Open Access Research article

Examining markers of safety in homecare using the international classification for patient safety

Marilyn T Macdonald1*, Ariella Lang2, Janet Storch3, Lynn Stevenson4, Tanya Barber5, Kristine Iaboni6 and Susan Donaldson7

Author Affiliations

1 School of Nursing, Faculty of Health Professions, Dalhousie University, 5869 University Avenue, PO Box, 15000, Halifax, Nova Scotia, B3H 4R2, Canada

2 VON Canada, 110 Argyle Avenue, Ottawa, Ontario, K2P 1B4, Canada

3 School of Nursing, University of Victoria, STN CSC, PO Box 1700, Victoria, British Columbia, V8W 2Y2, Canada

4 Vancouver Island Health Authority, 1952 Bay Street, Victoria, British Columbia, V8R 1J8, Canada

5 School of Nursing, Faculty of Health Professions, Dalhousie University, 5869 University Avenue, PO Box, 15000, Halifax, Nova Scotia, B3H 4R2, Canada

6 Department of Educational Psychology, Faculty of Graduate Studies, University of Alberta, 6-102 Education North Edmonton, Alberta, 11, T6G 2G5, Canada

7 Canadian Home Care Association, 7111 Syntax Drive 3rd Floor, Mississauga, Ontario, LON 8C3, Canada

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BMC Health Services Research 2013, 13:191  doi:10.1186/1472-6963-13-191

Published: 24 May 2013



Homecare is a growth enterprise. The nature of the care provided in the home is growing in complexity. This growth has necessitated both examination and generation of evidence around patient safety in homecare. The purpose of this paper is to examine the findings of a recent scoping review of the homecare literature 2004-2011 using the World Health Organization International Classification for Patient Safety (ICPS), which was developed for use across all care settings, and discuss the utility of the ICPS in the home setting. The scoping review focused on Chronic Obstructive Pulmonary Disease (COPD), and Congestive Heart Failure (CHF); two chronic illnesses commonly managed at home and that represent frequent hospital readmissions. The scoping review identified seven safety markers for homecare: Medication mania; Home alone; A fixed agenda in a foreign language; Strangers in the home; The butcher, the baker, the candlestick maker; Out of pocket: the cost of caring at home; and My health for yours: declining caregiver health.


The safety markers from the scoping review were mapped to the 10 ICPS high-level classes that comprise 48 concepts and address the continuum of health care: Incident Type, Patient Outcomes, Patient Characteristics, Incident Characteristics, Contributing Factors/Hazards, Organizational Outcomes, Detection, Mitigating Factors, Ameliorating Actions, and Actions Taken to Reduce Risk.


Safety markers identified in the scoping review of the homecare literature mapped to three of the ten ICPS classes: Incident Characteristics, Contributing Factors, and Patient Outcomes.


The ICPS does have applicability to the homecare setting, however there were aspects of safety that were overlooked. A notable example is that the health of the caregiver is inextricably linked to the wellbeing of the patient within the homecare setting. The current concepts within the ICPS classes do not capture this, nor do they capture how care responsibilities are shared among patients, caregivers, and providers.