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Patient Safety Events Among Children Receiving Home Health Care
Carolyn C Foster1,2, Peter Walsh1, Michelle High1
1Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois.
Insights
Over 1 in 10 children receiving home health care (HHC) experienced a reported incident, with nearly half being patient safety events. This study highlights critical areas for improving pediatric HHC safety, particularly concerning medications and devices.
Area of Science:
- Pediatric Home Health Care Safety
- Patient Safety Events
- Health Care Quality Improvement
Background:
- Children with medical complexity require complex home care, but safety issues in this setting are under-researched.
- Systems-level approaches to patient safety in pediatric home health care (HHC) are still developing.
- Quantifying and categorizing HHC staff incidents is essential for preventing safety events.
Purpose of the Study:
- To determine the rates and types of patient safety events in a national US pediatric population receiving HHC.
- To identify common causes and impacts of safety events in pediatric home care.
Main Methods:
- Retrospective cohort study analyzing staff incident reports from a pediatric HHC agency across 11 US states (September 2022 - August 2023).
- Included patients under 21 years receiving HHC (excluding psychiatric care).
- Analyzed patient safety events per 1000 HHC-days, classifying errors using the NCC MERP Index.
Main Results:
- 307 of 678 incidents (45.3%) were patient safety events among 348 children (11.9%).
- The rate was 0.68 patient safety events per 1000 HHC-days, with medication (38.8%) and implanted device (32.7%) errors being most frequent.
- Harmful errors involved skin injuries and falls; approximately half required additional monitoring or emergency care.
Conclusions:
- Over 10% of children receiving HHC experienced reported incidents, with nearly half being patient safety events.
- This study provides crucial data on pediatric HHC safety, identifying key areas like medication and device safety.
- Further research should investigate contributing factors, prevention strategies, and incorporate parental perspectives.
Importance:
Children with medical complexity often require complicated home care regimens, yet health care safety issues in community settings have been rarely described. Systems-level approaches to addressing patient safety in pediatric home health care (HHC) also remain nascent. Quantifying and categorizing HHC staff incidents is a first step toward preventing the occurrence of safety events in this population.
Objective:
To identify the rates and types of patient safety events within a US national pediatric population receiving HHC.
Design, Setting, And Participants:
This was a retrospective cohort study (September 1, 2022, to August 31, 2023) that used staff incident reports from a pediatric HHC agency with sites in 11 US states. Participants were patients aged younger than 21 years receiving HHC within the study year, excluding psychiatric HHC.
Exposure:
Days of HHC receipt.
Main Outcomes And Measures:
Rate and type of staff-reported patient safety events per 1000 HHC-days, reviewed by 3 trained clinician reviewers, and classified using the National Coordinating Council for Medication Error Reporting and Prevention Index.
Results:
This study identified 2901 children (males, 1710 [59.0%]) who received a median of 98.0 (IQR, 14.0-312.0) days of HHC. The mean (SD) age was 8.7 (5.3) years. A total of 678 incident reports were filed for 348 children (11.9%). Of these, 307 (45.3%) were patient safety events, including 168 harmful errors (54.7%), 110 nonharmful errors (35.8%), and 22 hazards (7.2%). This equated to a mean (SD) of 0.68 (4.40) patient safety events per 1000 HHC-days. Errors most frequently involved medications (108 [38.8%]) and implanted devices (91 [32.7%]). Harmful errors were most frequently related to non-pressure-related skin injuries (45 [26.8%]) and falls (30 [17.9%]). Approximately half of all errors required additional monitoring (133 [47.8%]) and 45 (16.2%) required emergency care. Patient safety events were more likely in children with invasive home ventilation compared with other types of implanted medical technology.
Conclusions And Relevance:
In this cohort study of children receiving HHC, more than 1 in 10 had a reported incident, of which approximately half were patient safety related. This work provides new data about pediatric HHC safety. Further work should explore factors contributing to and preventing health care-related harms to children at home and include parent perspectives.
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