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Patient Safety in Long-Term Care Under the Microscope

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Canadian Patient Safety Institute releases background paper

EDMONTON, Feb. 25 /CNW/ – A background paper released today by the Canadian Patient Safety Institute (CPSI) calls for a stronger research push to identify the best practices to optimize the safety of residents in long-term care settings.

The paper, jointly funded by CPSI, Capital Health (Edmonton) and CapitalCare (Edmonton), reviewed the current scientific literature on resident safety in long-term care and surveyed long-term care stakeholders from across the country – including frontline staff, senior management, policy makers, researchers, and family members.

The study concludes that despite the abundance of scientific literature examining quality and patient safety in long-term care, there are numerous limitations with existing studies and very few have been conducted in Canada. This has left a considerable knowledge gap regarding patient safety in Canadian long-term care settings.

“All those we interviewed by phone or in roundtable discussion articulated with great passion and candor what they feel are the most pressing concerns with patient safety,” says the paper’s co-author Dr. Laura Wagner, a gerontological nursing research scientist at Baycrest Geriatric Health Care System in Toronto. “They spoke of their own experiences as nurses, managers, policy makers, or as family members of loved ones receiving care. Collectively they identified priority issues and strategies for improvement.”

Pressure ulcers, medication issues, falls, resident aggression and infections are common concerns in nursing home environments. However, the study identified staffing/human resources and communication as the top two priorities with the potential to affect safety in long-term care. With staffing/human resources, the most frequent concerns raised were staff skills not meeting the increasing clinical complexity of residents, and the recruitment and retention of staff. Communication concerns related to several areas: inter-disciplinary communication, family engagement, care planning, transitions in care setting, change management, disclosure of incidents/adverse events, and medication issues.

The study recommends that all long-term care facilities establish a concerns resolution process involving management, residents, and families; education for staff on appropriate disclosure; and the establishment of processes for communication that ensure continuity of care. Training and leadership development for management was highlighted as a key recommendation for the continued creation of a culture of safety in long-term care environments.

“We now have a blueprint of informed opinion identifying what we need to things about,” says Tiana Rust, the report’s co-author and doctoral candidate in the Department of Psychology at the University of Alberta. “The next steps are to build the research capacity to accurately identify the issues specific to Canada, recommend priority actions, and collaborate with stakeholders and decision makers to implement these consistently in long-term care settings across the country.”

The full report is available online at CPSI’s website at http://patientsafetyinstitute.ca. A summary of the report will also be published in the Patient Safety Papers issue of Healthcare Quarterly in early 2008.