Karen Curtin – Head of Quality and Patient Safety at TCP Homecare – explains how the company has built up a culture of patient care and safety in the home and how it works to improve its standards and services on an ongoing basis
Delivering hospital-based care directly to the homes of patients has become more important now than ever before. Since March 2020 there has been an increased demand for home and community-based care. During this time TCP Homecare have continued to support patients of all ages by providing hospital-based treatments directly to their homes. Some of these treatments include IV antibiotics, wound care, catheter care, medication management, chemotherapy and a pharmaceutical dispensing and delivery service.
As healthcare delivery methods change, in an era where virtual clinics and video calls with GPs are increasingly implemented, we too are enabling remote care to patients while delivering documented records of care directly to the referring team.
Care pathways have been developed with defined inclusion criteria. Risk is minimised during transition of care as our team of clinical staff review each patient referral against the approved care pathways.
Our community nurses are highly trained to deal with medical emergencies, but also trained in monitoring medical conditions and reporting back to the referring teams. Additionally, each real-time report for the episodes of care are reviewed by our senior nursing team. This adds further oversight by recognising signs that may indicate a deteriorating patient by reviewing trends in wound care, pressure sores or signs of sepsis. Clear communication with the referring team in a standardised manner is paramount.
Further onward support is provided by our recently developed homecare app, 24-hour emergency nurse lines and and also certain care pathways will include additional phone calls to patients between scheduled visits.
My background in home care
Having qualified with a degree in Biochemistry from NUI Galway, my career began in diagnostic and pharmaceutical manufacturing sites. It was during this time that I developed an advanced understanding of regulation, lean procedures and good documentation practices in laboratory environments. My progression to clinical healthcare began initially in hospital pathology, and then on to quality and patient safety roles.
I spent two years as a Manager in the Quality and Patient Safety department in a Level 4 Hospital in Dublin which is JCI (Joint Commission International) Accredited, thereby independently assessed for the quality of care that is provided. Being that step closer to patient care was initially a considerable change from pharmaceutical manufacturing, but I knew it was where I wanted to be.
Quality Standards at TCP Homecare
At TCP Homecare, my role as Head of Quality and Patient Safety spans all areas of the organisation – nursing, pharmacy, logistics, patient care, waste management, medicinal storage and transportation.
As the Responsible Person (RP) for the site, I also maintain responsibility for the quality of our pharmaceutical supply chain activities in line with good distribution practice.
TCP Homecare began primarily as a distribution and pharmacy business, with our Quality Management System (QMS) built on the strong regulatory foundation of Good Distribution Practice (GDP) and the Pharmaceutical Society of Ireland pharmacy regulation. Over the years our community nursing activities has become our predominant activity, and our Quality Management System (QMS) now incorporates healthcare standards including HIQA Standards and HSE Guidelines.
We have maintained our ISO 9001:2015 Standard (Quality Management Systems) and in the last five years have been awarded and maintained certification to ISO:15224:2016 Quality Management Systems in Healthcare.
Our quality team work, not only to regulatory and accreditation standards, but also to ensure that we meet the needs of our clients and patients too. We achieve this by standardising the highest level of care across our processes.
Our Clinical Governance Structure, which is chaired by our Clinical Medical Director, ensures that our innovative approach to healthcare in the home is risk assessed, guaranteeing the highest level of safety and quality of care is delivered in any new or existing service we provide. Our quality standards and commitment to patient safety means that we are a trusted partner of the HSE, and of multiple pharmaceutical organisations with which we work closely in the delivery of care in the community.
TCP Homecare is a company that has always put the patient first. When I started with TCP Homecare, we were a team of just 13. Now the company has over 200 employees, yet that culture has remained unchanged.
The patient’s transition to the home environment is designed to be straightforward and easy for the referring team, the patient, and also their family or carer(s). Behind the scenes, our teams are busy ensuring this transfer takes place in a safe manner. For example, on-time deliveries of dispensed medicinal products, delivery of laboratory grade fridges for storage of medicines, serviced and calibrated medical devices in line with manufacturers guidelines, collection and onward destruction of clinical and sharps waste. All these activities ensure that the standard of care that would be expected for inpatient care is maintained.
Through all this, we are sensitive to patients’ confidentiality and data protection – our delivery vans and nurses’ vehicles are unmarked to protect patient confidentiality, and our patient care teams will only speak with the patient or nominated next-of-kin by phone.
Our staff, too, are trained on safeguarding, lone-working and consent processes.
A survey of our patients in 2020 showed that 94% of our patients on our home IV antibiotics service rated our standard of care as ‘excellent’ and all those surveyed stated that they would prefer this treatment to inpatient care.
Many patients have also reported reduced anxiety whilst undergoing their treatment at home, and as such, we receive many thank-you cards and frequent positive feedback from our patients. Where treatment is suitable for home environments, patients’ satisfaction is high, due to the convenience and comfort of being treated at home, sleeping in their own beds, eating home cooked food and being with their loved ones. It also increases the patient’s and family’s ability to function independently. Staying in hospital can be stressful – so too is the impact on ability to work or arranging childcare.
But it’s not just patients that value the transfer of activities into the community; our HSE colleagues and referrers have welcomed and commended our services, which have helped to support the transition of services out of the acute setting and into the communities of the patients that we serve.
Quality Improvement and Measurement
Our investment in our staff and systems remains a key focus. We recently measured the patient safety culture at TCP Homecare. Overwhelmingly, our teams stated that they would freely speak up if they saw something that may negatively affect patient care. And of course, the effort cannot end there – we need to continue to support our staff and patients by learning from incidents.
We are currently investing in an electronic incident and risk management system, in line with those recently adopted by acute hospitals in Ireland. This will ensure that staff have a readily accessible and simple system to report any errors or near miss events at any time on their mobile devices.
The expectation is that delivery of care will continue to shift away from the hospital setting. The demographics of an aging society will require many supports to aid our health system, and the trend toward home care will continue.
And TCP Homecare will continue to bring hospital care home.
Advertorial: In association with TCP Homecare.