In an E r a of Re for m: T he Cultur e of Safe ty in L ong T - PowerPoint PPT Presentation

In an E r a of Re for m: T he Cultur e of Safe ty in L ong T e r m Car e F ac ilitie s Sa id Ab usa le m, PhD, RN T imo thy Cra wfo rd, PhD, MPH Ma ry-Be th Co ty, PhD, RN Ba rb a ra Po livka , PhD, RN

Ac knowle dgme nts - T his study wa s suppo rte d b y the Unive rsity o f L o uisville I nte rna l Re se a rc h Gra nts Pro g ra m - T he re se a rc h te a m wo uld like to tha nk a ll a no nymo us pa rtic ipa nts a nd pe rso ns who he lpe d c o nduc t this study: Vic kie T e nc e r Chris Ha nno n Je ssic a Jo ne s

Cultur e of Safe ty  Building a pe rso n-c e nte re d c ulture o f sa fe ty is a c o re e le me nt in impro ving re side nt sa fe ty a nd c a re q ua lity in L T CF s.  An e ffe c tive c ulture o f sa fe ty a ffe c ts re side nts’ c a re e xpe rie nc e s a s we ll a s he a lthc a re wo rke rs’ mo tiva tio n, c o mmitme nt, pro duc tivity, a nd e ffe c tive ne ss.  T e a mwo rk, a ppro pria te sta ffing ra te a nd mix, no n-punitive re spo nse s to mista ke s, a nd e ffe c tive c o mmunic a tio n a nd le a de rship a re a ll pa rt o f a n e ffe c tive c ulture o f sa fe ty.  Cre a ting he a lthy e nviro nme nts tha t c o ntrib ute to pro mo ting o ptima l re side nt a nd sta ff o utc o me s re q uire s o rg a niza tio na l syste ms tha t e mpha size b uilding he a lthy c ulture s o f sa fe ty.

Cultur e of Safe ty- Continue d  I n c o ntra st, to xic wo rkpla c e c ulture s ha ve se rio us c o nse q ue nc e s fo r re side nt o utc o me s a nd sta ff we ll-b e ing . Hig h le ve ls o f sic k le a ve , po o r sta ff re te ntio n, a nd psyc ho lo g ic a l ill he a lth o f e mplo ye e s a re pre va le nt in to xic wo rkpla c e e nviro nme nts.

Adve r se E ve nts in L T CF  Ove r 1.63 millio n Ame ric a ns re side in 18,000 L T CF s.  Se ve ra l studie s ha ve re po rte d hig he r ra te s o f a dve rse e ve nts in L T CF s.  Adve rse e ve nts in L T CF s a re ma inly fa lls a nd pre ssure ulc e rs. T he pre va le nc e o f pre ssure ulc e rs in L T CF s ra ng e s fro m 6% to 25%, de pe nding o n fa c to rs suc h a s sta ff mix, o rg a niza tio na l c o mmitme nt, a nd e nfo rc ing e vide nc e -b a se d g uide line s.  L T CF re side nts fa ll a t a n a nnua l ra te o f 1.7 pe r b e d, with 10% to 25% susta ining se rio us injurie s e ve ntua lly le a ding to de a th. T he re la tio nship b e twe e n a dve rse e ve nts a nd a c ulture o f sa fe ty in L T CF s ha s no t ye t b e e n a de q ua te ly e xplo re d.

Adve r se E ve nts in L T CF - Continue d  L o we r a dve rse e ve nts a nd lo we r mo rta lity ra te s ha ve b e e n a ttrib ute d to a n a ppro pria te RN ra tio in he a lthc a re o rg a niza tio ns.  Altho ug h re se a rc he rs ha ve re c o mme nde d impro ve d c o mmunic a tio n a mo ng L T CF sta ff a s a me tho d o f re duc ing a dve rse e ve nts, limite d re se a rc h is a va ila b le in this a re a .  I t is c ruc ia l in the c urre nt c ha ng ing he a lth c a re e nviro nme nt to ide ntify o rg a niza tio na l fa c to rs tha t a ffe c t a dve rse e ve nts a nd re side nts’ sa fe ty c ulture in L T CF s.

Study Purpo se  Asse ss c ulture o f sa fe ty a nd its re la tio nships with o rg a niza tio na l fa c to rs suc h a s c o mmunic a tio n a nd le a de rship in L T CF s a nd se le c te d a dve rse e ve nts a s fa lls a nd UT I s.

Study Aims  1. I de ntify pre dic to rs o f se le c te d a dve rse e ve nts (fa lls, pre ssure ulc e rs/ wo unds, a nd he a lthc a re a sso c ia te d infe c tio ns).  2. I de ntify o rg a niza tio na l fa c to rs a sso c ia te d with: (a ) re side nts’ sa fe ty c ulture sc o re s, a nd (b ) se le c te d a dve rse e ve nts.  3. E va lua te the re la tio nships o f se le c te d a dve rse e ve nts with: (a ) sta ff turno ve r ra te s, (b ) sta ffing le ve ls, (c ) L T CF dire c to rs’ le a de rship style , a nd (d) c o mmunic a tio n pe rfo rma nc e .

Study De sign and Se tting  T his study use d b o th a c ro ss-se c tio na l surve y de sig n a nd se c o nda ry a na lysis o f e xisting da ta .  Using sta nda rdize d re lia b le a nd va lid instrume nts, he a lthc a re sta ff, inc luding nursing supe rviso rs a nd a dministra to rs, RNs, lic e nse d pra c tic a l nurse s (L PNs), a nd nursing a ssista nts (NAs) in pa rtic ipa ting L T CF s we re surve ye d.  Administra to rs o f a stra tifie d ra ndo m sa mple , 5 o ut o f the 70 e lig ib le L T CF s c o nta c te d a g re e d to pa rtic ipa te a nd pro vide d pe rmissio n fo r the ir fa c ility to pa rtic ipa te .  Se c o nda ry a na lysis o f e xisting da ta fro m the Nursing Ho me Co mpa re We b site wa s c o nduc te d.  Nursing Home Compa re we b site ha s info rma tio n a b o ut the q ua lity o f c a re , a dve rse e ve nts, a nd sta ffing ra tio s pro vide d b y Me dic a re o r Me dic a id fo r c e rtifie d nursing home s thro ug ho ut the na tio n.

Sample  L imiting the sa mple to o nly Me dic a id-c e rtifie d L T CF s e nsure d a ho mo g e no us sa mple with simila r o rg a niza tio na l c ha ra c te ristic s a nd re q uire me nts.  A sa mple o f L T CF s wa s re c ruite d a nd e nro lle d (N = 5).  I nc lusio n c rite ria fo r surve y pa rtic ipa nts we re E ng lish spe a king a nd c urre nt re side nt c a re e mplo ye e s suc h a s nursing supe rviso rs, RNs, L PNs, NAs, SWs, PT s, a nd OT s.

Pr oc e dur e  T ra ine d re se a rc h sta ff visite d the fa c ility during a sc he dule d sta ff me e ting to e xpla in the study a nd re q ue st pa rtic ipa tio n.  T he surve y pa c ke t, inc luding a pre a mb le le tte r de sc rib ing the study, the surve y, a nd a n e nve lo pe we re distrib ute d to a ll re side nt c a re e mplo ye e s o n e ve ry shift.  Re fre shme nts we re pro vide d to sta ff to impro ve the re spo nse ra te .  Re minde r flye rs we re po ste d in a re a s suc h a s sta ff b re a k ro o ms a nd lo c ke r ro o ms fo r o ne mo nth fo llo wing the sta ff me e ting .  Da ta we re c o lle c te d a no nymo usly, pa rtic ipa nts we re pro vide d with a n e nve lo pe to re turn the ir c o mple te d surve y in a study ma il b o x.

Me asur e s  Re side nt safe ty c ultur e . T he Nursing Ho me Surve y o n pe rso n- c e nte re d c ulture o f sa fe ty wa s de ve lo pe d b y AHRQ (2008). Re po rte d Cro nb a c h’ s a lpha s ra ng e d fro m .63 to .84. T he NHSPSC ha s 42 ite ms tha t me a sure 12 c o mpo site s: T e a mwo rk -4 ite ms Ha ndo ffs- 4 ite ms Sta ffing - 4 ite ms F e e db a c k & Co mmunic a tio n Ab o ut I nc ide nts- 4 ite ms Co mplia nc e With Pro c e dure s-3 ite ms Co mmunic a tio n Ope nne ss- 3 ite ms Ove ra ll Pe rc e ptio ns o f Re side nt T ra ining & Skills- 3 ite ms Sa fe ty – 3 ite ms No npunitive Re spo nse to Mista ke s- 4 Ma na g e me nt Suppo rt fo r Re side nt ite ms Sa fe ty – 3 ite ms Supe rviso r E xpe c ta tio ns & Ac tio ns Org a niza tio na l L e a rning - 4 ite ms Pro mo ting Re side nt Sa fe ty- 3 ite ms

F indings  T he 211 re spo nde nts we re : lic e nse d nurse s (27%), nursing a ssista nts (35%), a dministra to rs/ ma na g e rs (8%), a dministra tive suppo rt (3%), a nd re ha b ilita tio n sta ff (13%).  Nine ty-e ig ht pa rtic ipa nts (46%) wo rke d o ve rtime .  T he ma jo rity o f pa rtic ipa nts we re ne utra l (ne ithe r a g re e d no r disa g re e d) with re g a rd to sta te me nts c o nc e rning c o mplia nc e with pro c e dure s, a de q ua te sta ffing le ve ls, a nd no n-punitive re spo nse s to e rro rs.

Spe ar man Cor r e lations among Quality Me asur e s, Staffing Me asur e s, and Patie nt Safe ty Cultur e Subsc ale s Shor t- Stay L ong- stay L ong- Stay L ong- Stay Ulc e r s F alls UT Is Ulc e r s -0.43*** 0.14* 0.54*** Numbe r of Ce rtifie d Be ds -0.43*** 0.14* 0.54*** Numbe r of Re side nts -0.50*** 0.70*** 0.70*** -0.35*** Numbe r of lic e nse d nurse sta ff hours pe r re side nt pe r da y -0.88*** RN hours pe r re side nt pe r da y -0.45*** 0.65*** 0.72*** -0.40*** L PN/ L VN hours pe r re side nt pe r da y 0.48*** 0.23** -0.27*** NA hours pe r re side nt pe r da y 0.32*** 0.40*** Physic a l the ra py sta ff hours pe r re side nt pe r da y -0.15* T ota l Sa fe ty Sc ore -0.12* -0.14* T e a mwork -0.25*** -0.14* Ha ndoffs -0.137* Org a niza tiona l L e a rning *p<0.05 **p<0.001 ***p<0.0001

F inding s- Co ntinue d  Hig he st me a n sc o re s we re fe e db a c k a nd c o mmunic a tio n a b o ut inc ide nts with a me a n o f 4.35 (SD = 0.71), me a n supe rviso r e xpe c ta tio ns a nd a c tio ns pro mo ting re side nt sa fe ty 4.03 (SD = 0.89), a nd me a n sc o re o f o ve ra ll pe rc e ptio ns o f re side nt sa fe ty 4.24 (SD = 0.68). (A sc o re o f 4 = a g re e a nd 5 = stro ng ly a g re e ).  A Spe a rma n's ra nk-o rde r c o rre la tio n wa s run to de te rmine the re la tio nship b e twe e n ra te o f fa lls a nd ha ndo ffs re po rts. T he re wa s a ne g a tive c o rre la tio n b e twe e n ha ndo ffs re po rt a nd ra te o f fa lls rs = -0.247, p<0.0001, a nd the re wa s a ne g a tive re la tio nship b e twe e n ha ndo ffs a nd ra te o f UT I s rs = - 0.143, p<0.05.