Color & Control:

Road Map for Safety at Home

Providing safe care in a home setting poses unique challenges that require the engagement and active involvement of professional care providers, clients and family caregivers.

Recommendations from an expert roundtable

By Nadine Henningsen

A recent landmark report entitled “Safety at Home: A Pan-Canadian Home Care Study,” led by the Canadian Patient Safety Institute (CPSI), revealed a 10–13 per cent annual rate of adverse events among individuals receiving home care, of which over half were deemed preventable. Recognizing the need to address this important issue, the Canadian Home Care Association (CHCA), partnered by the CPSI, hosted an invitational roundtable on September 11, 2013. More than 40 home care leaders from across the country, including policy planners, administrators, service providers, accreditation bodies and researchers, collaborated to share their experiences and knowledge in the hopes of improving the safety of clients receiving home and community care.

CPSI staff members gave presentations on current and planned initiatives in home care safety, as did Dr. Régis Blais, co-principal investigator of the Safety at Home study. The CPSI has recently renewed its commitment to home care safety, naming home care as one of four key clinical priority areas for the next five years. Working with the CHCA at this roundtable was the first of many initiatives the CPSI has undertaken to begin this work.

Meeting the safety challenge
Achieving the vision of valuing, recognizing and embracing safety at home can be a daunting task. Providing safe care in an unpredictable or inconsistent home setting poses unique challenges that require the engagement and active involvement of professional care providers, clients and family caregivers.

In order to embed and sustain the principles of safety at home, there is a need to build and nurture a culture where safety is everyone’s responsibility, and accountability and information are openly shared without fear of negative consequences.

Knowledge, understanding and awareness are fundamental to achieving this goal. Facilitating increased understanding of safety at home requires research to support evidence-based decision-making in both policies and programming. Knowing what works and why, as well as vice versa, is essential if practices are to be standardized across the country.

rccm-home2Developing a road map
Building upon the vast experience and expertise of the home care leaders and researchers attending the September roundtable, a number of key actions were identified to start to draw the road map for a unified vision of safety at home.

Designated guides 
As with any journey, strong leadership and direction are needed to maintain momentum and engage participants throughout the initiative. The CHCA and CPSI were identified as two national organizations that can assume key roles in engaging stakeholders across the country to refine and communicate the “safety at home” vision, principles and actions. Through their respective national networks, these organizations are able to promote a systems-level approach to safety at home by broadening partnerships beyond the community to include acute care, long-term care and primary health care.

A pan-Canadian approach will provide a platform to identify and share best practices, tools and resources, and support evidence-based decision-making. Increased awareness and understanding of safety at home for clients, family caregivers and health care providers, through targeted communications and educational resources, will sustain and support local organizations’ safety goals and programs.

Essential travel companions
All in attendance agreed that a vision of safety in the home must include clients and family caregivers, in addition to professional health care teams. The fundamental tenet of this vision is an awareness of safety in the home as a collaborative, positive and empowering philosophy that is valued and recognized, and established as everyone’s responsibility.

Home care leaders unanimously agreed that there is often a wide disparity between the client’s and family caregivers’ acceptance of “what is safe” and professional care providers’ perception of acceptable risk. Some clients elect to live with a certain level of risk, and providers need to be cognizant of those individuals’ wishes and ensure they are respected.

Recognized cartographers
Designing the roadmap must be a collaborative effort across the continuum of integrated care.

Defining safety at home, and ensuring alignment of the definition and vision with required operating practices across numerous organizational entities, requires the involvement of accrediting bodies and the articulation of standards. Through the engagement of recognized accreditation organizations, stakeholders can identify and promote indicators for safety at home within the home care sector and across the health system. Some of this work has already begun as a result of the Safety at Home study.

Engaged pilgrims
Our journey requires the commitment of organizations and their staff, often for an extended period of time, to achieve the vision of safety at home. National and local activities will need to engage a broad range of stakeholders in developing and implementing safety at home strategies. Specific strategies and actions, as well as tools and resources, are needed to support clients and family caregivers in achieving the confidence and competency to determine and manage their own safety at home. Connections must be made with organizations and associations such as hospital consortiums and primary health care teams to ensure they include safety at home on their agendas. All of these components are necessary to create a clear road map and to build a strong foundation for our vision.

A fixed destination 
Safety at home must become a priority for all health care systems across the country, and for clients and family caregivers. It is a critical element of quality initiatives and process improvements. Our journey is not new. It is in fact a reinforcement of existing obligations to maintain safety standards and is a fundamental tenet of all client-centred health care. There are numerous best practice guidelines to support our journey and excellent safety initiatives that can be adopted by other jurisdictions.

Our road map will ensure we are all focused on the same destination: a collaborative, positive and empowering philosophy where safety at home is valued, recognized and the responsibility of all. Home care leaders have recognized and embraced this vision; let’s get packed and start our journey today.

Nadine Henningsen is the Executive Director of the Canadian Home Care Association and is involved in national initiatives that support advocacy, awareness and the enhancement of home care. With more than 20 years experience in the home care sector, Nadine has led projects in primary health care, systems integration and information technology. She is the President of the Canadian Caregiver Coalition, and a member of the Quality End-of-Life Care Coalition. 


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