When is Home Care High Risk Care?

John Sweeney, CEO

“Áras Attracta scandal due to ‘accepted

culture of abuse” (Irish Examiner, 2014)

“Patients dehumanised and treated as objects”

(Primetime Investigates “The Home Care Scandal”

2010)

Health Minister warned 'there will be another Leas

Cross scandal”' by TD (Irish Independent, 2014)

Portlaoise Report

• “Poor experiences by patients and families were compounded by ineffective governance”

• “Risk management structures were poorly developed. Risks were not comprehensively reviewed or addressed.”

• “The Management Team did not corporately collate, analyse, trend or use incident or complaint information proactively to address risks and share any resulting learning.”

Portlaoise Report. HIQA, 2015

Savita Halappanavar Report

• “Every health system must ensure that there exists the ability to learn when things go wrong and ensure that errors are not repeated and learn from the best available evidence to ensure models of care are safe, effective and up-to-date.”

Savita Halappanavar Report. HIQA,2013

UL Hospital Report

• “There was no evidence to indicate that the Executive Management Team routinely monitored locally agreed patient experience metrics, such as the number of quality and patient safety auditsconducted, complaints management and key performance indicators.”

UL Hospital Report. HIQA, 2014

What are the Risks in Home Care Services?

The Risks

• “Home care is an intricate combination of the provision of basic to complex health-care interventions in a residential setting that is not designed for the delivery of health care.”

• “These circumstances expose home care clients to a different set of risk factors than they might experience in institutionalized settings.”

Equality and Human Rights Commission, 2011

The Risks

1. Inconsistencies in the way care is planned and delivered in Homecare.

2. Lack of integration of Home Care teams, lack of care coordination across healthcare sectors and failures in communication.

3. Poor standardization of processes, documentation, equipment and packaging of medication.

4. Clients and caregivers sometimes make decisions that put their health at risk.

Canadian Patient Safety Institute. 2013

Risk of Abuse

Physical Abuse

• “Rather than say ‘sit in the chair’, they’d push me back into the chair, that sort of thing.”

Neglect of Personal Care

• “They are supposed to do an hour in the morning and an hour in the evening, but ... she’s gone within 10 to 15 minutes.”

Equality and Human Rights Commission, 2011

Risk of Abuse

Lack of Autonomy and Choice

• “The earliest we were told of someone being put to bed was 2.45 pm.”

Lack of Respect for Privacy

• “I feel my dignity is not being respected when being showered and dressed when I have several trainees observing quite an intimate routine.”

Equality and Human Rights Commission, 2011

Homecare Top Risks

1. Falls

2. Medication errors

3. Psychosocial

4. Behavioural or mental health problems

5. Wound infections

British Medical Journal, 2013

Challenges to Home Care Staff

• “The least satisfying element is not having enough time, you try not to hurry them [older people] (or to let them know you haven’t enough time) but you are aware that your next client is watching the clock and waiting for you to arrive.”

Equality and Human Rights Commission, 2011

Are we “Good Enough”?

• Absence of a specific regulatory framework

• What will make the difference?

“Homecare of the very highest quality”

“We provide the highest quality of care”

”Quality Care at Home”

Are We “Good Enough”?

• Research - 17% of hospital patients experience an adverse event.

• Research - HC Reported rate at 13%

– (1/3 preventable)

• Additional Records Review– up to 66.5%

International Journal for Quality in Health Care, 2013 (Canada)

We will have to be better than

“Good Enough”

• Duty of Care to Clients

• Law Reform Commission Report

• HIQA Safer Better Care Standards

• Media Scrutiny

Building the Framework

• Development, implementation, continuous review and improvement of an effective Quality and Safety Management System.

• Model must be built on a framework that is reflective of the sector – one which will support any ensuing regulation

….designed to improve the safety

and quality of home care.

Why?

Why Not?

• Difficult

• Costly

• Time Consuming

• Takes Away Core Focus of Business

• Its Optional …….

Benefits?

• Ensures the Quality and Safety of Care

• Effective Governance and Communication

• Proactive and Reactive Risk Management

• Continuous Measurement and Analysis

• Framework for all Regulations

• National / International Recognition

• Increases efficiency/reduces costs

What Will it Mean?

• The Client:

– Appropriate / Comprehensive / Evaluated Care

– Confidence and Safety

• The Organisation:

– Significant Change – Structures – Process - Outcome

– Better Organisation and Business

Home Care is High Risk Care

John.Sweeney@healthcareinformed.com

References

• Nancy Sears , G. Ross Baker , Jan Barnsley , Sam Shortt. “International Journal for Quality in Health Care. The incidence of adverse events among home care patients.” First published online: 2 January 2013

• Doran D, Blais R, et al. “Safety at Home. A Pan-Canadian Home Care Safety Study.” Canadian Patient Safety Institute 2013 http://www.patientsafetyinstitute.ca/English/research/commissionedResearch/SafetyatHome/Documents/Safety%20At%20Home%20Care.pdf

• Blais R, Sears NA, Doran D, et al. “Assessing adverse events among home care clients in three Canadian provinces using chart review”. BMJ QualSaf doi:10.1136/bmjqs-2013-002039 (published online first 4 Jul 2013) http://qualitysafety.bmj.com/content/early/2013/07/02/bmjqs-2013-002039.short?g=w_qs_ahead_tab

• Health Information and Quality Authority (May, 2015) “Report of the investigation into the safety, quality and standards of services provided by the Health Service Executive to patients in the Midland Regional Hospital, Portlaoise.”

• Health Information and Quality Authority (June, 2014) “Report of the review of the governance arrangements as reflected in the safety, quality and standards of services at UL Hospitals”.

• Health Information and Quality Authority (Oct 2013) “Investigation into the safety, quality and standards of services provided by the Health Service Executive to patients, including pregnant women, at risk of clinical deterioration, including those provided in University Hospital Galway, and as reflected in the care and treatment provided to Savita Halappanavar”.