When the Home Becomes a Hospital

08/26/2011

Infusion pumps, ventilators and oxygen concentrators – complicated medical devices that not long ago you’d find only in a hospital. Not so today. 

Rising health-care costs, an aging population, injured returning veterans and a growing preference to receive care at home – all have driven the delivery of sophisticated health care services into the home. The problem? Placing technologies in settings for which they were not designed is leading to accidents.

Problems range from plugging an infusion pump into a wall incorrectly to forgetting to remove a cap, blocking the flow of medicine. These malfunctions and mistakes have caused serious injuries and, in some cases, death. 

But new research could drive changes across federal agencies to make home care safer. David Wegman, MD, emeritus professor of work environment, chaired a National Research Council committee that investigated existing systems, revealing problems with product design, shortcomings of health information technology and a lack of training for caregivers. 

The committee, which is part of the National Academy of Sciences, released the research results in a new report “Health Care Comes Home: The Human Factors” and presented it in Washington, D.C. to federal agencies and advocacy groups such as AARP.

“The good news is that home health care allows many people to avoid hospitalization and nursing homes,” says Wegman, who has served on a number of National Academy of Sciences committees. “The bad news is that as the home health trend rises, so will the number of problems and complications, unless we make improvements and do a better job of educating caregivers and care receivers.”

One in four U.S. adults, or more than 61 million Americans, cared for an adult family member, partner or friend with a medical condition or disability in 2009, according to AARP.

“The important distinction about our research is that environmental factors must be taken into consideration when designing products and developing training,” says Wegman. “Catheters, electrodes and devices are not being used only in clean open spaces by highly trained clinicians. Rather, the products are being used in homes with pets, clutter, noise and even electric guitar amplifiers and video games – all of which can conflict with medical devices and cause serious harm.”

The committee developed specific actions that the Agency for Healthcare Research and Quality (AHRQ), the U.S. Food and Drug Administration (FDA) and federal housing agencies should take to improve the quality of health care at home. The report is also a valuable resource for residential health care providers and caregivers.

The report recommends that the FDA promote more easily understood instructions for medical devices and for the agency to work with the Office of the National Coordinator for Health Information Technology to regulate, certify and monitor devices and health information technologies. The committee also suggests that advocacy groups and professional service organizations develop training for both professional caregivers and family members.

To read the full report, visit the National Academies Press website.