Abstract
The objective of this study is redesigning quality and safety of care in Nursing Homes (NH), through a participatory approach based on human factors and ergonomics principles and techniques. We started with an in-deep qualitative analysis of daily practices in 4 nursing homes, selected on the basis of their performance (good and bad) and location (urban and rural). Then we performed on-site observations and ethnographic interviews with workers and patients. To conduct the explicit, non-participant observations, an original grid was developed, inspired by the definition and dimensions of quality. The crude notes of observations were subsequently re-aggregated on the grid by themes and dimensions of the observation scheme, then subjected to expert reviewers who evaluated weaknesses and strengths. According to experts’ review, the most relevant safety related themes are infections and falls prevention, quality of nutrition, behavioural disorders and management of emergencies. On the basis of the elaboration of data, we then designed a multidimensional intervention encompassing interactive training sessions, scenario based redesign of weak care processes, supervision and feedback to front-line workers and management. A follow-up session is scheduled to monitor progress on site and provide feedback, as well as an evaluation of sensitive indicators at the intervention sites compared to the regional benchmark. Pilot study shows feasability of the intervention and active participation of the involved workers.
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References
Castle NG, Sonon KE (2006) A culture of patient safety in nursing homes. Qual Saf Health Care 15(6):405–408
Masotti P, McColl MA, Green M (2010) Adverse events experienced by homecare patients: a scoping review of the literature. Int J Qual Health Care 22(2):115–125
Gartshore E, Waring J, Timmons S (2017) Patient safety culture in care homes for older people: a scoping review. BMC Health Serv Res 17(1):1–11
Panagioti M, Blakeman T, Hann M, Bower P (2017) Patient-reported safety incidents in older patients with long-term conditions: a large cross-sectional study. BMJ Open 7(5):1–9
Simmons S, Schnelle J, Slagle J, Sathe NA, David Stevenson M, Carlo M et al (2016) Resident safety practices in nursing home settings. Agency for Healthcare Research and Quality, Rockville
Rust TB, Wagner LM, Hoffman C, Rowe M, Neumann I (2008) Broadening the patient safety agenda to include safety in long-term care. Healthc Q 11:31–34
Ouslander JG, Lamb G, Perloe M, Givens JH, Kluge L, Rutland T et al (2010) Potentially avoidable hospitalizations of nursing home residents: frequency, causes, and costs. J Am Geriatr Soc 58(4):627–635
Saliba D, Kington R, Buchanan J, Bell R, Wang M, Lee M et al (2000) Appropriateness of the decision to transfer nursing facility residents to the hospital. J Am Geriatr Soc 48(2):154–163
Waal GHD, Naber T, Schoonhoven L, Persoon A, Sauerwein H, Van Achterberg T (2006) Problems experienced by patients receiving parenteral nutrition at home: results of an open interview study. J Parenter Enteral Nutr 30(3):215–221
Shirotani N, Iino T, Numata K, Kameoka S (2006) Complications of central venous catheters in patients on home parenteral nutrition: an analysis of 68 patients over 16 years. Surg Today 36(5):420–424
Wagner LM, Rust T (2008) Safety in long-term care settings: broadening the patient safety agenda to include long-term care services. Canadian Patient Safety Institute
Wang KN, Bell JS, Chen EYH, Gilmartin-Thomas JFM, Ilomäki J (2018) Medications and prescribing patterns as factors associated with hospitalizations from long-term care facilities: a systematic review. Drugs Aging 26:1–35
Lim RHM, Anderson JE, Buckle PW (2016) Work domain analysis for understanding medication safety in care homes in England: an exploratory study. Ergonomics 59(1):15–26
Alldred DP, Standage C, Fletcher O, Savage I, Carpenter J, Barber N et al (2011) The influence of formulation and medicine delivery system on medication administration errors in care homes for older people. BMJ Qual Saf 20(5):397–401
Tariq A, Georgiou A, Westbrook J (2012) Medication incident reporting in residential aged care facilities: limitations and risks to residents’ safety. BMC Geriatr 12(1):67
Axelsson J, Elmstahl S (2004) Home care aides in the administration of medication. Int J Qual Health Care 16(3):237–243
Silvestre JH, Bowers BJ, Gaard S (2015) Improving the quality of long-term care. J Nurs Regul [Internet] 6(2):52–56. Elsevier Masson SAS
Specht JK (2013) Evidence based practice in long term care settings. J Korean Acad Nurs 43(2):145–153
Sohn M, Choi M (2017) Factors related to healthcare service quality in long-term care hospitals in South Korea: a mixed-methods study. Osong Public Health Res Perspect 8(5):332–341
Shin JH, Hyun TK (2015) Nurse staffing and quality of care of nursing home residents in Korea. J Nurs Scholarsh 47(6):555–564
Curatolo N, Gutermann L, Devaquet N, Roy S, Rieutord A (2014) Reducing medication errors at admission: 3 cycles to implement, improve and sustain medication reconciliation. Int J Clin Pharm 37(1):113–120
Arnoldo L, Cattani G, Cojutti P, Pea F, Brusaferro S (2016) Monitoring polypharmacy in healthcare systems through a multi-setting survey: should we put more attention on long term care facilities? J Public Health Res 5(3):104–108
Institute of Medicine (2001) Crossing the quality chasm: a new health system for the 21th century. National Academy Press, Washington, DC
Vaughn T, Koepke M, Kroch E, Lehrman W, Sinha S, Levey S (2006) Engagement of leadership in quality improvement initiatives: executive quality improvement survey results. J Patient Saf 2(1):2–9
World Health Organization (2006) Quality of care: a process for making strategic choices in health systems. World Health Organization, Geneva
Hutchins E (1995) Cognition in the wild. Massachusetts Institute of Technology Press, Cambridge
Nuti S, Rosa A, Trambusti B (2014) La mappatura delle residenze per anziani non autosufficienti in Toscana- Report 2014. Laboratorio Management & Sanità, Scuola Superiore Sant’Anna, Pisa
ARS Toscana (2014) Progetto ministeriale CCM: qualità e sicurezza
Castle NG, Ferguson, JC (2010) What is nursing home quality and how is it measured? Gerontologist 50(4): 426–442
Mor V, Berg K, Angelelli J, Gifford D, Morris J, Moore T (2003) The quality of quality measurement in US nursing homes. Gerontologist 43:S237–S246
McHugh M, Shi Y, Ramsay PP, Harvey JB, Casalino LP, Shortell SM, et al (2016) Patient-centered medical home adoption: results from aligning forces for quality. Health Affairs 35(1):141–149
Corbetta P (1999) Metodologia e tecniche della ricerca sociale. Il Mulino
Vincent C, Taylor-Adams S, Chapman EJ, Hewett D, Prior S, Strange P et al (2000) How to investigate and analyse clinical incidents: clinical risk unit and association of litigation and risk management protocol. BMJ 320:777
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Lefosse, G. et al. (2019). An Action Research for Patient Safety and Service Quality in Nursing Homes. In: Bagnara, S., Tartaglia, R., Albolino, S., Alexander, T., Fujita, Y. (eds) Proceedings of the 20th Congress of the International Ergonomics Association (IEA 2018). IEA 2018. Advances in Intelligent Systems and Computing, vol 818. Springer, Cham. https://doi.org/10.1007/978-3-319-96098-2_85
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