Safety Climate Associated With Adverse Events in Nursing Homes: A National VA Study

Area of Science:

• Healthcare quality and safety research.
• Geriatric care and nursing home management.
• Patient safety and risk management.

Background:

• Adverse events in nursing homes contribute significantly to patient morbidity and mortality.
• Investigating the root causes of these events is crucial for improving care.
• Safety climate, encompassing staff perceptions and actions regarding safety, is a key area for study.

Purpose of the Study:

• To examine the relationship between safety climate and adverse events in Veterans Affairs (VA) Community Living Centers (CLCs).
• To identify specific safety climate domains that influence the occurrence of adverse events among frontline staff.

Main Methods:

• A cross-sectional study involving 56 VA CLCs nationwide.
• Data collected from 1397 and 1645 staff members in 2017 and 2018 via the CLC Employee Survey of Attitudes about Resident Safety (CESARS).
• Adverse events (pressure ulcers, falls, major fall injuries, catheter use) measured using Minimum Data Set (MDS) data; safety climate assessed through 7 CESARS domains; statistical analysis using beta-logistic regression.

Main Results:

• Enhanced supervisor commitment to safety was linked to fewer major fall injuries and reduced catheter use among clinicians and nurses.
• Improved environmental safety ratings correlated with lower rates of pressure ulcers and major fall injuries.
• Positive environmental safety perceptions also reduced catheter use among nursing assistants.

Conclusions:

• Fostering a supportive supervisory environment and a safe physical setting in nursing homes can mitigate adverse events.
• Targeted interventions focusing on supervisor commitment and environmental safety may improve resident outcomes.
• Safety climate is a modifiable factor that can enhance the quality of care in long-term facilities.