HRQ Effective Health Care Technical Brief

Angie Szumlinski
August 4, 2016

Resident Safety Practices in
Nursing Home Settings Structured Abstract


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Background. Resident
safety issues are common in nursing homes. Relevant literature reports a range
of poor clinical outcomes thought to be preventable if specific care processes
were consistently implemented.

Purpose. To
describe the state of the science around nursing home safety in order to
establish a research agenda for moving the field forward.

Findings. Key
safety issues as defined by Agency for Healthcare Research and Quality Common
Format criteria are adverse events such as falls, pressure ulcers, infection,
and medication errors/adverse drug events, including inappropriate use.
Thirty-six recent systematic reviews evaluated nursing home safety-related
interventions to address these issues.

Evidence is lacking on the
degree to which national uptake of efficacious interventions targeting adverse
events or factors that may lead to adverse events has occurred, with barriers
including staffing costs needed to implement the interventions and low-quality
evidence. Little evidence suggests that hospitals have significantly improved
safety in many domains that are important to care of nursing home residents,
whose vulnerability and complexity make them markedly different from most
hospital patients.

Future research needs include
defining safety in the nursing home context, which differs considerably from
that of hospitals. Defining safety must take into account the context of care
and the interplay of resident characteristics and needs within the context of
staffing and programmatic decisions that are influenced by various payment and
regulatory models. Future research should also address understanding the
relationship between adherence to quality-of-life and person-centered care
standards and incidence of some types of adverse events, overcoming barriers to
implementing proven interventions, and improving safety event reporting.

Nursing homes must find the
balance between preserving person-centeredness and resident autonomy while
ensuring safety, quality of care, and quality of life for residents. Overall,
safety outcomes per se have not been well studied in nursing homes; however,
outcomes associated with quality of care and, in some cases, quality of life
have been studied, and those outcomes may be inexorably linked to safety
outcomes. These negative outcomes related to (and potentially contributing to)
negative safety outcomes include catheter left in bladder and physical vi
restraints, as well as documented conditions, including unintentional weight
loss, decline in activities of daily living, fecal/urinary incontinence,
depressive symptoms, and pain

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