Improving Homecare Risk Management and Patient Safety

Background: Risk management in the domiciliary healthcare setting is a harder challenge than in a hospital environment. Many, not always predictable, variables related to the patient, the caregiver, the health professionals and the home environment make it impossible to guarantee complete safety in homecare. The first aim of the study was to verify that the Electrical Medical Devices (EMD) and medical Consumables Supplies (CS) provided to mechanically ventilated and artificially fed patients at home comply with requirements for safe homecare.  Methods: We conducted a Failure Modes, Effects and Criticality Analysis (FMECA) on two processes, mechanical ventilation and artificial feeding at home, and defined a local institutional list of the requirements for safe home healthcare; a checklist containing all the items in the list was administered to ventilated and artificially fed patients at home.  Results: The checklist was used for 92 home patients, sex M/F=52/40, mean age 59,8±22 years (range 2÷102 years). Many failures were highlighted when the checklist was applied and problems affecting AMBU resuscitator bags, tracheostomy tubes, ventilators in patients being mechanically ventilated around-the-clock and ventilator circuits were identified as the most critical potential vulnerabilities for homecare patients.  Conclusion: The checklist is a simple and valid tool for implementing proactive clinical risk management initiatives in homecare. Although it is impossible to guarantee complete safety in any healthcare environment, scheduling periodic checks with checklists to assess the quantitative and qualitative adequacy of EMD and CS provided to the patient could contribute to the homecare risk reduction.