Understanding risk and safety in home health care: the limits of generic frameworks.

BACKGROUND Patient safety and adverse events in primary care are receiving increasing attention from policy makers, professional bodies and researchers. Various taxonomic models have been developed to specify the factors that predispose to adverse events in hospital settings. These are assumed to have general applicability across different healthcare settings. However, they have never been applied to home health care. AIMS This study helps define the value of one such model in a domiciliary setting. The principal purpose of the study was to understand the circumstances in which the involvement of local authority-funded home carers as well as NHS-funded district nurses in medication-related activities for older people living at home in the UK might jeopardise patient safety. METHOD The study was undertaken in two contrasting sites. One was in London and the other in the Midlands. District nurses and home carers were purposively selected to take part in semi-structured interviews. The data were used to construct a taxonomic model that specified the factors that predispose older people to adverse events when medication-related responsibilities are transferred from district nursing to home care services. RESULTS The new taxonomy was compared to the taxonomic model under investigation. Dissonance existed within a number of categories. CONCLUSIONS The model under investigation was found to be too narrow for application in domiciliary settings. The challenges that exist in home health care are often very different from those that exist in hospital settings, from which the model under investigation was derived. The root causes of accidents are most likely to be identified by models empirically derived from, and tailored to fit, the particular circumstances in which they are to be applied.