The incidence of adverse events among home care patients

Abstract

Objective: Incidence of adverse events (AEs) among home care patients and preventability ratings were estimated. Risk factors, AE types and factors associated with AEs were identified.

Design: This study used a stratified, randomized sample of home care patients discharged in the fiscal year 2004/05. Trained nurse reviewers completed retrospective chart abstractions; charts for cases that were positive for screening criteria suggesting the presence of AEs were reviewed by trained physicians to determine the presence of and preventability of AEs.

Setting: Three publicly funded home care programs in Ontario, Canada.

Main outcome measures: Prevalence and types of AEs; ratings of preventability.

Results: At least one screening criterion was positively identified in 286 (66.5%) of 430 cases. Physician reviewers identified 61 AEs in 55 (19.2%) of the 286 (12.8% of the 430) cases. The AE rate was 13.2 per 100 home care cases [95% confidence interval (CI): 10.4-16.6%, standard error 1.6%]. 32.7% (20 of 61 AEs) of the AEs were rated as having >50% probability of preventability; 6 deaths (10.9% of patients with an AE; 1.4% of all patients) occurred in AE-positive patients. The most common AEs were falls and adverse drug events.

Conclusions: Providing health care through home care programs creates unintended harm to patients. The incidence rate of AEs of 13.2% suggests a significant number of home care patients experience AEs, one-third of which were considered preventable. Improvements in patient and informal caregiver education, skill development and clinical planning may be useful interventions to reduce AEs.