Patient Safety Culture and the Association with Safe Resident Care in Nursing Homes.

Center for Gerontology and Healthcare Research, Brown University, Box G-S121(6), Providence, RI 02912. .
The Gerontologist (Impact Factor: 2.48). 03/2012; DOI: 10.1093/geront/gns007
Source: PubMed

ABSTRACT Purpose of the study:Studies have shown that patient safety culture (PSC) is poorly developed in nursing homes (NHs), and, therefore, residents of NHs may be at risk of harm. Using Donabedian's Structure-Process-Outcome (SPO) model, we examined the relationships among top management's ratings of NH PSC, a process of care, and safety outcomes. DESIGN AND METHODS: Using top management's responses from a nationally representative sample of 3,557 NHs on the 2008 Nursing Home Survey on PSC, the Online Survey, Certification, and Reporting Database, and the Minimum Data Set, we examined the relationships among the three components of Donabedian's SPO model: structure (PSC), a process of care (physical restraints), and patient safety outcomes (residents who fell). RESULTS: Results from generalized estimating equations indicated that higher ratings of PSC were significantly related to lower prevalence of physical restraints (odds ratio [OR] = 0.997, 95% confidence interval [CI] = 0.995-0.999) and residents who fell (OR = 0.999, 95% CI = 0.998-0.999). Physical restraint use was related to falls after controlling for structural characteristics and PSC (OR = 1.698, 95% CI = 1.619-1.781). IMPLICATIONS: These findings can contribute to the development of PSC in NHs and promote improvements in health care that can be measured by process of care and resident outcomes.

Download full-text


Available from: Kathryn Hyer, Jun 23, 2015
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Abstract The prevention of falls is a key safety priority for hospitals. There are no tools that examine the safety climate from a falls prevention perspective. The aim of this study was to measure the falls prevention safety climate at an Australian metropolitan hospital. The Victorian Safety Climate Survey (SCS) was used to examine the general safety climate, with four items replicated and modified to examine the falls prevention climate. Data (n = 458) for the six SCS domains compared favourably with statewide data. The falls prevention items were correlated with the original items from which they were derived but responses regarding falls prevention tended to be less positive than patient safety more broadly. Priorities for improvement identified using a falls safety climate survey can inform the development of falls prevention strategies and form the basis of a more comprehensive tool to explore the falls prevention safety climate.
    Contemporary nurse: a journal for the Australian nursing profession 02/2014; 47(1-2). DOI:10.5172/conu.2013.4340 · 0.65 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Increased awareness regarding the importance of patient safety issues has led to the proliferation of theoretical conceptualizations, frameworks, and articles that apply safety experiences from high-reliability industries to medical settings. However, empirical research on patient safety and patient safety climate in medical settings still lags far behind the theoretical literature on these topics. The broader organizational literature suggests that ease of reporting, unit norms of openness, and participative leadership might be important variables for improving patient safety. The aim of this empirical study is to examine in detail how these three variables influence frontline staff perceptions of patient safety climate within health care organizations. A cross-sectional study design was used. Data were collected using a questionnaire composed of previously validated scales. The results of the study show that ease of reporting, unit norms of openness, and participative leadership are positively related to staff perceptions of patient safety climate. Health care management needs to involve frontline staff during the development and implementation stages of an error reporting system to ensure staff perceive error reporting to be easy and efficient. Senior and supervisory leaders at health care organizations must be provided with learning opportunities to improve their participative leadership skills so they can better integrate frontline staff ideas and concerns while making safety-related decisions. Finally, health care management must ensure that frontline staff are able to freely communicate safety concerns without fear of being punished or ridiculed by others.
    Health care management review 12/2013; 40(1). DOI:10.1097/HMR.0000000000000005 · 1.30 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose of the Study:This study evaluates a nursing home Fall Management program to see if residents' mobility increased and injurious falls decreased. DESIGN AND METHODS: Administrative health care use and fall occurrence report data were analyzed from 2 rural health regions in Manitoba, Canada, from June 1, 2003 to March 31, 2008. A quasiexperimental, pre-post, comparison group design was used to compare rates of three outcomes, falls, injurious falls, and falls resulting in hospitalization, by RHA (program vs nonprogram nursing homes) and period (preprogram vs postprogram). Data collectors entered occurrence report information into spreadsheets. This was supplemented with administrative health care use data. RESULTS: The program appears to have benefitted residents-falls trended upward, injurious falls remained stable, and hospitalized falls decreased significantly (0.036-0.021 per person-year [ppy]; p = .043). Compared with nonprogram residents in the postperiod, both groups had the same fall rate, but program residents had significantly fewer injurious falls (0.596-0.746 ppy; p = .02) and hospitalized falls (0.02-0.041 ppy; p = .023). IMPLICATIONS: These results are among a small body of literature showing that Fall Management was associated with improved outcomes in program nursing homes from pre- to postperiod and compared with nonprogram nursing homes. This research provides some support for the benefits of being proactive and implementing injury prevention strategies universally and pre-emptively before a resident falls, helping to minimize injuries while keeping residents mobile and active. Larger scale research is needed to identify the true effectiveness of the Fall Management program and generalizability of results.
    The Gerontologist 01/2013; 53(5). DOI:10.1093/geront/gns197 · 2.48 Impact Factor