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Patient safety in the home (Influences on safety (Home environment…
Patient safety in the home
Ageing population
2020 > 20% pop over 65
Disabilities
cancer, heart disease, dementia, renal and respiratory disorders
most common = sight and hearing disorders
Ratio between working age and over 65 increase
Avoiding unnecessary hospitalization
Avoid increased risk of poor outcomes
Challenges
Power and control move away from organisations and professionals
Patients and carers more involved
Care planning
Diagnostic and assessment
When to escalate
liaise between professionals
Responses
Tech
Building Solidarity in families and citizens
Harm in the home
medication-related events,
pressure ulcers
psychological harm
Accidental injury
Falls
Gaps in knowledge
Risk to Family and Other Care Givers
Unpaid carers are particularly vulnerable to stress, long term burn out and ill health
Transfer burden of care to family and patient
Transition and coordination
Discharge from hospital vulnerable point, characterised by fragmented, disjointed services
Influences on safety
Socio-economic Conditions Take on a Much Greater Importance
Issue equality impact
Large variation in resources available
text
Space
Relatives available to 'work' as carers
Paid support
Lifestyle factors - diet, fitness etc.
Home environment
Lighting
Space, clutter
Hygiene
Disposal,sharps
Sterilising
Falls hazards
Patient characteristics e.g. mobility
Other domestic e.g. Electrical
Increasing responsibility of carers
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Training and experience of home care
Medicine administration but low knowledge
Adherence to simple procedures
Recovery strategies may be important
Fragmented approach of healthcare professionals
Coordination and communication
Differing advice
Non adherence
Continuity of care and relationships
Safety strategies and interventions
Autonomy Vs safety
mastered compromise’ in which a team of the patient, health and social care pro- fessionals and relatives each brings their own perspective and together arrive at a negotiated way forward.
broader strategic approaches to safety
Optimization Strategies in Home Care
staff spend listening to patients and carers, explaining, and coordinating may be one of the best ways of improving safety in the community and home care
Discharge Planning
Clear and timely hospital discharge information, including medication reconciliation
New primary care support e.g. Care managers, practice facilitators
Nurse discharge support
Training of Patients and Carers
anticipation, prepa- ration and continuing responsibility
Training around expectations and tasks
Risk control strategies
Standards and controls difficult to achieve
Monitoring, Adaptation and Response Strategies
Largely patients and family responsibility
Developing safety cultures and other safety routines
Detecting deterioration
electronic health record, physiological sensors, decision analytics and mobile phones applied in the home
Rapid response
Home monitoring
Smart tech
Tele medicine
Implanted devices
New system of care
Mitigation
Greater risk of adverse events
Need to anticipate and plan
Psychological
Emergency
Rapid response
Speedy rehospitalisation
right person, right time
Weekend and evening capacity
Family and carer responsibility
Psychological impact of major error
Support given
Administering mMedication
Training and support