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

Authors' recommendations: 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 restraints, as well as documented conditions, including unintentional weight loss, decline in activities of daily living, fecal/urinary incontinence, depressive symptoms, and pain.

Project Status: Completed

Year Published: 2016

URL for published report: https://www.effectivehealthcare.ahrq.gov/ehc/products/621/2224/nursing-home-safety-report-160510.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)