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.