title: Defining Safety in the Nursing Home Setting: Implications for Future Research.
abstract: Currently, the Agency for Healthcare Research and Quality (AHRQ) Common Format for nursing homes (NHs) accommodates voluntary reporting for 4 adverse events: falls with injury, pressure ulcers, medication errors, and infections. In 2015, AHRQ funded a technical brief to describe the state of the science related to safety in the NH setting to inform a research agenda. Thirty-six recent systematic reviews evaluated NH safety-related interventions to address these 4 adverse events and reported mostly mixed evidence about effective approaches to ameliorate them. Furthermore, these 4 events are likely inadequate to capture safety issues that are unique to the NH setting and encompass other domains related to residents' quality of care and quality of life. Future research needs include expanding our definition of safety in the NH setting, which differs considerably from that of hospitals, to include contributing factors to adverse events as well as more resident-centered care measures. Second, future research should reflect more rigorous implementation science to include objective measures of care processes related to adverse events, intervention fidelity, and staffing resources for intervention implementation to inform broader uptake of efficacious interventions. Weaknesses in implementation contribute to the current inconclusive and mixed evidence base as well as remaining questions about what outcomes are even achievable in the NH setting, given the complexity of most resident populations. Also related to implementation, future research should determine the effects of specific staffing models on care processes related to safety outcomes. Last, future efforts should explore the potential for safety issues in other care settings for older adults, most notably dementia care within assisted living.
authors.affiliation: Division of Geriatrics, Department of Medicine, Vanderbilt University, Nashville, TN; Center for Quality Aging, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Nashville, TN; Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, TN. Electronic address: Sandra.simmons@vanderbilt.edu.
authors.forename: Sandra F
authors.initials: SF
authors.lastname: Simmons
authors.affiliation: Division of Geriatrics, Department of Medicine, Vanderbilt University, Nashville, TN; Center for Quality Aging, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Nashville, TN; Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, TN.
authors.forename: John F
authors.initials: JF
authors.lastname: Schnelle
authors.affiliation: Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Evidence-based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Nila A
authors.initials: NA
authors.lastname: Sathe
authors.affiliation: Department of Anesthesiology, Center for Research and Innovation in Systems Safety (CRISS) Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Slagle
authors.affiliation: Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: David G
authors.initials: DG
authors.lastname: Stevenson
authors.affiliation: Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, TN; Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Nashville, TN.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Carlo
authors.affiliation: Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Evidence-based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Melissa L
authors.initials: ML
authors.lastname: McPheeters
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D003428:Cross Infection / Q000517:prevention & control; D006801:Humans; D008134:Long-Term Care; D008508:Medication Errors / Q000517:prevention & control; D009735:Nursing Homes; D003668:Pressure Ulcer / Q000517:prevention & control; D011785:Quality Assurance, Health Care; D012449:Safety / Q000592:standards*
keywords: Nursing home; long-term care; measurement; patient safety; post-acute care