title: Safety in the home healthcare sector:  development of a new household safety checklist.
abstract: OBJECTIVE
  Unsafe household conditions could adversely affect safety and quality in home health care. However, risk identification tools and procedures that can be readily implemented in this setting are lacking. To address this need, we developed and tested a new household safety checklist and accompanying training program.
  
  
  METHODS
  A 50-item, photo-illustrated, multi-hazard checklist was designed as a tool to enable home healthcare paraprofessionals (HHCPs) to conduct visual safety inspections in patients' homes. The checklist focused on hazards presenting the greatest threat to the safety of seniors. A convenience sample of 57 HHCPs was recruited to participate in a 1-hour training program, followed by pilot testing of the checklist in their patients' households. Checklist data from 116 patient homes were summarized using descriptive statistics. Qualitative feedback on the inspection process was provided by HHCPs participating in a focus group.
  
  
  RESULTS
  Pretesting and posttesting determined that the training program was effective; participating HHCPs' ability to identify household hazards significantly improved after training (P<0.001). Using the checklist, HHCPs were able to identify unsafe conditions, including fire safety deficiencies, fall hazards, unsanitary conditions, and problems with medication management. Home healthcare paraprofessionals reported that the checklist was easy to use and that inspections were well accepted by patients. Inspections took roughly 20 minutes to conduct.
  
  
  CONCLUSIONS
  Home healthcare paraprofessionals can be effectively trained to identify commonplace household hazards. Using this checklist as a guide, visual household inspections were easily performed by trained HHCPS. Additional studies are needed to evaluate the reliability of the checklist and to determine if hazard identification leads to interventions that improve performance outcomes.
authors.affiliation: Department of Epidemiology and Biostatistics, Philip R Lee Institute for Health Policy Studies, University of California, San Francisco, School of Medicine, San Francisco, California 94118, USA. Robyn.gershon@ucsf.edu
authors.forename: Robyn R M
authors.initials: RR
authors.lastname: Gershon
authors.forename: Maureen
authors.initials: M
authors.lastname: Dailey
authors.forename: Lori A
authors.initials: LA
authors.lastname: Magda
authors.forename: Halley E M
authors.initials: HE
authors.lastname: Riley
authors.forename: Jay
authors.initials: J
authors.lastname: Conolly
authors.forename: Alexis
authors.initials: A
authors.lastname: Silver
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057189:Checklist; D005260:Female; D017144:Focus Groups; D018574:Home Care Agencies / Q000458:organization & administration*; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D018570:Risk Assessment / Q000379:methods*