Choosing the right tool to measure safety culture in long-term care facilities for older adults : an evidence-based approach

Abstract

Background: As part of its ongoing commitment to enhancing resident safety, the Care Malta Group, which operates nine long-term care facilities for older adults across Malta and Gozo, has introduced a number of initiatives involving both service users and staff. Building on these efforts, the organisation is focused on enhancing patient safety culture within its long-term services for older adults. To support this change, a literature search was conducted to identify and implement a validated tool for measuring patient safety culture within such an organisation. While the measurement of patient safety culture is standard practice in hospital settings, there is less experience with the measurement of patient safety culture in long-term care facilities for older adults. Research question: What tools are used to measure patient safety culture in long-term care facilities for older adults? Methodology: A Critically Appraised Topic (CAT) was conducted using peer-reviewed literature. A SPIDER framework was used, based on the research question. This was used to identify the key words and to inform the literature search strategy and establish the inclusion and exclusion criteria. A systematic search was conducted using the following databases: CINHAL complete, Cochrane, MEDLINE, PsycINFO, PUBMED and EBSCO and ProQuest. A PRISMA flow diagram was used to describe the selection process of the final studies that fit the inclusion and exclusion criteria. All included literature was critically appraised and applied to inform evidence-based practice. Results: The literature search yielded 11 peer-reviewed studies, including a systematic review, a scoping review and 9 cross-sectional studies. The most frequently used tool to assess patient safety culture in long-term care settings for older adults was the Nursing Home Survey on Patient Safety Culture (NHSPSC) by the Agency for Healthcare Research and Quality. Dimensions covered by this questionnaire include 21 items grouped in 8 composite measures, namely, handoffs and information exchange, management support for resident safety management, response to mistakes, organisational learning, speaking up, staffing, supervisor support for resident safety, and teamwork. The tool also includes nine single-item measures: compliance with procedures, training, willingness to recommend and background questions (staff position, tenure in the nursing home, hours worked per week, shift, and nursing home unit). Conclusion: Based on the evidence collected from this Critically Appraised Topic, the Nursing Home Survey on Patient Safety Culture (NHSPSC) was chosen for adoption within the long-term care facilities for older adults of Care Malta. Recommendations: Evaluating the patient safety culture is an important step in identifying areas for improvement and guiding effective safety interventions within long-term care facilities. The process for the adoption of the tool was planned. As some healthcare workers are not fluent in English, the tool will need to be translated into Maltese in accordance with official guidelines. A pilot study including the Maltese and English versions will be done. The tool will be validated to support and measure ongoing improvement within long-term care facilities.