510 - Nurses’ Reponses to Patient Safety Events when Caring for Children with Medical Complexity at Home

Publication Number: 1490.510

Sofia Seewald, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Anna Jolliff, Vanderbilt University Medical Center, Nashville, TN, United States; Peter Walsh, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Carol Haywood, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Michelle High, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Cara L. Coleman, Virginia Medicine, INOVA Campus, Occoquan, VA, United States; Margaret Storey, DePaul University, Evanston, IL, United States; Debbi Harris, Family Voices of Minnesota, Eagan, MN, United States; Kathleen E. Walsh, Boston Children's Hospital, boston, MA, United States; Alisa Khan, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States; Nicole E. Werner, Vanderbilt University Medical Center, Nasvhille, TN, United States; Carolyn Foster, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States

Background: Children with medical complexity (CMC) live with multisystem conditions which lead to dependence on intricate medication regimens and medical technologies necessitating home nursing. However, prior research suggests that home nurses can be inconsistently prepared to identify and respond to in-home safety events for CMC.

Objective: We aimed to examine what influences nurses' decision making during in-home safety events for CMC as targets for future intervention.

Design/Methods: We conducted a qualitative study using virtual critical decision method (CDM) interviews with home nurses to elucidate their cognitive process in responding to a safety event. CDM is a cognitive tasks analysis approach used to explore how those with domain expertise make high-stakes, time-pressured decisions. Nurses were asked to share a specific in-home safety event in chronological order, after which their cognitive processes at each timepoint were probed. Two coders extracted transcribed interview text to a decision analysis table to identify macrocognitive functions, cues, prior experience and training, situation assessments, goals, and emotions. Next, we used inductive thematic analysis to identify key themes from interviews. Nurses reported sociodemographic information by survey.

Results: We conducted 15 CDM interviews with home nurses of CMC. In this sample, 80% of home nurses were female, and 60% had worked directly with children in the home setting for <=10 years. Participants primarily discussed device-, medication-, supply-, or illness-related safety events (Table 1). We identified four main themes: (1) limited training and contingency planning can leave home nurses underprepared to respond to safety events; (2) inadequate or inconsistent availability of supplies/tools in the home setting can increase safety risks; (3) barriers in communication within and between home and clinic-based teams can create uncertainty, delay help-seeking, and compound error; (4) families, home nurses, and other clinicians often have different understandings of acceptable risk, responsibility, and goals when responding to safety events in the home environment (Table 2).

Conclusion(s): Our findings highlight key opportunities to improve safety event response and preparedness among home nurses caring for CMC. Improvements in training, access to equipment and supplies, and care communication tools may help enhance patient safety at home for CMC by decreasing reliance on temporary solutions or workarounds. Our results urge future design interventions to support home nurses in preventing medication and device-related safety events for CMC.

Home Nurse Safety Events Summary


Main Themes with Exemplar Quotes