The Relationship Between Culture of Safety and Rate of Adverse Events in Long-Term Care Facilities

Abstract

The aim of the study was to assess the relationship of culture of safety dimensions and the rate of unanticipated care outcomes in longterm care facilities (LTCFs) using the Agency for Healthcare Research and Quality framework of resident safety culture.Methods: Cross-sectional survey data were collected on 13 dimensions of culture of safety in five LTCFs from registered nurses, licensed practical nurses (LPNs), nursing assistants, administrators/managers, administrative support, and rehabilitation staff. Secondary data on falls in the five LTCFs from quarters 1 to 3 of 2014 were obtained from the Centers for Medicare and Medicaid Services in February 2015. Spearman's ρ and the Generalized Estimating Equations using a log link (Poisson distribution) were used. Results:Communication and feedback about incidences reported the highest mean scores (M = 4.35, SD =0.71). Higher rate of falls was associated with a lower level of team work, lower degree of handoffs, and lower levels of organizational learning. The risk for falls increased as the number of residents per facility increased (rate ratio [RR] = 1.02; 95% confidence interval [CI] = 1.01-1.02) and as the number of LPN hours per resident increased (RR = 37.7, 95% CI = 18.5-76.50). Risk for long stay urinary tract infections increased as number of residents increased (RR =1.01, 95% CI =1.01-1.01). Increase in culture of safety score was associated with decrease in risk of falls, long stay urinary tract infections, and short stay ulcers.Conclusions: With the shortage of registered nurses in LTCFs and new reimbursement regulations, many LTCFs are hiring LPNs to have full staffing and save money. Licensed practical nurses may lack essential knowledge to decrease the rate of falls.

Patient safety culture and obstacles to adverse event reporting in nursing homes

“…Moreover, the relationship between patient safety culture and adverse events in nursing homes remains controversial. Some studies reported that an improvement in safety culture was associated with a decrease in rates of adverse events (Abusalem et al, 2019;Li et al, 2019), but no association found between them in a large national collaborative study (Smith et al, 2018…”

“…The majority of the literature on patient safety culture has focused on hospital settings, with relatively few studies conducted in nursing homes (Gartshore et al., 2017; Weaver et al., 2013). Quantitative surveys have been used in most studies conducted in the long‐term care facilities (Abusalem et al., 2019) or nursing homes (Desmedt, Petrovic, Beuckelaere, & Vandijck, 2018; Lin, Tseng, Hsu, Chiang, & Tseng, 2017; Ree & Wiig, 2019; Titlestad, Haugstvedt, Igland, & Graue, 2018). A few studies have reported on the relationship between patient safety culture and adverse events in nursing homes (Gartshore et al., 2017; Weaver et al., 2013).…”

Culture of Safety: Impact on Improvement in Infection Prevention Process and Outcomes

“…Articles varied considerably in measuring safety culture with respect to instruments, mode of survey administration, timing relative to an intervention (e.g., baseline only or multiple measurements over time), unit of analysis (e.g., hospital-wide or ICU specific), and respondents (e.g., all staff vs only infection prevention leaders). Overall, 39 (70.9%) articles measured safety culture with a standardized tool such as the AHRQ Hospital Survey of Patient Safety Culture (HSOPSC) (n = 16) [47,[64][65][66][67][68][69][70][71][72][73][74][75][76][77][78]; Nursing Home Survey on Patient Safety Culture (NHSPSC) (n = 2) [79,80]; the Safety Attitudes Questionnaire (SAQ) (n = 9) [62,[81][82][83][84][85][86][87]; the National Database of Nursing Quality Indicators (NDNQI) (n = 2) [74,88]; or qualitative methods (n = 4). Not all articles mentioned which safety culture domains were assessed, while some only assessed one domain of safety culture (e.g., teamwork) [78,84].…”

Philippine professional core competencies’ impact on nurses’ key performance indicators (KPIs) for patient safety outcomes

“…Nurse practitioners who often assume leadership functions claimed malpractice errors in public data gathered from the National Practitioner Data Bank (Sweeney et al, 2017). While the culture of safety is inversely proportional with the rate of errors in the clinical setting (Abusalem et al, 2019;Sholl et al, 2019), Kieft et al (2014) asserted the chief significance of quality of healthcare interventions to achieve a worthy patient experience, which a basic advocacy concept among nurses (Abbasinia et al, 2019). As the significant surgeon nurses' demands drastically ensued, the lack of appropriate education and experience is of considerable concern because professional competence constantly emanates from suitable knowledge and executive function (Feliciano et al, 2019;Sousa and Alves, 2015).…”

“…Meanwhile, the 2015 Australian Council of Healthcare Standards (ACHS) Key Performance Indicators (KPIs) for patient safety outcomes include medication safety, infection control, pressure ulcer prevention, fall prevention, and blood management. As disputes on professionalism and safety culture persistently associate with alarming rates of hospital malpractice, a study came into a decision to undertake in determining the impact of these professional core competencies on the identified KPIs for patient safety outcomes (Abusalem et al, 2019;Sholl et al, 2019).…”