Defining Safety in the Nursing Home Setting: Implications for Future Research

Area of Science:

• Gerontology
• Healthcare Quality Improvement
• Patient Safety

Background:

• The Agency for Healthcare Research and Quality (AHRQ) Common Format for nursing homes (NHs) currently tracks four voluntary adverse events: falls with injury, pressure ulcers, medication errors, and infections.
• A 2015 technical brief highlighted the need for a research agenda on NH safety, evaluating 36 systematic reviews on interventions for these four events.

Purpose of the Study:

• To identify limitations in current NH safety reporting and propose future research directions.
• To address the inadequacy of existing adverse event categories in capturing NH-specific safety issues.
• To inform a research agenda for improving safety and quality of life in nursing home residents.

Main Methods:

• Systematic review of 36 recent reviews on NH safety-related interventions.
• Analysis of the state of the science regarding safety in the NH setting.
• Identification of gaps in current research and reporting.

Main Results:

• Evidence for interventions addressing the four common adverse events in NHs is mostly mixed.
• Current reporting formats are insufficient to capture the full spectrum of safety issues unique to NHs.
• Implementation science weaknesses hinder the understanding of intervention effectiveness and achievable outcomes.

Conclusions:

• Future research must broaden the definition of safety in NHs to include contributing factors and resident-centered measures.
• Rigorous implementation science, including objective process measures and staffing analyses, is crucial for advancing NH safety.
• Research should also explore safety in other settings for older adults, such as assisted living dementia care.