importance of performing formative usability testing during the early phases of a medical device design process, considering users' mental models, and avoiding assumptions about healthcare providers' abilities.
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Affiliation(s)
- Kevin C. Jiang
- Department of Biomedical Engineering, University of Michigan, 1101 Beal Avenue, Ann Arbor, MI 48109
| | - Ibrahim Mohedas
- Department of Mechanical Engineering, University of Michigan, 2350 Hayward Street, Ann Arbor, MI 48109
| | - Gashaw Andargie Biks
- Department of Health Systems and Policy, Institute of Public Health, University of Gondar, P.O. Box 196, Gondar 6200, Ethiopia
| | - Mulat Adefris
- Department of Obstetrics and Gynecology, University of Gondar, P.O. Box 196, Gondar 6200, Ethiopia
| | - Takele Tadesse Adafrie
- Department of Epidemiology and Biostatistics, University of Gondar, P.O. Box 196, Gondar 6200, Ethiopia
| | - Delayehu Bekele
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, P.O. Box 1271, Gulele Addis Ababa 1000, Ethiopia
| | - Zerihun Abebe
- Office of the Provost, St. Paul's Hospital Millennium Medical College, P.O. Box 1271, Gulele Addis Ababa 1000, Ethiopia
| | - Ajay Kolli
- Medical School, University of Michigan, 1301 Catherine Street, Ann Arbor, MI 48109
| | - Annabel Weiner
- School of Information, University of Michigan, 105 South State Street, Ann Arbor, MI 48109
| | - José Davila
- Department of Psychology, University of Michigan, 530 Church Street, Ann Arbor, MI 48109
| | - Biruk Mengstu
- College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Carrie Bell
- Department of Obstetrics and Gynecology, University of Michigan, 4260 Plymouth Road, Ann Arbor, MI 48109
| | - Kathleen H. Sienko
- Department of Mechanical Engineering, University of Michigan, 2350 Hayward Street, Ann Arbor, MI 48109
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Clemente F, Faiella G, Rutoli G, Bifulco P, Romano M, Cesarelli M. Critical failures in the use of home ventilation medical equipment. Heliyon 2019; 5:e03034. [PMID: 32368632 PMCID: PMC7190690 DOI: 10.1016/j.heliyon.2019.e03034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 06/20/2019] [Accepted: 12/10/2019] [Indexed: 11/25/2022] Open
Abstract
Home ventilation involves the use of medical devices at patient's home by personnel who are not healthcare practitioners. This implies new potential risks not fully addressed by current standards and guidelines. A methodological approach to investigate potential failures and define improvement actions to address the dangerous potential situations in HV is required. A multidisciplinary team performed an extended version of Failure Mode, Effect and Criticality Analysis (FMECA) to analyse the home ventilation service provided by the Local Healthcare Unit of Naples (ASL NA1) that assisted 60 homebound ventilator dependent patients. The failures were identified in three risk areas: device, electrical system & fire hazard, and indoor air quality. The corrective actions were formulated with two extra steps: identification of critical failures with a threshold applied to the risk priority number and analysis of causes by means of contributory factors (Organization, Technology, Information, and Structure) based on Reason's theory of failures. 22 of 86 potential failures were identified as critical. Specific corrective actions were addressed and proposed through contributory factors to improve the overall quality of home ventilation service. The use of this systemic approach oriented the improvements to reduce the harms caused by vulnerabilities in high-risk care service as life support home ventilation.
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Affiliation(s)
- Fabrizio Clemente
- Institute of Cristallography, National Research Council (IC-CNR), Rome, Italy
| | | | - Gennaro Rutoli
- Biotechnology Unit - Local Healthcare Unit of Naples, ASLNA1, Naples, Italy
| | - Paolo Bifulco
- Department of Electric Engineering and Information Technologies (DIETI), School of Engineering, University of Naples Federico II, Naples, Italy
| | - Maria Romano
- Department of Experimental and Clinical Medicine (DSMC), University "Magna Graecia", Catanzaro, Italy
| | - Mario Cesarelli
- Department of Electric Engineering and Information Technologies (DIETI), School of Engineering, University of Naples Federico II, Naples, Italy
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Abstract
OBJECTIVES To describe common areas of threats to patient safety and quality of care when caregivers provide care. Recommendations for caregivers to enable them to provide safe care are included. DATA SOURCES Research-based articles and reports. CONCLUSION The literature is limited in discussion on home safety issues for caregivers. Non cancer-specific literature provides some direction for recommendations for nurses to guide caregivers. IMPLICATIONS FOR NURSING PRACTICE The home environment is an unregulated and uncontrolled site, and the safety risks families take are unknown. Professionals should assess the caregiver's knowledge and ability when providing caregiving guidance to ensure the patient is receiving safe and quality care. Nurses need to stress the importance of providing safe quality care and provide education and community resources.
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13
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Keller SC, Cosgrove SE, Arbaje AI, Chang RH, Krosche A, Williams D, Gurses AP. It's Complicated: Patient and Informal Caregiver Performance of Outpatient Parenteral Antimicrobial Therapy-Related Tasks. Am J Med Qual 2019; 35:133-146. [PMID: 31161769 PMCID: PMC6917971 DOI: 10.1177/1062860619853345] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Outpatient parenteral antimicrobial therapy (OPAT) requires patients and caregivers to infuse antimicrobials through venous catheters (VCs) in the home. The objective of this study was to perform a patient-centered goal-directed task analysis to identify what is required for successful completion of OPAT. The authors performed 40 semi-structured patient interviews and 20 observations of patients and caregivers performing OPAT-related tasks. Six overall goals were identified: (1) understanding and developing skills in OPAT, (2) receiving supplies, (3) medication administration and VC maintenance, (4) preventing VC harm while performing activities of daily living, (5) managing when hazards lead to failures, and (6) monitoring status. The authors suggest that patients and caregivers use teach-back, take formal OPAT classes, receive visual and verbal instructions, use cognitive aids, learn how to troubleshoot, and receive clear instructions to address areas of uncertainty. Addressing these goals is essential to ensuring the safety of and positive experiences for our patients.
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Affiliation(s)
- Sara C. Keller
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Alicia I. Arbaje
- Johns Hopkins University School of Medicine, Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Rachel H. Chang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Amanda Krosche
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Ayse P. Gurses
- Johns Hopkins University School of Medicine, Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Johns Hopkins Whiting School of Engineering, Johns Hopkins University, Baltimore, MD
- Carey School of Business, Baltimore, MD
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14
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Haltbakk J, Graue M, Harris J, Kirkevold M, Dunning T, Sigurdardottir AK. Integrative review: Patient safety among older people with diabetes in home care services. J Adv Nurs 2019; 75:2449-2460. [PMID: 30835874 DOI: 10.1111/jan.13993] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 11/29/2018] [Accepted: 12/21/2018] [Indexed: 12/01/2022]
Abstract
AIMS To identify diabetes specific patient safety domains that need to be addressed to improve home care of older people; to assess research from primary studies to review evidence on patient safety in home care services for older people with diabetes. DESIGN An integrative review. DATA SOURCES Domains for patient safety in diabetes home care settings were identified by conducting two searches. We performed searches in: CINAHL, Medline, Embase, and Cochrane Library for the years 2000-2017. REVIEW METHODS The first search identified frameworks or models on patient safety in home care services published up to October 2017. The second search identified primary studies about older people with diabetes in the home care setting published between 2000-2017. RESULTS Data from the 21 articles populated and refined 13 predetermined domains of patient safety in diabetes home care. These were used to explore how the domains interact to either increase or reduce risk. The domains constitute a model of associations between aspects of diabetes home care and adverse events. The results highlight a knowledge gap in safety for older persons with diabetes, influenced by e.g. hypoglycaemia, falls, pain, foot ulcers, cognitive impairment, depression, and polypharmacy. Moreover, providers' inadequate diabetes-specific knowledge and assessment skills contribute to the risk of adverse events. CONCLUSION Older persons with diabetes in home care are at risk of adverse events due to their reduced ability to self-manage their condition, adverse medication effects, the family's ability to take responsibility or home care service's suboptimal approaches to diabetes care.
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Affiliation(s)
- Johannes Haltbakk
- Department of Health- and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Marit Graue
- Department of Health- and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Centre for Evidence Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
| | - Janet Harris
- MPH in International Health Management & Leadership, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Marit Kirkevold
- Centre for Evidence Based Practice, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Trisha Dunning
- Centre for Quality and Patient Safety Research, Deakin University and Barwon Health Partnership, Geelong, Melbourne, Australia
| | - Arun K Sigurdardottir
- School of Health Sciences, University of Akureyri, Akureyri, Iceland.,Akureyri Hospital, Akureyri, Iceland
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15
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Keller SC, Cosgrove SE, Kohut M, Krosche A, Chang HE, Williams D, Gurses AP. Hazards from physical attributes of the home environment among patients on outpatient parenteral antimicrobial therapy. Am J Infect Control 2019; 47:425-430. [PMID: 30471975 PMCID: PMC6893846 DOI: 10.1016/j.ajic.2018.09.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Outpatient parenteral antimicrobial therapy (OPAT) requires that patients and their caregivers administer antimicrobial medications in the home via venous catheters. Hazards from physical attributes of the home environment may impede safe performance of OPAT tasks. METHODS We performed a qualitative study, including semistructured telephone interviews and contextual inquiries, of patients performing OPAT tasks inside the home. Eligible participants were discharged from 2 academic medical centers in Baltimore, Maryland, on OPAT. We coded interview transcripts and contextual inquiry forms based on a model of healthcare work systems. RESULTS Twenty-nine patients underwent semistructured telephone interviews, and 14 patients underwent contextual inquiry. We identified hazards including bathing, animal or pets, extremes in temperature, household clutter, indoor soil and food exposures, outdoor soil, and travel. Patients often developed strategies to mitigate these hazards. DISCUSSION Multiple hazards related to the home environment could have led to harm, and in the absence of specific guidance, patients developed strategies to mitigate these hazards. CONCLUSIONS Educational interventions to improve OPAT should incorporate an understanding of hazards that may occur in the home environment.
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Affiliation(s)
- Sara C Keller
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Sara E Cosgrove
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael Kohut
- Armstrong Institute of Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Huai-En Chang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Deborah Williams
- Department of Quality Management, Johns Hopkins Home Care Group, Baltimore, MD
| | - Ayse P Gurses
- Armstrong Institute of Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD
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Reyes P, Larée D, Weinstein A, Jara Á. Towards a conceptual model for the use of home healthcare medical devices: The multi-parameter monitor case. PLoS One 2018; 13:e0208723. [PMID: 30532224 PMCID: PMC6285365 DOI: 10.1371/journal.pone.0208723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 11/22/2018] [Indexed: 11/19/2022] Open
Abstract
In the last decade there has been an increase in the use of medical devices in the home environment. These devices are commonly the same as those used in hospitals by healthcare professionals. The use of these these devices by lay users outside of a clinical environment may become unsafe. This study presents a methodology that allows decision makers to identify potential risk situations that may arise when lay users operate healthcare medical devices at home. Through a usability study based on the Grounded Theory methodology, we create a conceptual model in which we identified problems and errors related to the use of a multi-parameter monitor in a home environment by a group of lay users. The conceptual model is reified as a graphical representation, which allows stakeholders to identify (i) the weaknesses of the device, (ii) unsafe operation modes, and (iii) the most suitable device for a specific user.
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Affiliation(s)
- Pablo Reyes
- School of Biomedical Engineering, Universidad de Valparaíso, Valparaíso, Chile
- * E-mail:
| | - Dominique Larée
- School of Biomedical Engineering, Universidad de Valparaíso, Valparaíso, Chile
| | - Alejandro Weinstein
- School of Biomedical Engineering, Universidad de Valparaíso, Valparaíso, Chile
- Advanced Center for Electrical and Electronics Engineering, Universidad Técnica Federico Santa María, Valparaíso, Chile
| | - Álvaro Jara
- School of Biomedical Engineering, Universidad de Valparaíso, Valparaíso, Chile
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Joseph A, Henriksen K, Malone E. The Architecture Of Safety: An Emerging Priority For Improving Patient Safety. Health Aff (Millwood) 2018; 37:1884-1891. [DOI: 10.1377/hlthaff.2018.0643] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Anjali Joseph
- Anjali Joseph is a professor of architecture and the Spartanburg Regional Healthcare System Endowed Chair in Architecture and Health Design, School of Architecture, Clemson University, in South Carolina
| | - Kerm Henriksen
- Kerm Henriksen is a senior adviser, Human Factors and Patient Safety, at the Agency for Healthcare Research and Quality, in Rockville, Maryland
| | - Eileen Malone
- Eileen Malone is a Realizing Improved Patient Care through Human Centered Design in the Operating Room advisory board member, School of Architecture, Clemson University
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18
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Schaepe C, Ewers M. "I see myself as part of the team" - family caregivers' contribution to safety in advanced home care. BMC Nurs 2018; 17:40. [PMID: 30220881 PMCID: PMC6137892 DOI: 10.1186/s12912-018-0308-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 08/23/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The use of medical technology and the various contributing and interdepending human factors in home care have implications for patient safety. Although family caregivers are often involved in the provision of advanced home care, there is little research on their contribution to safety. The study aims to explore family caregivers in Home Mechanical Ventilation (HMV) safety experiences and how safety is perceived by them in this context. Furthermore, it seeks to understand how family caregivers contribute to the patients' and their own safety in HMV and what kind of support they expect from their health care team. METHODS An explorative, qualitative study was applied using elements from grounded theory methodology. Data were collected through individual interviews with 15 family caregivers to patients receiving HMV in two regions in Germany. The audiotaped interviews were then subject to thematic analysis. RESULTS The findings shows that family caregivers contribute to safety in HMV by trying to foster mutual information sharing about the patient and his/her situation, coordinating informally health care services and undertaking compensation of shortcomings in HMV. CONCLUSION Consequently, family caregivers take on considerable responsibility for patient safety in advanced home care by being actively and constantly committed to safety work.Nurses working in this setting should be clinically and technically skilled and focus on building partnership relations with family caregivers. This especially encompasses negotiation about their role in care and patient safety. Support and education should be offered if needed. Only skilled nurses, who can provide safe care and who can handle critical situations should be appointed to HMV. They should also serve as professional care coordinators and provide educational interventions to strengthen family caregivers' competence.
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Affiliation(s)
- Christiane Schaepe
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Health and Nursing Science, Berlin, Germany
| | - Michael Ewers
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Health and Nursing Science, Berlin, Germany
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19
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McGraw CA. Nurses' perceptions of the root causes of community-acquired pressure ulcers: Application of the Model for Examining Safety and Quality Concerns in Home Healthcare. J Clin Nurs 2018; 28:575-588. [PMID: 30129137 DOI: 10.1111/jocn.14652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 02/01/2023]
Abstract
AIMS AND OBJECTIVES To explore how the context of care influences the development of community-acquired pressure ulcers from the perspective of nurses working in home healthcare settings, to identify and categorise the factors perceived as contributing to the development of these ulcers using the Model for Examining Safety and Quality Concerns in Home Healthcare, and to explore how these risks are managed in practice. BACKGROUND Pressure ulcer reduction is a priority in both hospital and community settings. Evidence suggests the factors affecting safety and performance in community settings are not the same as in hospital. However, research pertaining to pressure ulcer risk management has predominantly been undertaken in hospital settings. DESIGN The study was framed by a qualitative exploratory design. METHODS Semistructured interviews were conducted with a purposive sample of 19 registered nurses recruited from an independent regional tissue viability network and five community nursing provider organisations in London. RESULTS The experiences and perceptions of participants mapped onto the components of the Model for Examining Safety and Quality Concerns in Home HealthCare: patient characteristics, provider characteristics, nature of home healthcare tasks, social and community environment, medical devices and new technology, physical environment, and external environment. Four strategies to address identified risks were established: behavioural interventions, technical interventions, safeguarding interventions and initiatives to promote better integration between health, local authorities and families. CONCLUSION Understanding the complex interplay between people and other elements of the healthcare system is critical to the prevention, management and investigation of pressure ulcers. This study has illuminated these elements from the perspective of nurses working in community settings. RELEVANCE TO CLINICAL PRACTICE Further consideration should be given to the importance of place when both developing risk management strategies for pressure ulcer prevention and learning the lessons from failure.
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20
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The Feasibility of Home Palliative Care for Cancer Patients: The Perspective of Iranian Nurses. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2018. [DOI: 10.5812/ijcm.80114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Werner NE, Jolliff AF, Casper G, Martell T, Ponto K. Home is where the head is: a distributed cognition account of personal health information management in the home among those with chronic illness. ERGONOMICS 2018; 61:1065-1078. [PMID: 29402181 PMCID: PMC7909619 DOI: 10.1080/00140139.2018.1435910] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 01/23/2018] [Indexed: 06/07/2023]
Abstract
Managing chronic illness requires personal health information management (PHIM) to be performed by lay individuals. Paramount to understanding the PHIM process is understanding the sociotechnical system in which it frequently occurs: the home environment. We combined distributed cognition theory and the patient work system model to investigate how characteristics of the home interact with the cognitive work of PHIM. We used a 3D virtual reality CAVE that enabled participants who had been diagnosed with diabetes (N = 20) to describe how they would perform PHIM in the home context. We found that PHIM is distinctly cognitive work, and rarely performed 'in the head'. Rather, features of the physical environment, tasks, people, and tools and technologies present, continuously shape and are shaped by the PHIM process. We suggest that approaches in which the individual (sans context) is considered the relevant unit of analysis overlook the pivotal role of the environment in shaping PHIM. Practitioner Summary: We examined how Personal Health Information Management (PHIM) is performed in the homes of diabetic patients. We found that approaches to studying cognition that focus on the individual, to the exclusion of their context, overlook the pivotal role of environmental, social, and technological features in shaping PHIM.
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Affiliation(s)
- Nicole E. Werner
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Virtual Environments Group, Wisconsin Institutes for Discovery, Madison, WI, USA
| | - Anna F. Jolliff
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, WI, USA
| | - Gail Casper
- Virtual Environments Group, Wisconsin Institutes for Discovery, Madison, WI, USA
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Thomas Martell
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Kevin Ponto
- Virtual Environments Group, Wisconsin Institutes for Discovery, Madison, WI, USA
- School of Human Ecology, University of Wisconsin-Madison, Madison, WI, USA
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22
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Wiig S, Ree E, Johannessen T, Strømme T, Storm M, Aase I, Ullebust B, Holen-Rabbersvik E, Hurup Thomsen L, Sandvik Pedersen AT, van de Bovenkamp H, Bal R, Aase K. Improving quality and safety in nursing homes and home care: the study protocol of a mixed-methods research design to implement a leadership intervention. BMJ Open 2018; 8:e020933. [PMID: 29599394 PMCID: PMC5875614 DOI: 10.1136/bmjopen-2017-020933] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/07/2018] [Accepted: 02/20/2018] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Nursing homes and home care face challenges across different countries as people are living longer, often with chronic conditions. There is a lack of knowledge regarding implementation and impact of quality and safety interventions as most research evidence so far is generated in hospitals. Additionally, there is a lack of effective leadership tools for quality and safety improvement work in this context. METHODS AND ANALYSIS The aim of the 'Improving Quality and Safety in Primary Care-Implementing a Leadership Intervention in Nursing Homes and Homecare' (SAFE-LEAD) study is to develop and evaluate a research-based leadership guide for managers to increase quality and safety competence. The project applies a mixed-methods design and explores the implications of the leadership guide on managers' and staffs' knowledge, attitudes and practices. Four nursing homes and four home care services from different Norwegian municipalities will participate in the intervention. Surveys, process evaluation (interviews, observations) and document analyses will be conducted to evaluate the implementation and impact of the leadership intervention. A comparative study of Norway and the Netherlands will establish knowledge of the context dependency of the intervention. ETHICS AND DISSEMINATION The study is approved by the Norwegian Centre for Research Data (2017/52324 and 54855). The results will be disseminated through scientific articles, two PhD dissertations, an anthology, presentations at national and international conferences, and in social media, newsletters and in the press. The results will generate knowledge to inform leadership practices in nursing homes and home care. Moreover, the study will build new theory on leadership interventions and the role of contextual factors in nursing homes and home care.
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Affiliation(s)
- Siri Wiig
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Eline Ree
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Terese Johannessen
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Torunn Strømme
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Marianne Storm
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Ingunn Aase
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Berit Ullebust
- Center for Developing Institutional and Home Care Services Sogn and Fjordane, Førde, Norway
| | - Elisabeth Holen-Rabbersvik
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Health and Nursing Sciences, University of Agder, Kristiansand, Norway
- Songdalen Municipality, Songdalen, Norway
| | - Line Hurup Thomsen
- Center for Developing Institutional and Home Care Services Rogaland, Stavanger, Norway
| | | | | | - Roland Bal
- School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
| | - Karina Aase
- SHARE- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Abstract
An important domain of patient safety is the management of medications in home and community settings by patients and their caregiving network. This study applied human factors/ergonomics theories and methods to data about medication adherence collected from 61 patients with heart failure accompanied by 31 informal caregivers living in the US. Seventy non-adherence events were identified, described, and analysed for performance shaping factors. Half were classified as errors and half as violations. Performance shaping factors included elements of the person or team (e.g. patient limitations), task (e.g. complexity), tools and technologies (e.g. tool quality) and organisational, physical, and social context (e.g. resources, support, social influence). Study findings resulted in a dynamic systems model of medication safety applicable to patient medication adherence and the medication management process. Findings and the resulting model offer implications for future research on medication adherence, medication safety interventions, and resilience in home and community settings. Practitioner Summary: We describe situational and habitual errors and violations in medication use among older patients and their family members. Multiple factors pushed performance towards risk and harm. These factors can be the target for redesign or various forms of support, such as education, changes to the plan of care, and technology design.
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Affiliation(s)
- Robin Sue Mickelson
- a Vanderbilt School of Nursing , Vanderbilt University , Nashville , TN , USA
- b The Center for Research and Innovation in Systems Safety (CRISS) , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Richard J Holden
- c Department of BioHealth Informatics , Indiana University School of Informatics and Computing , Indianapolis , IN , USA
- d Indiana University Center for Aging Research , Regenstrief Institute, Inc. , Indianapolis , IN , USA
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24
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Gard G, Larsson A. Working conditions and workplace health and safety promotion in home care: A mixed-method study from Swedish managers' perspectives. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2017; 72:359-365. [PMID: 28095115 DOI: 10.1080/19338244.2017.1279998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 12/24/2016] [Indexed: 06/06/2023]
Abstract
Today, we can see a trend toward increased psychosocial strain at work among home-care managers and staff. The aim of this study is to describe home care managers' views on their own psychosocial working conditions and on how to promote workplace health and safety in a municipality in northern Sweden. A mixed-methods design was used, including questionnaire and qualitative focus group data. The qualitative data were analyzed by manifest content analysis. The results indicate that most managers perceived increased variety in work and opportunities for development at work, but at the same time increased demands. The managers suggested that workplace health and safety could be improved by risk assessment and improved communication, a clear communication chain by a real as well as a virtual platform for communication. In summary, workplace health and safety could be improved by risk assessments and by a physical as well as a virtual platform for communication.
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Affiliation(s)
- Gunvor Gard
- a Department of Health Sciences , Luleå University of Technology , Luleå , Sweden
- b Department of Health Sciences , Lund University , Lund , Sweden
| | - Agneta Larsson
- a Department of Health Sciences , Luleå University of Technology , Luleå , Sweden
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25
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Heiden SM, Holden RJ, Alder CA, Bodke K, Boustani M. Human factors in mental healthcare: A work system analysis of a community-based program for older adults with depression and dementia. APPLIED ERGONOMICS 2017; 64:27-40. [PMID: 28610811 PMCID: PMC5535802 DOI: 10.1016/j.apergo.2017.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 03/16/2017] [Accepted: 05/03/2017] [Indexed: 06/07/2023]
Abstract
Mental healthcare is a critical but largely unexplored application domain for human factors/ergonomics. This paper reports on a work system evaluation of a home-based dementia and depression care program for older adults, the Aging Brain Care program. The Workflow Elements Model was used to guide data collection and analysis of 59 h of observation, supplemented by key informant input. We identified four actors, 37 artifacts across seven types, ten action categories, and ten outcomes including improved health and safety. Five themes emerged regarding barriers and facilitators to care delivery in the program: the centrality of relationship building; the use of adaptive workarounds; performance of duplicate work; travel and scheduling challenges; and communication-related factors. Findings offer new insight into how mental healthcare services are delivered in a community-based program and key work-related factors shaping program outcomes.
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Affiliation(s)
- Siobhan M Heiden
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
| | - Richard J Holden
- Department of BioHealth Informatics, Indiana University School of Informatics and Computing, Indianapolis, IN, USA; Indiana University Center for Aging Research (IU CAR), Indianapolis, IN, USA.
| | - Catherine A Alder
- Indiana University Center for Aging Research (IU CAR), Indianapolis, IN, USA; Regenstrief Institute, Indianapolis, IN, USA
| | - Kunal Bodke
- Indiana University Center for Aging Research (IU CAR), Indianapolis, IN, USA; Regenstrief Institute, Indianapolis, IN, USA
| | - Malaz Boustani
- Indiana University Center for Aging Research (IU CAR), Indianapolis, IN, USA; Regenstrief Institute, Indianapolis, IN, USA; Eskenazi Health, Indianapolis, IN, USA
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26
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Tudor Car L, El-Khatib M, Perneczky R, Papachristou N, Atun R, Rudan I, Car J, Vincent C, Majeed A. Prioritizing problems in and solutions to homecare safety of people with dementia: supporting carers, streamlining care. BMC Geriatr 2017; 17:26. [PMID: 28103810 PMCID: PMC5244548 DOI: 10.1186/s12877-017-0415-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 01/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dementia care is predominantly provided by carers in home settings. We aimed to identify the priorities for homecare safety of people with dementia according to dementia health and social care professionals using a novel priority-setting method. METHODS The project steering group determined the scope, the context and the criteria for prioritization. We then invited 185 North-West London clinicians via an open-ended questionnaire to identify three main problems and solutions relating to homecare safety of people with dementia. 76 clinicians submitted their suggestions which were thematically synthesized into a composite list of 27 distinct problems and 30 solutions. A group of 49 clinicians arbitrarily selected from the initial cohort ranked the composite list of suggestions using predetermined criteria. RESULTS Inadequate education of carers of people with dementia (both family and professional) is seen as a key problem that needs addressing in addition to challenges of self-neglect, social isolation, medication nonadherence. Seven out of top 10 problems related to patients and/or carers signalling clearly where help and support are needed. The top ranked solutions focused on involvement and education of family carers, their supervision and continuing support. Several suggestions highlighted a need for improvement of recruitment, oversight and working conditions of professional carers and for different home safety-proofing strategies. CONCLUSIONS Clinicians identified a range of suggestions for improving homecare safety of people with dementia. Better equipping carers was seen as fundamental for ensuring homecare safety. Many of the identified suggestions are highly challenging and not easily changeable, yet there are also many that are feasible, affordable and could contribute to substantial improvements to dementia homecare safety.
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Affiliation(s)
- Lorainne Tudor Car
- Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Mona El-Khatib
- Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Robert Perneczky
- Neuroepidemiology and Ageing Research Unit, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
- Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany
| | - Nikolaos Papachristou
- Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, UK
| | - Igor Rudan
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Medical School, Edinburg, UK
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Charles Vincent
- Department of Experimental Psychology, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
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27
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Keller SC, Gurses AP, Werner N, Hohl D, Hughes A, Leff B, Arbaje AI. Older Adults and Management of Medical Devices in the Home: Five Requirements for Appropriate Use. Popul Health Manag 2017; 20:278-286. [PMID: 28075698 DOI: 10.1089/pop.2016.0070] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Medical devices, or instruments or tools to manage disease, are increasingly used in the home, yet there have been limited evaluations of how older adults and caregivers safely use these devices. This study concerns a qualitative evaluation of (1) barriers and facilitators of appropriate use, and (2) outcomes of inappropriate use, among older adults at the transition from hospital to home with skilled home health care (SHHC). Guided by a human factors engineering work system model, the authors (1) conducted direct observations with contextual inquiry of the start-of-care or resumption-of-care SHHC provider visit, and (2) semi-structured interviews with 24 older adults and their informal caregivers, and 39 SHHC providers and administrators. Five requirements for the appropriate use of home medical devices were identified. A systems approach integrating the hospital with the SHHC agency is needed to make the use of home medical devices safer.
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Affiliation(s)
- Sara C Keller
- 1 Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland.,2 Armstrong Institute of Patient Safety and Quality, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Ayse P Gurses
- 2 Armstrong Institute of Patient Safety and Quality, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Nicole Werner
- 3 Living Environments Laboratory, Department of Industrial and Systems Engineering, Center for Quality and Productivity Improvement, College of Engineering, Wisconsin Institutes for Discovery, University of Wisconsin-Madison , Madison, Wisconsin.,4 Geriatrics Research Education and Clinical Center , William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
| | - Dawn Hohl
- 5 Johns Hopkins Home Care Group , Baltimore, Maryland
| | - Ashley Hughes
- 6 Division of Geriatric Medicine, Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Bruce Leff
- 6 Division of Geriatric Medicine, Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland.,7 Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health , Baltimore, Maryland.,8 Department of Community and Public Health, Johns Hopkins School of Nursing , Baltimore, Maryland
| | - Alicia I Arbaje
- 6 Division of Geriatric Medicine, Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland.,9 Department of Clinical Investigation, Johns Hopkins University Bloomberg School of Public Health , Baltimore, Maryland
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28
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Holden RJ, Valdez RS, Schubert CC, Thompson MJ, Hundt AS. Macroergonomic factors in the patient work system: examining the context of patients with chronic illness. ERGONOMICS 2017; 60:26-43. [PMID: 27164171 PMCID: PMC5639913 DOI: 10.1080/00140139.2016.1168529] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Human factors/ergonomics recognises work as embedded in and shaped by levels of social, physical and organisational context. This study investigates the contextual or macroergonomic factors present in the health-related work performed by patients. We performed a secondary content analysis of findings from three studies of the work of chronically ill patients and their informal caregivers. Our resulting consolidated macroergonomic patient work system model identified 17 factors across physical, social and organisational domains and household and community levels. These factors are illustrated with examples from the three studies and discussed as having positive, negative or varying effects on health and health behaviour. We present three brief case studies to illustrate how macroergonomic factors combine across domains and levels to shape performance in expected and unexpected ways. Findings demonstrate not only the importance of context for patients' health-related activities but also specific factors to consider in future research, design and policy efforts. Practitioner Summary: Health-related activities of patients are embedded in and shaped by levels of social, physical and organisational context. This paper combined findings from three studies to specify 17 contextual or macroergonomic factors in home- and community-based work systems of chronically ill patients. These factors have research, design and policy implications.
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Affiliation(s)
- Richard J. Holden
- Indiana University School of Informatics and Computing, Indianapolis, Indiana, USA
- Corresponding author: Richard J. Holden, Walker Plaza – WK 319, 719 Indiana Avenue, Indianapolis, IN, USA 46202. . 1-317-278-5323
| | | | | | | | - Ann S. Hundt
- University of Wisconsin-Madison, Madison, Wisconsin, USA
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29
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Keller SC, Gurses AP, Arbaje AI, Cosgrove SE. Learning from the patient: Human factors engineering in outpatient parenteral antimicrobial therapy. Am J Infect Control 2016; 44:758-60. [PMID: 26944005 PMCID: PMC4930887 DOI: 10.1016/j.ajic.2016.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 01/04/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Sara C Keller
- Division of Infectious Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Ayse P Gurses
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alicia I Arbaje
- Division of Geriatric Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sara E Cosgrove
- Division of Infectious Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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30
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Lang A, Macdonald M, Marck P, Toon L, Griffin M, Easty T, Fraser K, MacKinnon N, Mitchell J, Lang E, Goodwin S. Seniors managing multiple medications: using mixed methods to view the home care safety lens. BMC Health Serv Res 2015; 15:548. [PMID: 26651331 PMCID: PMC4677040 DOI: 10.1186/s12913-015-1193-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 11/19/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Patient safety is a national and international priority with medication safety earmarked as both a prevalent and high-risk area of concern. To date, medication safety research has focused overwhelmingly on institutional based care provided by paid healthcare professionals, which often has little applicability to the home care setting. This critical gap in our current understanding of medication safety in the home care sector is particularly evident with the elderly who often manage more than one chronic illness and a complex palette of medications, along with other care needs. This study addresses the medication management issues faced by seniors with chronic illnesses, their family, caregivers, and paid providers within Canadian publicly funded home care programs in Alberta (AB), Ontario (ON), Quebec (QC) and Nova Scotia (NS). METHODS Informed by a socio-ecological perspective, this study utilized Interpretive Description (ID) methodology and participatory photographic methods to capture and analyze a range of visual and textual data. Three successive phases of data collection and analysis were conducted in a concurrent, iterative fashion in eight urban and/or rural households in each province. A total of 94 participants (i.e., seniors receiving home care services, their family/caregivers, and paid providers) were interviewed individually. In addition, 69 providers took part in focus groups. Analysis was iterative and concurrent with data collection in that each interview was compared with subsequent interviews for converging as well as diverging patterns. RESULTS Six patterns were identified that provide a rich portrayal of the complexity of medication management safety in home care: vulnerabilities that impact the safe management and storage of medication, sustaining adequate supports, degrees of shared accountability for care, systems of variable effectiveness, poly-literacy required to navigate the system, and systemic challenges to maintaining medication safety in the home. CONCLUSIONS There is a need for policy makers, health system leaders, care providers, researchers, and educators to work with home care clients and caregivers on three key messages for improvement: adapt care delivery models to the home care landscape; develop a palette of user-centered tools to support medication safety in the home; and strengthen health systems integration.
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Affiliation(s)
- Ariella Lang
- Victorian Order of Nurses (VON Canada), Ottawa, ON, Canada.
| | | | | | - Lynn Toon
- Victorian Order of Nurses (VON Canada), Ottawa, ON, Canada.
| | | | - Tony Easty
- University Health Network, Toronto, ON, Canada.
| | | | | | | | - Eddy Lang
- Alberta Health Services/University of Calgary, Calgary, AB, Canada.
| | - Sharon Goodwin
- Victorian Order of Nurses (VON Canada), Ottawa, ON, Canada.
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Lang A, Toon L, Cohen SR, Stajduhar K, Griffin M, Fleiszer AR, Easty T, Williams A. Client, caregiver, and provider perspectives of safety in palliative home care: a mixed method design. ACTA ACUST UNITED AC 2015. [DOI: 10.1186/2056-5917-1-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Holden RJ, Schubert CC, Mickelson RS. The patient work system: an analysis of self-care performance barriers among elderly heart failure patients and their informal caregivers. APPLIED ERGONOMICS 2015; 47:133-50. [PMID: 25479983 PMCID: PMC4258227 DOI: 10.1016/j.apergo.2014.09.009] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 08/15/2014] [Accepted: 09/08/2014] [Indexed: 05/09/2023]
Abstract
Human factors and ergonomics approaches have been successfully applied to study and improve the work performance of healthcare professionals. However, there has been relatively little work in "patient-engaged human factors," or the application of human factors to the health-related work of patients and other nonprofessionals. This study applied a foundational human factors tool, the systems model, to investigate the barriers to self-care performance among chronically ill elderly patients and their informal (family) caregivers. A Patient Work System model was developed to guide the collection and analysis of interviews, surveys, and observations of patients with heart failure (n = 30) and their informal caregivers (n = 14). Iterative analyses revealed the nature and prevalence of self-care barriers across components of the Patient Work System. Person-related barriers were common and stemmed from patients' biomedical conditions, limitations, knowledge deficits, preferences, and perceptions as well as the characteristics of informal caregivers and healthcare professionals. Task barriers were also highly prevalent and included task difficulty, timing, complexity, ambiguity, conflict, and undesirable consequences. Tool barriers were related to both availability and access of tools and technologies and their design, usability, and impact. Context barriers were found across three domains-physical-spatial, social-cultural, and organizational-and multiple "spaces" such as "at home," "on the go," and "in the community." Barriers often stemmed not from single factors but from the interaction of several work system components. Study findings suggest the need to further explore multiple actors, contexts, and interactions in the patient work system during research and intervention design, as well as the need to develop new models and measures for studying patient and family work.
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Affiliation(s)
- Richard J Holden
- Department of BioHealth Informatics, Indiana University School of Informatics and Computing, Indianapolis, IN, USA; Center for Health Informatics Research & Innovation (CHIRI), Indianapolis, IN, USA.
| | - Christiane C Schubert
- Department of Medical Education, Loma Linda University School of Medicine, Loma Linda, CA, USA
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Guise V, Anderson J, Wiig S. Patient safety risks associated with telecare: a systematic review and narrative synthesis of the literature. BMC Health Serv Res 2014; 14:588. [PMID: 25421823 PMCID: PMC4254014 DOI: 10.1186/s12913-014-0588-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 11/10/2014] [Indexed: 12/04/2022] Open
Abstract
Background Patient safety risk in the homecare context and patient safety risk related to telecare are both emerging research areas. Patient safety issues associated with the use of telecare in homecare services are therefore not clearly understood. It is unclear what the patient safety risks are, how patient safety issues have been investigated, and what research is still needed to provide a comprehensive picture of risks, challenges and potential harm to patients due to the implementation and use of telecare services in the home. Furthermore, it is unclear how training for telecare users has addressed patient safety issues. A systematic review of the literature was conducted to identify patient safety risks associated with telecare use in homecare services and to investigate whether and how these patient safety risks have been addressed in telecare training. Methods Six electronic databases were searched in addition to hand searches of key items, reference tracking and citation tracking. Strict inclusion and exclusion criteria were set. All included items were assessed according to set quality criteria and subjected to a narrative synthesis to organise and synthesize the findings. A human factors systems framework of patient safety was used to frame and analyse the results. Results 22 items were included in the review. 11 types of patient safety risks associated with telecare use in homecare services emerged. These are in the main related to the nature of homecare tasks and practices, and person-centred characteristics and capabilities, and to a lesser extent, problems with the technology and devices, organisational issues, and environmental factors. Training initiatives related to safe telecare use are not described in the literature. Conclusions There is a need to better identify and describe patient safety risks related to telecare services to improve understandings of how to avoid and minimize potential harm to patients. This process can be aided by reframing known telecare implementation challenges and user experiences of telecare with the help of a human factors systems approach to patient safety.
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Affiliation(s)
- Veslemøy Guise
- Department of Health Studies, University of Stavanger, Kjell Arholms gate, 4036, Stavanger, Norway.
| | - Janet Anderson
- Department of Health Studies, University of Stavanger, Kjell Arholms gate, 4036, Stavanger, Norway. .,Florence Nightingale School of Nursing and Midwifery, Kings College London, London, UK.
| | - Siri Wiig
- Department of Health Studies, University of Stavanger, Kjell Arholms gate, 4036, Stavanger, Norway.
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Xie A, Carayon P. A systematic review of human factors and ergonomics (HFE)-based healthcare system redesign for quality of care and patient safety. ERGONOMICS 2014; 58:33-49. [PMID: 25323570 PMCID: PMC4297241 DOI: 10.1080/00140139.2014.959070] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Healthcare systems need to be redesigned to provide care that is safe, effective and efficient, and meets the multiple needs of patients. This systematic review examines how human factors and ergonomics (HFE) is applied to redesign healthcare work systems and processes and improve quality and safety of care. We identified 12 projects representing 23 studies and addressing different physical, cognitive and organisational HFE issues in a variety of healthcare systems and care settings. Some evidence exists for the effectiveness of HFE-based healthcare system redesign in improving process and outcome measures of quality and safety of care. We assessed risk of bias in 16 studies reporting the impact of HFE-based healthcare system redesign and found varying quality across studies. Future research should further assess the impact of HFE on quality and safety of care, and clearly define the mechanisms by which HFE-based system redesign can improve quality and safety of care.
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Affiliation(s)
- Anping Xie
- Armstrong Institute for Patient Safety and Quality, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pascale Carayon
- Center for Quality and Productivity Improvement, Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
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Taylor E, Hignett S, Joseph A. The environment of safe care: considering building design as one facet of safety. ACTA ACUST UNITED AC 2014. [DOI: 10.1177/2327857914031020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patient safety is often considered in a behavioral context – what can someone do differently to improve outcomes? However, as a complex system of interactions, patient safety is better advanced through a systems thinking lens of human factors and ergonomics (HFE). While HFE is sometimes considered in three domains: physical, cognitive, and organizational, research in the area of the design of the physical environment is often limited to products, equipment and furnishings to accommodate a diverse population of users. With an increased focus on reimbursement related to patient safety as part of healthcare reform, organizations are becoming more aware of their own shortcomings and grappling with solutions to improve performance – typically people and processes. Yet the influence of the built environment, the space in which people work and are cared for, can act as a barrier or enhancement to achieving the desired results – physically, cognitively, and organizationally. Latent conditions of the built environment can contribute to hazards and risk within the system and using Reason’s Swiss Cheese Model can also become an additional layer of defense. A consensus-based safety risk assessment (SRA) design decision tool is being developed to address these built environment latent conditions funded through a three-year grant from the Agency for Healthcare Research and Quality (AHRQ).
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Affiliation(s)
- Ellen Taylor
- The Center for Health Design, Concord, CA, USA
- Loughborough University, Loughborough, Leicestershire, UK
| | - Sue Hignett
- Loughborough University, Loughborough, Leicestershire, UK
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Abstract
OBJECTIVE MedWatch, the Food and Drug Administration's (FDA's) nationwide adverse event reporting system, serves to monitor device performance after a medical device is approved or cleared for market. Through the MedWatch adverse event reporting system, the FDA receives Medical Device Reports of deaths and serious injuries with negative-pressure wound therapy (NPWT) systems, many of which are used in homes and in extended-care facilities. In response to reported events, this study was conducted to obtain additional information about device issues that healthcare professionals face in these settings, as well as challenges that caregivers might encounter using this technology at home. The study was exploratory and descriptive in nature. PARTICIPANTS The FDA surveyed wound care specialists and professional home healthcare providers to learn about users' experiences with NPWT. DESIGN In the first phase of the study, a semistructured questionnaire was developed for telephone interviews and self-administration. In the second phase, a web-based survey was adapted from the semistructured instrument. RESULTS Respondent concerns primarily centered on issues not directly related to the NPWT devices: NPWT prescription, provider education in addition to patient training and appropriate wound management practices, notably ongoing wound assessment, and patient monitoring. CONCLUSION Overall, respondents thought that there was a definite benefit to NPWT, regardless of the care setting, and that it was a safe therapy when prescribed and administered appropriately.
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Carayon P, Wetterneck TB, Rivera-Rodriguez AJ, Hundt AS, Hoonakker P, Holden R, Gurses AP. Human factors systems approach to healthcare quality and patient safety. APPLIED ERGONOMICS 2014; 45:14-25. [PMID: 23845724 PMCID: PMC3795965 DOI: 10.1016/j.apergo.2013.04.023] [Citation(s) in RCA: 323] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 04/24/2013] [Indexed: 05/03/2023]
Abstract
Human factors systems approaches are critical for improving healthcare quality and patient safety. The SEIPS (Systems Engineering Initiative for Patient Safety) model of work system and patient safety is a human factors systems approach that has been successfully applied in healthcare research and practice. Several research and practical applications of the SEIPS model are described. Important implications of the SEIPS model for healthcare system and process redesign are highlighted. Principles for redesigning healthcare systems using the SEIPS model are described. Balancing the work system and encouraging the active and adaptive role of workers are key principles for improving healthcare quality and patient safety.
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Affiliation(s)
- Pascale Carayon
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 1550 Engineering Drive, Madison, WI 53706, USA; Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1550 Engineering Drive, Madison, WI 53706, USA.
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Larsson A, Karlqvist L, Westerberg M, Gard G. Perceptions of health and risk management among home care workers in Sweden. PHYSICAL THERAPY REVIEWS 2013; 18:336-343. [PMID: 24078781 PMCID: PMC3779860 DOI: 10.1179/108331913x13746741513153] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Municipal home care workers provide high-quality services to an increasing proportion of elderly people living in private homes. The work environments and working conditions of these workers vary to a great extent, implying rapid priority-making among both employers and employees to ensure that the work can be performed in a safe way. Objectives: This study aims to examine home care workers’ perceptions of health, risks, working conditions, and risk management within their organization. Method: The study was based on cross-sectional data collected from home care service staff in a municipality in the north of Sweden. Nursing assistants and care aides (n = 133) replied to a self-administered questionnaire. Descriptive statistics and between-group differences were analysed. Results: Home care work was perceived to require high levels of professional skill and ingenuity, a good psychosocial work situation, but required a high physical workload. The general health, the capacity and self-efficacy of the staff in relation to work were good. Difficulty in performing risk assessments and following safety regulations due to lack of time, equipment, and information were identified. Conclusion: There is a need to increase participation in risk assessments among the staff, improve management support, structures, and cooperation with other divisions of the social services and the medical care organizations.
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Affiliation(s)
- A Larsson
- Division of Health and Rehabilitation, Department of Health Science, Luleå University of Technology, Sweden
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Lang A, Macdonald MT, Storch J, Stevenson L, Mitchell L, Barber T, Roach S, Toon L, Griffin M, Easty A, Curry CG, LaCroix H, Donaldson S, Doran D, Blais R. Researching Triads in Home Care. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2013. [DOI: 10.1177/1084822313501077] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Home care demand in Canada has more than doubled in recent years. While research related to safety in home care is growing, it lags behind that of patient safety in institutional settings. One of the gaps in the literature is the study of the perceptions of home care triads (clients, their unpaid caregivers, and paid providers). Thus, the objectives of this qualitative study were to describe the safety challenges of home care triads and to further understand the multiple dimensions of safety that contribute to or reduce safety concerns for these triads. Findings indicate that clients, unpaid caregivers, and providers struggle in the home care system. Home care models that are client centered need to be considered to provide seamless, quality, sustainable home care.
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Affiliation(s)
| | | | - Jan Storch
- University of Victoria, British Columbia, Canada
| | - Lynn Stevenson
- Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | | | - Tanya Barber
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sheri Roach
- Capital District Health Authority, Halifax, Nova Scotia, Canada
| | | | - Melissa Griffin
- Centre for Global Health Innovation, Toronto, Ontario, Canada
| | - Anthony Easty
- Centre for Global Health Innovation, Toronto, Ontario, Canada
| | | | | | - Susan Donaldson
- Canadian Home Care Association, Mississauga, Ontario, Canada
| | | | - Régis Blais
- Université de Montréal (DASUM), Montréal, Quebec, Canada
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Holden RJ, Carayon P, Gurses AP, Hoonakker P, Hundt AS, Ozok AA, Rivera-Rodriguez AJ. SEIPS 2.0: a human factors framework for studying and improving the work of healthcare professionals and patients. ERGONOMICS 2013; 56:1669-86. [PMID: 24088063 PMCID: PMC3835697 DOI: 10.1080/00140139.2013.838643] [Citation(s) in RCA: 599] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Healthcare practitioners, patient safety leaders, educators and researchers increasingly recognise the value of human factors/ergonomics and make use of the discipline's person-centred models of sociotechnical systems. This paper first reviews one of the most widely used healthcare human factors systems models, the Systems Engineering Initiative for Patient Safety (SEIPS) model, and then introduces an extended model, 'SEIPS 2.0'. SEIPS 2.0 incorporates three novel concepts into the original model: configuration, engagement and adaptation. The concept of configuration highlights the dynamic, hierarchical and interactive properties of sociotechnical systems, making it possible to depict how health-related performance is shaped at 'a moment in time'. Engagement conveys that various individuals and teams can perform health-related activities separately and collaboratively. Engaged individuals often include patients, family caregivers and other non-professionals. Adaptation is introduced as a feedback mechanism that explains how dynamic systems evolve in planned and unplanned ways. Key implications and future directions for human factors research in healthcare are discussed.
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Affiliation(s)
- Richard J. Holden
- Assistant Professor, Department of Medicine, Division of General Internal Medicine & Public Health, Department of Biomedical Informatics Vanderbilt University School of Medicine, Phone: +1-615-936-4343, Fax: +1-615-936-7373, Center for Research and Innovation in Systems Safety, 719 Medical Arts Building, 1211 21st Avenue S, Nashville, TN, 37212
| | - Pascale Carayon
- Procter & Gamble Bascom Professor in Total Quality, Department of Industrial and Systems Engineering, Director of the Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 3126 Engineering Centers Building, 1550 Engineering Drive, Madison, WI 53706 - USA, tel: +1-608-265-0503 or +1-608-263-2520, fax: +1-608-263-1425
| | - Ayse P. Gurses
- Associate Professor, Armstrong Institute for Patient Safety and Quality, Department of Anesthesiology and Critical Care Medicine, Division of Health Sciences Informatics, School of Medicine, Department of Health Policy and Management, Bloomberg School of Public Health, Department of Civil Engineering, Whiting School of Engineering, The Johns Hopkins University, 750 E. Pratt St. 15Floor, Baltimore, MD 21202, Phone: +1-410-637-4387
| | - Peter Hoonakker
- Research Scientist and Associate Director of Research, Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 3132 Engineering Centers Building, 1550 Engineering Drive, Madison, WI 53706 – USA, Phone: +1-608-658 0837, Fax: +1-608-263-1425
| | - Ann Schoofs Hundt
- Associate Scientist and Associate Director of Education, Center for Quality and Productivity Improvement, University of Wisconsin-Madison, 3132 Engineering Centers Building, 1550 Engineering Drive, Madison, WI 53706 – USA, Phone: +1-608-262-9100, Fax: +1-608-263-1425
| | - A. Ant Ozok
- Associate Professor, Department of Information Systems, UMBC, Adjunct Associate Professor, Department of Anesthesiology, Visiting Associate Professor, The Armstrong Institute of Patient Safety and Quality, School of Medicine, The Johns Hopkins University, 1000 Hilltop Circle, Baltimore, MD 21250, Phone : +1-410-455-8627, Fax : +1-410-455-1073
| | - A. Joy Rivera-Rodriguez
- Assistant Professor, Department of Industrial Engineering, Clemson University, Phone: +1-864-656-3114, Fax: +1-864-656-0795, 130-C Freeman Hall, Box 340920 Clemson, SC 29631
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Holden RJ, Mickelson RS. Performance barriers among elderly chronic heart failure patients. ACTA ACUST UNITED AC 2013. [DOI: 10.1177/1541931213571166] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Applications of the human factors and ergonomics (HFE) approach in the healthcare domain have largely targeted the work of healthcare professionals. Here, we argue for the importance of targeting the work of patients and their lay caregivers, a relatively underdeveloped approach we call patient-engaged HFE. A multi-method study of the barriers to the self-care work of elderly chronic heart failure patients (N=27) and caregivers (N=11) illustrates the approach. Analyses of interview data using a macroergonomic Work System framework revealed a large variety of barriers unique to patient work as well as to CHF self-care. The most common person-related barriers were physical limitations and knowledge gaps. Task-related barriers included medication complexity and side-effects. Tool and technology barriers included lack of or overdependence on aids. Context barriers were organizational (e.g., no indoor gyms), social (e.g., sodiumrich food culture), and physical-environmental (e.g., stairs). Findings motivate further applying HFE concepts and methods (e.g., workload, decision support, distributed cognition, resilience) to patient work.
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Carayon P, Karsh BT, Gurses AP, Holden R, Hoonakker P, Hundt AS, Montague E, Rodriguez J, Wetterneck TB. Macroergonomics in Healthcare Quality and Patient Safety. REVIEW OF HUMAN FACTORS AND ERGONOMICS 2013; 8:4-54. [PMID: 24729777 PMCID: PMC3981462 DOI: 10.1177/1557234x13492976] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The US Institute of Medicine and healthcare experts have called for new approaches to manage healthcare quality problems. In this chapter, we focus on macroergonomics, a branch of human factors and ergonomics that is based on the systems approach and considers the organizational and sociotechnical context of work activities and processes. Selected macroergonomic approaches to healthcare quality and patient safety are described such as the SEIPS model of work system and patient safety and the model of healthcare professional performance. Focused reviews on job stress and burnout, workload, interruptions, patient-centered care, health IT and medical devices, violations, and care coordination provide examples of macroergonomics contributions to healthcare quality and patient safety. Healthcare systems and processes clearly need to be systematically redesigned; examples of macroergonomic approaches, principles and methods for healthcare system redesign are described. Further research linking macroergonomics and care processes/patient outcomes is needed. Other needs for macroergonomics research are highlighted, including understanding the link between worker outcomes (e.g., safety and well-being) and patient outcomes (e.g., patient safety), and macroergonomics of patient-centered care and care coordination.
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Affiliation(s)
- Pascale Carayon
- University of Wisconsin-Madison. Johns Hopkins University. Northwestern University. Clemson University. Vanderbilt University
| | - Ben-Tzion Karsh
- University of Wisconsin-Madison. Johns Hopkins University. Northwestern University. Clemson University. Vanderbilt University
| | - Ayse P Gurses
- University of Wisconsin-Madison. Johns Hopkins University. Northwestern University. Clemson University. Vanderbilt University
| | - Richard Holden
- University of Wisconsin-Madison. Johns Hopkins University. Northwestern University. Clemson University. Vanderbilt University
| | - Peter Hoonakker
- University of Wisconsin-Madison. Johns Hopkins University. Northwestern University. Clemson University. Vanderbilt University
| | - Ann Schoofs Hundt
- University of Wisconsin-Madison. Johns Hopkins University. Northwestern University. Clemson University. Vanderbilt University
| | - Enid Montague
- University of Wisconsin-Madison. Johns Hopkins University. Northwestern University. Clemson University. Vanderbilt University
| | - Joy Rodriguez
- University of Wisconsin-Madison. Johns Hopkins University. Northwestern University. Clemson University. Vanderbilt University
| | - Tosha B Wetterneck
- University of Wisconsin-Madison. Johns Hopkins University. Northwestern University. Clemson University. Vanderbilt University
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Harrison MB, Keeping-Burke L, Godfrey CM, Ross-White A, McVeety J, Donaldson V, Blais R, Doran DM. Safety in home care: a mapping review of the international literature. INT J EVID-BASED HEA 2013. [DOI: 10.1111/1744-1609.12027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Currie L. Review: Registered nurses’ collective safety organising behaviours: the association with perceptions of patient safety culture. J Res Nurs 2013. [DOI: 10.1177/1744987112462509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Lynne Currie
- Project Manager: Evaluating & Improving (Patient Safety, Measurement), Quality Standards & Innovation Unit, Royal College of Nursing, UK
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45
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Wibberley G. The problems of a ‘dirty workplace’ in domiciliary care. Health Place 2013; 21:156-62. [DOI: 10.1016/j.healthplace.2013.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 01/08/2013] [Accepted: 01/10/2013] [Indexed: 10/27/2022]
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Sittig DF, Singh H. A new sociotechnical model for studying health information technology in complex adaptive healthcare systems. Qual Saf Health Care 2013; 19 Suppl 3:i68-74. [PMID: 20959322 DOI: 10.1136/qshc.2010.042085] [Citation(s) in RCA: 380] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Conceptual models have been developed to address challenges inherent in studying health information technology (HIT). METHOD This manuscript introduces an eight-dimensional model specifically designed to address the sociotechnical challenges involved in design, development, implementation, use and evaluation of HIT within complex adaptive healthcare systems. DISCUSSION The eight dimensions are not independent, sequential or hierarchical, but rather are interdependent and inter-related concepts similar to compositions of other complex adaptive systems. Hardware and software computing infrastructure refers to equipment and software used to power, support and operate clinical applications and devices. Clinical content refers to textual or numeric data and images that constitute the 'language' of clinical applications. The human--computer interface includes all aspects of the computer that users can see, touch or hear as they interact with it. People refers to everyone who interacts in some way with the system, from developer to end user, including potential patient-users. Workflow and communication are the processes or steps involved in ensuring that patient care tasks are carried out effectively. Two additional dimensions of the model are internal organisational features (eg, policies, procedures and culture) and external rules and regulations, both of which may facilitate or constrain many aspects of the preceding dimensions. The final dimension is measurement and monitoring, which refers to the process of measuring and evaluating both intended and unintended consequences of HIT implementation and use. We illustrate how our model has been successfully applied in real-world complex adaptive settings to understand and improve HIT applications at various stages of development and implementation.
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Affiliation(s)
- Dean F Sittig
- UT-Memorial Hermann Center for Healthcare Quality & Safety, University of Texas School of Biomedical Informatics at Houston, 6410 Fannin St UTPB 1100.43, Houston, TX 77030, USA.
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Gershon RRM, Dailey M, Magda LA, Riley HEM, Conolly J, Silver A. Safety in the home healthcare sector: development of a new household safety checklist. J Patient Saf 2012; 8:51-9. [PMID: 22543362 DOI: 10.1097/pts.0b013e31824a4ad6] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Unsafe household conditions could adversely affect safety and quality in home health care. However, risk identification tools and procedures that can be readily implemented in this setting are lacking. To address this need, we developed and tested a new household safety checklist and accompanying training program. METHODS A 50-item, photo-illustrated, multi-hazard checklist was designed as a tool to enable home healthcare paraprofessionals (HHCPs) to conduct visual safety inspections in patients' homes. The checklist focused on hazards presenting the greatest threat to the safety of seniors. A convenience sample of 57 HHCPs was recruited to participate in a 1-hour training program, followed by pilot testing of the checklist in their patients' households. Checklist data from 116 patient homes were summarized using descriptive statistics. Qualitative feedback on the inspection process was provided by HHCPs participating in a focus group. RESULTS Pretesting and posttesting determined that the training program was effective; participating HHCPs' ability to identify household hazards significantly improved after training (P<0.001). Using the checklist, HHCPs were able to identify unsafe conditions, including fire safety deficiencies, fall hazards, unsanitary conditions, and problems with medication management. Home healthcare paraprofessionals reported that the checklist was easy to use and that inspections were well accepted by patients. Inspections took roughly 20 minutes to conduct. CONCLUSIONS Home healthcare paraprofessionals can be effectively trained to identify commonplace household hazards. Using this checklist as a guide, visual household inspections were easily performed by trained HHCPS. Additional studies are needed to evaluate the reliability of the checklist and to determine if hazard identification leads to interventions that improve performance outcomes.
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Affiliation(s)
- Robyn R M Gershon
- Department of Epidemiology and Biostatistics, Philip R Lee Institute for Health Policy Studies, University of California, San Francisco, School of Medicine, San Francisco, California 94118, USA.
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Craven C, Byrne K, Sims-Gould J, Martin-Matthews A. Types and patterns of safety concerns in home care: staff perspectives. Int J Qual Health Care 2012; 24:525-31. [DOI: 10.1093/intqhc/mzs047] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ramachandran G, Howard J, Maynard A, Philbert M. Handling worker and third-party exposures to nanotherapeutics during clinical trials. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2012; 40:856-864. [PMID: 23289688 DOI: 10.1111/j.1748-720x.2012.00714.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The article focuses on issues relating to occupational exposures of researchers and lab workers, and exposures of bystanders such as health care workers and family members during HSR using nanomaterials. Such third-party exposures give rise to unique challenges relating to oversight as well as exposures to worker groups not previously studied. Given the current state of knowledge regarding health risks from such exposures, a more precautionary approach to oversight seems advisable.
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Affiliation(s)
- Gurumurthy Ramachandran
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota in Minneapolis, MN, USA
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