Nilsson Lena, Lindblad Marléne, Johansson Nathalie, Säfström Lisa, Schildmeijer Kristina, Ekstedt Mirjam, Unbeck Maria
Department of Anaesthesiology and Intensive Care, Department of Medical and Health Sciences, Faculty of Medicine and Health Science, Linköping University, Linköping, Sweden.
Department of Health Sciences, Swedish Red Cross University, Stockholm, Sweden.
Int J Nurs Stud. 2023 Feb;138:104434. doi: 10.1016/j.ijnurstu.2022.104434. Epub 2022 Dec 23.
The provision of home healthcare is increasing in response to the growing aging population with the need for chronic disease management in their homes. Safety work differs from hospital care. The incidence of adverse events in home healthcare is sparsely studied but is estimated to occur in-one third of patients, and most are deemed preventable. Although nursing care is crucial for risk assessment and preventive work in the home environment, the role of registered nurses in the prevention of no-harm incidents and adverse events has not received sufficient scientific attention.
To explore nursing-sensitive events in patients receiving home healthcare.
DESIGN, SETTING AND PARTICIPANTS: A Swedish national multicenter study based on a structured record review of 600 randomly chosen healthcare records from 10 organizations in different regions of the country.
Ten trained teams, each including physician(s) and registered nurses, undertook a review based on the Global Trigger Tool method. The review covered a maximum of 90 days from admission to home healthcare. First, each record was screened for the presence of 38 predefined triggers. In the second step, every potential event was assessed according to preventability, types of events, severity, time of occurrence, consequences of the event, and potential contributing causes.
In total, 699 events were identified in the study. Of these, 495 (74.0%) were classified as nursing-sensitive (227 no-harm incidents and 268 adverse events) and affected 267 (44.5%) patients, with a mean of 1.9 events per patient. The majority (n = 367, 73.1%) were considered preventable. The most prominent types of nursing-sensitive event were falls (n = 138, 27.9%), pressure ulcers (n = 62, 12.5%), healthcare-associated infections (n = 58, 11.7%) and medication management (n = 50, 10.1%). Concerning severity, 45.9% were classified as no-harm incidents and another 36.6% resulted in temporary harm that required extra healthcare resources: 226 hospital days, 66 physician visits in outpatient care, and 99 in home healthcare. All severity types occurred from day 1, except death, which included only one patient. The most frequent contributing factors were deficiencies in nursing care, treatment & diagnosis, with the subgroups nursing care, observation, treatment & follow-up, followed by deficiencies in the organization.
Nursing-sensitive events in home healthcare are common, often preventable, and occur from the start of the care period. This study contributes to increased knowledge of patient safety shortcomings and points to the important role that registered nurses play in patient safety work.
随着老年人口不断增加，对慢性病居家管理的需求也在增长，居家医疗服务的提供量正在上升。居家医疗安全工作与医院护理有所不同。居家医疗中不良事件的发生率鲜有研究，但据估计，三分之一的患者会发生不良事件，且大多数被认为是可预防的。尽管护理对于居家环境中的风险评估和预防工作至关重要，但注册护士在预防无伤害事件和不良事件方面所起的作用尚未得到足够的科学关注。
探讨接受居家医疗服务患者中的护理敏感事件。
设计、设置和参与者：一项瑞典全国性多中心研究，基于对从该国不同地区10个机构随机选取的600份医疗记录进行结构化记录审查。
10个经过培训的团队，每个团队包括医师和注册护士，采用全球触发工具法进行审查。审查涵盖从开始接受居家医疗服务起最多90天的时间。首先，筛查每份记录中是否存在38个预先定义的触发因素。第二步，根据可预防性、事件类型、严重程度、发生时间、事件后果以及潜在促成因素，对每一个潜在事件进行评估。
该研究共识别出699起事件。其中，495起（74.0%）被归类为护理敏感事件（227起无伤害事件和268起不良事件），涉及267名（44.5%）患者，平均每位患者发生1.9起事件。大多数（n = 367，73.1%）被认为是可预防的。最突出的护理敏感事件类型为跌倒（n = 138，27.9%）、压疮（n = 62，12.5%）、医疗相关感染（n = 58，11.7%）和用药管理（n = 50，10.1%）。关于严重程度，45.9%被归类为无伤害事件，另有36.6%导致了需要额外医疗资源的暂时伤害：226个住院日、门诊护理中的66次医师出诊以及居家医疗中的99次出诊。除死亡（仅1例患者）外，所有严重程度类型从第1天起就有发生。最常见的促成因素是护理、治疗与诊断方面的不足，其子类别包括护理、观察、治疗与随访，其次是组织方面的不足。
居家医疗中的护理敏感事件很常见，通常是可预防的，且从护理期开始就会发生。本研究有助于增加对患者安全缺陷的认识，并指出注册护士在患者安全工作中所起的重要作用。
