Patient Safety Events Among Children Receiving Home Health Care.

IMPORTANCE

Children with medical complexity often require complicated home care regimens, yet health care safety issues in community settings have been rarely described. Systems-level approaches to addressing patient safety in pediatric home health care (HHC) also remain nascent. Quantifying and categorizing HHC staff incidents is a first step toward preventing the occurrence of safety events in this population.

OBJECTIVE

To identify the rates and types of patient safety events within a US national pediatric population receiving HHC.

DESIGN, SETTING, AND

PARTICIPANTS

This was a retrospective cohort study (September 1, 2022, to August 31, 2023) that used staff incident reports from a pediatric HHC agency with sites in 11 US states. Participants were patients aged younger than 21 years receiving HHC within the study year, excluding psychiatric HHC.

EXPOSURE: Days of HHC receipt.

MAIN OUTCOMES AND MEASURES: Rate and type of staff-reported patient safety events per 1000 HHC-days, reviewed by 3 trained clinician reviewers, and classified using the National Coordinating Council for Medication Error Reporting and Prevention Index.

RESULTS

This study identified 2901 children (males, 1710 [59.0%]) who received a median of 98.0 (IQR, 14.0-312.0) days of HHC. The mean (SD) age was 8.7 (5.3) years. A total of 678 incident reports were filed for 348 children (11.9%). Of these, 307 (45.3%) were patient safety events, including 168 harmful errors (54.7%), 110 nonharmful errors (35.8%), and 22 hazards (7.2%). This equated to a mean (SD) of 0.68 (4.40) patient safety events per 1000 HHC-days. Errors most frequently involved medications (108 [38.8%]) and implanted devices (91 [32.7%]). Harmful errors were most frequently related to non-pressure-related skin injuries (45 [26.8%]) and falls (30 [17.9%]). Approximately half of all errors required additional monitoring (133 [47.8%]) and 45 (16.2%) required emergency care. Patient safety events were more likely in children with invasive home ventilation compared with other types of implanted medical technology.

CONCLUSIONS AND RELEVANCE: In this cohort study of children receiving HHC, more than 1 in 10 had a reported incident, of which approximately half were patient safety related. This work provides new data about pediatric HHC safety. Further work should explore factors contributing to and preventing health care-related harms to children at home and include parent perspectives.