Many home health sentinel events are fires in the home

Patient education, staff vigilance needed

Your nurses teach patients how to administer their medications, check their blood sugars, use their oxygen, care for their wounds, and, in general, take care of themselves as they deal with their illness or condition. Your nurses also review the safety of the home environment; but how well are they protecting your patients from the risks of fire?

According to the latest sentinel event statistics collected by the Oakbrook Terrace, IL-based Joint Commission on Accreditation of Healthcare Organizations, almost 43% of sentinel events reported by home care programs are for fire in the patient’s home, says Maryanne L. Popovich, RN, MPH, executive director of the home care accreditation division of the Joint Commission. This statistic leads all other causes of home care sentinel events, with medication errors reported the second most frequently at 14.3% and patient falls reported slightly more than 6% of the time, she adds.

"Overall, the number of fires in patient homes that result in injury or death has decreased since we started collecting sentinel event data for home care in 1997, but the frequency points out the need for thorough assessments and patient education," says Popovich. "In March 2001, we issued a sentinel event alert related to home fires after studying the root causes of the events," she says.

Because the sentinel event reporting system requires a home care agency to report any serious injury or death that occurs in the patient’s home while the patient is in the care of a home health agency, not all fires are directly related to the home care agency’s actions, points out Popovich. This means that non-home-health-related reasons such as faulty wiring, unsafe holiday decorations, or the carelessness of a cognitively impaired patient operating a stove can cause fires, she says. "For this reason, it is very important that home care nurses include a thorough home safety evaluation for all patients," she adds. A home safety evaluation should include a process for testing smoke alarms and designing an evacuation plan if needed, she suggests.

Home care nurses change the patient’s environment, bringing in equipment that may increase fire risks, so it is vital that the initial assessment include training specific to fire safety with items such as oxygen tanks, says Karen Apkins, RN, head nurse at Titusville (PA) Hospital Home Health. "Some patients are more at risk for fires because they are using oxygen," she says. While all Titusville patients get a thorough general safety assessment that includes looking for items such as frayed electrical cords, patients using oxygen get more thorough teaching that focuses on the dangers of open flames and oxygen, she says. "In rural areas, we are dealing with kerosene heaters and wood stoves, so we make a point of explaining fire safety and oxygen," she explains.

"Don’t forget to talk about other open flames such as fireplaces, gas stoves, and candles when educating patients about fire safety," points out Popovich. "Even if the patient or the family caregiver doesn’t smoke, remember that visitors or other relatives may smoke," she says.

In addition to assessing the home environment for safety hazards, be sure you assess your patient and the family caregiver carefully, especially when oxygen is in the home, suggests Popovich. The best education program possible won’t alleviate risk if the person in the home is unable to understand the risks, she adds.

Also, communicate with your physicians and vendors supplying oxygen, says Popovich. "Poor communication between the home care staff, physicians, and vendors was listed as the root cause in over 50% of the sentinel events," she says.

Most important, document any suggestions you make to the patient and caregiver to decrease the risk of fire, suggests Apkins. If you notice a lack of smoke detectors, faulty wiring, or candles close to draperies, and you suggest adding the detectors, fixing the wires, or moving the candles, document and date your suggestions, she says. "Although we are careful to document all clinical issues, we sometimes forget that documentation of non-clinical items is just as important," she says. "Our assessment of fire risk and suggestions for reduction of that risk are just as important to the welfare of our patients as anything we do."