Interventions Within the Scope of Occupational Therapy to Address Preventable Adverse Events in Inpatient and Home Health Postacute Care Settings: A Systematic Review

Author:

Hunter Elizabeth G.1,Rhodus Elizabeth2

Affiliation:

1. Elizabeth G. Hunter, PhD, OTR/L, is Assistant Professor, Graduate Center for Gerontology, College of Public Health, University of Kentucky, Lexington; beth.hunter2@uky.edu

2. Elizabeth Rhodus, PhD, OTR, is Postdoctoral Fellow, Sanders-Brown Center on Aging, College of Medicine, University of Kentucky, Lexington.

Abstract

Importance: Practitioners need to be familiar with, and involved in, managing quality-related adverse events in postacute care. Objective: To determine interventions within the scope of occupational therapy that address preventable adverse events in adult postacute inpatient and home health settings. Data Sources: Articles published from January 1995 through 2019 identified through searches of MEDLINE, PsycINFO, CINAHL, OTseeker, and Cochrane databases. Study Selection and Data Collection: Articles were collected, evaluated, and analyzed by two independent reviewers. They were assessed and synthesized with a goal of informing clinical practice. Findings: Twenty-four articles were included in the review. Of the 10 Centers for Medicare & Medicaid Services preventable adverse events, 6 were addressed: diabetes management (n = 2), dysphagia (n = 5), infection control (n = 1), pressure ulcers (n = 6), falls (n = 5), and discharge management (n = 5). There was strong strength of evidence that exercise programs should, when appropriate, be implemented in both inpatient and home health settings to decrease the risk of falls. There was moderate strength of evidence that practitioners could consider implementing a facility wide evidence-based pressure ulcer program; providing multidisciplinary rehabilitation and swallow strengthening exercises for dysphagia; implementing a multidisciplinary, multicomponent falls program; and using a manualized depression intervention in home health to decrease hospital readmission. Conclusions and Relevance: The review highlights the importance of preventable adverse events and of occupational therapy practitioners acknowledging and managing these events to enhance health outcomes and to control health care costs. What This Article Adds: Many interventions typically performed by occupational therapy practitioners address preventable adverse events. The review highlights the importance of practitioners being aware of this category of impairment or injury.

Publisher

AOTA Press

Subject

Occupational Therapy

Reference52 articles.

1. Agency for Healthcare Research and Quality. (2019, September7). Patient safety primer: Adverse events, near misses and errors. https://psnet.ahrq.gov/primer/adverse-events-near-misses-and-errors

2. Agency for Healthcare Research and Quality. (2020). Section 4: Ways to approach the quality improvement process. https://www.ahrq.gov/cahps/quality-improvement/improvement-guide/4-approach-qi- process/index.html

3. American Occupational Therapy Association. (2020). OT Home Health Evaluation Checklist and Quality Measures. https://www.aota.org/∼/media/Corporate/Files/Practice/Manage/value/Home-Health- Eval-Checklist.pdf

4. Aspden, P., Corrigan, J. M., Wolcott, J., & Erickson, S. M. (Eds.). (2009). Patient safety: Achieving a new standard for care. National Academies Press. www.nap.edu/openbook.php?record_id=10863&page=R1

5. “Never events” and the quest to reduce preventable harm;Austin;Joint Commission Journal on Quality and Patient Safety,2015

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