期刊
INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH
卷 18, 期 14, 页码 -出版社
MDPI
DOI: 10.3390/ijerph18147581
关键词
quality improvement; care home; older people; training; avoidable harms; evaluation; mixed methods
资金
- West Midlands Academic Health Sciences Network (WMAHSN) Patient Safety Collaborative
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and CareWest Midlands (CLAHRC WM)
A mixed methods evaluation of a large quality improvement program in 29 care homes showed an increase in safety climate scores and significant reductions in avoidable harm events. The program led to improvements in teamwork, working practices, information sharing, and skills among care home staff. However, high turnover rates among care staff may impact the long-term sustainability of these changes.
Older people living in care homes are at risk from avoidable harms, which may require hospital attendance or admission. This paper describes a mixed methods evaluation of a large quality improvement (QI) programme that provides skills training and facilitated support to staff in 29 care homes across two localities in the West Midlands, UK. The Safety Attitudes Questionnaire (SAQ) is used to assess changes to care home safety climate between baseline and programme end at 24 months. We use routinely collected data to assess pre- and post-programme avoidable harms and hospital attendance/admission rates. Semi-structured interviews with programme managers (n = 18), and staff (n = 49) in four case study homes are also used to assess perspectives on programme implementation. Our results show that safety climate scores increase by 1.4 points. There are significant reductions in falls (p = 0.0006), severe pressure ulcers (p = 0.014), UTIs (p = 0.001) and 'any' events (p = 0.0003). Emergency hospital attendances reduced, but admissions increased. Interview participants report improvements to teamwork, working practices, information sharing, knowledge and skills. Upskilling care home staff can improve working practices and attitudes towards resident safety and care quality, which may be associated with significant reductions in avoidable harms rates. Care staff turnover rates are high, which may impact the potential for longer-term sustainability of the changes observed.
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