Abstract
Objectives
Adverse events in nursing homes are leading causes of morbidity and mortality, prompting
facilities to investigate their antecedents. This study examined the contribution
of safety climate—how frontline staff typically think about safety and act on safety
issues—to adverse events in Veterans Affairs (VA) nursing homes or Community Living
Centers (CLCs).
Design
Cross-sectional study.
Setting and Participants
A total of 56 CLCs nationwide, 1397 and 1645 CLC staff (including nurses, nursing
assistants, and clinicians/specialists), respectively, responded to the CLC Employee
Survey of Attitudes about Resident Safety (CESARS) in 2017 and 2018.
Methods
Adverse events (pressure ulcers, falls, major injuries from falls, and catheter use)
were measured using the FY2017-FY2018 Minimum Data Set (MDS). Safety climate was defined
as 7 CESARS domains (safety priorities, supervisor commitment to safety, senior management
commitment to safety, personal attitudes toward safety, environmental safety, coworker
interactions around safety, and global rating of CLC). The associations between safety
climate domains and each adverse event were determined separately for each frontline
group, using beta-logistic regression with random effects.
Results
Better ratings of supervisor commitment to safety were associated with lower rates
of major injuries from falls [odds ratio (OR) 0.33, 95% confidence interval (CI) 0.11-0.97,
clinicians] and catheter use (OR 0.42, 95% CI 0.21-0.85, nurses), and better ratings
of environmental safety were associated with lower rates of pressure ulcers (OR 0.23,
95% CI 0.09-0.61, clinicians), major injuries from falls (OR 0.48, 95% CI 0.24-0.93,
nurses), and catheter use (OR 0.55, 95% CI 0.32-0.93, nursing assistants). Better
global CLC ratings were associated with higher rates of catheter use. No other safety climate domains had significant associations.
Conclusions and Implications
Nursing homes may reduce adverse events by fostering supportive supervision of frontline
staff and a safer physical environment.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the American Medical Directors AssociationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Defining safety in the nursing home setting: Implications for future research.J Am Med Dir Assoc. 2016; 17: 473-481
- Nursing home safety: Current issues and barriers to improvement.Annu Rev Public Health. 2008; 29: 369-382
- Patient safety climate in US hospitals: Variation by management level.Med Care. 2008; 46: 1149-1156
- Nursing home senior managers and direct care staff: Are there differences in their perceptions of safety climate?.J Patient Saf. 2019 Feb 9; ([Epub ahead of print])
- An exploration of safety climate in nursing homes.J Patient Saf. 2012; 8: 104-124
- Measuring administrators' and direct care workers' perceptions of the safety culture in assisted living facilities.Jt Comm J Qual Patient Saf. 2012; 38: 375-382
- Certified nursing assistants' perceptions of nursing home patient safety culture: Is there a relationship to clinical outcomes?.J Am Med Dir Assoc. 2009; 10: 11-20
- Patient safety culture and the association with safe resident care in nursing homes.Gerontologist. 2012; 52: 802-811
- Relationship of safety climate and safety performance in hospitals.Health Serv Res. 2009; 44: 399-421
- The association of patient safety climate and nurse-related organizational factors with selected patient outcomes: A cross-sectional survey.Int J Nurs Stud. 2013; 50: 240-252
- Relationship of hospital organizational culture to patient safety climate in the Veterans Health Administration.Med Care Res Rev. 2009; 66: 320-338
- Organizational readiness to change assessment (ORCA): Development of an instrument based on the Promoting Action on Research in Health Services (PARIHS) framework.Implement Sci. 2009; 4: 38
- Base SAS(R) 9.2 Procedures Guide. 2010.(Available at:)https://support.sas.com/documentation/cdl/en/proc/61895/HTML/default/viewer.htm#standard-overview.htmDate accessed: December 11, 2019
- Relationship between quality of care and negligence litigation in nursing homes.N Engl J Med. 2011; 364: 1243-1250
- Perceptions of safety at work: A framework for linking safety climate to safety performance, knowledge, and motivation.J Occup Health Psychol. 2000; 5: 347-358
- The role of time pressure and different psychological safety climate referents in the prediction of nurses’ hand hygiene compliance.Saf Sci. 2016; 82: 29-43
- How does clinical supervision work? Using a “best evidence synthesis” approach to construct a basic model of supervision.Clin Superv. 2008; 27: 170-190
- A systematic review: The effect of clinical supervision on patient and residency education outcomes.Acad Med. 2012; 87: 428-442
- State of the science: Relationship-oriented management practices in nursing homes.Nurs Outlook. 2011; 59: 221-227
- Effective supervision in clinical practice settings: A literature review.Med Educ. 2000; 34: 827-840
- Falls in the nursing home: Are they preventable?.J Am Med Dir Assoc. 2006; 7 (52): S53-S58
- Implementation of fall prevention in residential care facilities: A systematic review of barriers and facilitators.Int J Nurs Stud. 2017; 70: 110-121
- Promoting a culture of safety as a patient safety strategy: A systematic review.Ann Intern Med. 2013; 158: 369-374
- Strategies for improving patient safety culture in hospitals: A systematic review.BMJ Qual Saf. 2013; 22: 11-18
- Strategies to prevent catheter-associated urinary tract infections in acute care hospitals.Infect Control Hosp Epidemiol. 2008; 29: S41-S50
- Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: An integrative review.BMJ Qual Saf. 2014; 23: 277-289
- Accuracy of nursing home medical record information about care-process delivery: Implications for staff management and improvement.J Am Geriatr Soc. 2004; 52: 1378-1383
- Assessment of nursing home reporting of major injury falls for quality measurement on nursing home compare.Health Serv Res. 2020; 55: 201-210
- Interventions for preventing falls in older people in care facilities and hospitals.Cochrane Database Syst Rev. 2018; 9: CD005465
- Comprehensive programs for preventing pressure ulcers: A review of the literature.Adv Skin Wound Care. 2012; 25 (quiz 189-190): 167-188
- Preventing in-facility pressure ulcers as a patient safety strategy: A systematic review.Ann Intern Med. 2013; 158: 410-416
- Is a pressure ulcer a marker for quality of care?.J Am Med Dir Assoc. 2005; 6: 228-230
- The influence of organizational tenure on safety climate strength: A first look.Accid Anal Prev. 2010; 42: 1431-1437
Article info
Publication history
Published online: July 19, 2020
Footnotes
The project described was supported by award number IIR 13-343 from the Health Services Research and Development Service of the VA Office of Research and Development. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government.
The authors declare no conflicts of interest.
Identification
Copyright
© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
