What causes more than 40% of home care sentinel events? Answer: Fire

Improve patient education and staff vigilance to ensure safety

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 Joint Commission on the Accreditation of Healthcare Organizations, almost 43% of sentinel events reported by home care programs were 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. That 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 patients’ 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," Popovich explains. "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 nonhome-health-related reasons such as faulty wiring, unsafe holiday decorations, and carelessness of a cognitively impaired patient operating a stove all can be reasons for the fires. "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, Popovich suggests.

Home care nurses do 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 explains. While all home health 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. "In rural areas, we are dealing with kerosene heaters and wood stoves, so we make a point of explaining fire safety and oxygen. We also talk with patients about the dangers of smoking cigarettes and letting family members smoke in the house," Apkins says.

"Don’t forget to talk about other open flames such as fireplaces, gas stoves, and candles when educating patients about fire safety," Popovich continues. "Even if your patient or the family caregiver doesn’t smoke, remember that visitors or other relatives may smoke," she says. "Be sure to talk to the patient and family caregiver about the dangers of smoking when oxygen is in use and point out that this applies to any visitor. In fact, it is a good idea to place a small placard on the tank, or other visible location, that reminds people not to smoke," Popovich suggests.

"Although we have written information about fire safety, with older patients and older family caregivers, it is better to present the information verbally," Apkins says. "Be sure that your general safety assessment also includes looking for fire extinguishers and clutter-free paths that will enable easy evacuation," she adds.

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, Popovich suggests. 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, Popovich explains. "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. Home care nurses should communicate with physicians if patients are noncompliant with fire safety steps, and vendors should also be made aware of potential problems, Popovich adds.

"Don’t forget that assessment of fire risk is ongoing because things in the home get moved around or more electrical extensions are added for extra equipment," Apkins says. Most importantly, document any suggestions you make to the patient and caregiver to decrease the risk of fire, she suggests.

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, Apkins stresses. "Although we are careful to document all clinical issues, we sometimes forget that documentation of nonclinical items is just as important. 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."

[For more information, contact:

Maryanne L. Popovich, RN, MPH, Executive Director, Home Care Accreditation Program, Joint Commission on the Accreditation of Healthcare Organizations, One Renaissance Blvd., Oakbrook Terrace, IL 60181. Phone: (630) 792-5742. Fax: (630) 792-5005. E-mail: mpopovich@jcaho.org

Karen Apkins, RN, Head Nurse, Titusville Hospital Home Health, 406 W. Oak St., Titusville, PA 16354-1404. Phone: (814) 827-1851, ext. 266.

To see a copy of the latest sentinel event statistics from the Joint Commission, go to: www.jcaho.org. Click on sentinel event statistics under the "Latest From JCAHO" heading, then choose sentinel event statistics. To see a copy of the March 2001 Sentinel Event Alert related to home care fires, choose Search and enter "Sentinel Event Alert, March 17, 2001."]