Home-Based Patient Care Safety

Home-Based Patient Care Safety

Jennifer Kennedy & Kim Skehan

Home-based care allows individuals to receive comprehensive care and support in the comfort of their own homes. This approach not only enhances the quality of life for patients but also reduces the burden and cost of care in a facility. However, keeping patients safe wherever they call home requires home-based care provider’s continuous assessment and mitigation of real and potential hazards in the patient care environment. In recognition of National Patient Safety Awareness Week, this blog explores the best practices and measures necessary to maintain a safe environment for patients receiving care at home.

Risk Assessment and Planning

In a facility, the patient is under 24/7 care and supervision, which is easier for care staff to control the environment and patient actions to maintain the patient’s safety. This is not the case with home-based care. It is important to remember that care providers are a guest in a patient’s home and the individual and their caregiver (if any) are not required to make suggested safety changes. Suggestions should always be provided with respect and concern for increasing safety in the care environment.  

Effective home-based patient care starts with a comprehensive risk assessment of the patient’s home. This involves identifying hazards in the home and developing strategies to mitigate them. Key steps include:

  • Evaluating the home environment for real and potential risks, such as uneven flooring, poor lighting, clutter in walkways, and inadequate handrails.
  • Assessing the patient’s physical condition and mobility to determine specific needs and potential challenges.
  • Identifying any medical equipment that will be used and ensuring it is in good working condition and the patient and caregiver (if any) understand how to use it.

Nurses and physical therapists are ideal clinicians to complete a risk assessment of the patient’s home to identify hazards and make suggestions to the patient for safety improvement. Interventions based on the outcomes of the risk assessment are integrated into the patient’s individualized care plan

Strategies to Minimize Common Safety Hazards in Home-Based Care

Implementing effective proactive strategies to minimize safety hazards can significantly enhance the quality of care and protect the well-being of patients. Here are some key strategies for home adaptation to address common hazards:

  • Fall prevention

Falls are a major concern in home-based care and a provider can only make suggestions to the patient and caregiver (if any) for modifications to reduce fall hazards. Some recommendations a provider can propose to reduce the risk of patient falls include:  

  • Installing grab bars and handrails in key areas such as bathrooms and staircases
  • Removing clutter from patient used areas and securing loose rugs to reduce the risk of accidents
  • Adjusting furniture layout to create clear and accessible pathways especially if assistive equipment is needed for ambulation
  • Using non-slip mats in areas prone to moisture, such as bathrooms and kitchens and advising the patient to wear shoes with non-slip soles
  • Improving lighting throughout the home, especially in hallways, staircases, and entrances
  • Providing patients with mobility aids, such as walkers, canes, and grab bars, to assist with stability and balance
  • Medical Equipment Safety
    • Regularly inspecting and maintaining medical equipment to ensure proper functionality
    • Providing training to patients and caregivers on the correct use of medical devices and when to report equipment issues
    • Implementing emergency protocols for equipment malfunction or failure
  • Medication Management

Proper medication management is essential to prevent errors and ensure patient safety. Medication safety is a key risk area for patients. Strategies for patients include:

  • Organizing medications
  • Setting up a medication schedule and using pill organizers to keep track of dosages
  • Clearly labeling all medications and storing them in a secure, easily accessible location
  • Medication reconciliation at admission to service and on every provider visit for identification of:
    • Polypharmacy
    • High risk medications 
    • Adverse drug interactions
  • Utilize alarms, smartphone apps, or written schedules to remind patients to take their medications on time
  • Educating patients and caregivers verbally and in writing instructions on medication administration, including dosage, timing, and potential side effects
  • Educating patients and caregivers on proper disposal for expired and unused medications
  • Encouraging open communication between patients, caregivers, and the provider to address any concerns or questions about medications

Infection Control

Preventing infections in a home environment requires vigilance. Strategies include:

  • Hand Hygiene: Encourage frequent handwashing and provide hand sanitizers throughout the home.
  • Sanitize Equipment: Regularly clean and disinfect medical equipment and surfaces to prevent bacterial growth.
  • Limit Visitors: Control the number of visitors and ensure they follow hygiene protocols to minimize the risk of infection.
  • Monitor Health: Watch for signs of infection and seek prompt medical attention when necessary.

Psychological and Social Well-being

The mental health of patients is as important as their physical health. Strategies include:

  • Social Interaction: Promote regular social interactions with family, friends, and support groups to reduce feelings of isolation.
  • Mental Health Services: Provide access to counseling and mental health services to help patients cope with stress and anxiety.
  • Supportive Environment: Create a positive and stimulating environment that supports the patient’s emotional well-being.

Fire Safety

Fire hazards can be mitigated by teaching the patient and caregiver the following measures:

  • Implementing a strict no-smoking policy inside the home to prevent accidental fires.
  • Never leave cooking unattended and turn off appliances when not in use and to use timers as reminders
  • Regularly inspect electrical devices for faults and avoid overloading outlets
  • Equip the home with smoke detectors and fire extinguishers in key areas, and ensure they are in working order.

Emergency Preparedness

Every patient should have an individualized emergency plan that outlines actions (provider and patient/caregiver) that are taken in the event of a natural or manmade disaster. Developing a detailed emergency plan that includes:  

  • Contact information for healthcare providers, family members, and emergency services
  • Ensuring that all caregivers are familiar with the emergency plan and know how to respond in various situations
  • Keeping emergency supplies, such as first aid kits and extra medications, readily available
  • Consideration of utilizing medical alert devices that can call for help if needed

Developing a Care Plan

Creating an individualized care plan that addresses the patient’s medical, physical, and emotional needs is key for home based patient care and includes identified safety risks and measures to address these risks. Communication and collaboration between care providers, patients, and family members and caregivers regarding the patient’s care and care plan is paramount to facilitating patient safety. Strategies include: 

  • Involving healthcare professionals, family members, and caregivers in the planning process to ensure a comprehensive approach.
  • Establishing clear communication channels among all parties involved in the patient’s care.
  • Regular Check-Ins
  • Scheduling regular visits from healthcare professionals to assess the patient’s condition and the overall safety of the home environment.
  • Encouraging patients and caregivers to report any safety concerns or incidents promptly.
  • Feedback and Evaluation
  • Collecting feedback from patients and caregivers to identify areas for improvement.
  • Implementing changes based on feedback and emerging best practices in home-based care safety.

Conclusion

Home-based patient care offers numerous benefits, but it requires careful planning and diligent implementation of safety measures. By conducting thorough risk assessments, modifying the home environment, managing medications effectively, preparing for emergencies, and continuously monitoring and improving care practices, we can ensure a safe and supportive environment for patients receiving care at home. The collaboration of healthcare professionals, caregivers, and family members is essential to achieving this goal and enhancing the overall quality of home-based patient care.

Implementing these strategies can significantly reduce the risks associated with home-based care. Continuous monitoring, feedback, and collaboration among healthcare professionals, caregivers, and family members are essential to creating a safe and supportive environment for patients receiving care at home.