Consensus-Based Safety Recommendations for Informal Home Care: A Mixed Methods Study

As home-based care expands globally, informal caregivers are responsible for medical and nursing responsibilities, raising serious concerns about safety and risk management. This study proposes expert-informed, safety recommendations tailored to informal caregiving in home settings. The study used a six-phase mixed methods design combining a Consensus Development Conference (CDC) process with elements of Failure Modes and Effects Analysis (FMEA). In the first five phases, 13 healthcare professionals, hereafter referred to as "the professionals" (10 nurses, one physician, one occupational therapist, and one social worker), engaged in deliberations and risk assessments. The professionals agreed on 15 caregiving domains such as medication administration, mobility, and caregiver well-being, mapped them to 53 home caregiving procedures, identified 160 potential failure modes (errors), and rated the effect severity of each failure mode. This process led to the development of an initial set of 450 safety recommendations. In the final phase, a multidisciplinary expert review conducted by the research team merged overlapping items, eliminating redundancies and ensuring accuracy, confirming 53 procedures, 147 distinct failure modes (errors), refining 213 procedure failure mode effect associations, and consolidating the corpus to 288 recommendations. The resulting recommendations are intended to guide the development of safety guidance for informal caregiving in home settings. These recommendations are considered expert-derived guidance, since end users did not participate in the study.