University of Pittsburgh Uses AHRQ's Patient Safety Culture Survey to Help Improve Nursing Home Care

The University of Pittsburgh School of Medicine adapted AHRQ's Hospital Survey on Patient Safety Culture to survey nursing home staff as part of ongoing research on patient safety in nursing homes. With the availability of benchmarking for the survey, Steven M. Handler, MD, MS, Assistant Professor of Medicine at the school's Division of Geriatric Medicine, demonstrated that the prevailing patient safety culture in nursing homes is significantly less developed than in the acute care setting.

Handler says, "I was introduced to the AHRQ survey when I was preparing to launch a survey to understand the barriers to medication error reporting in the nursing home setting. I thought it would be an excellent tool to establish a baseline for patient safety culture data in nursing homes before we implemented a new system to increase medication error reporting."

Responding to the AHRQ survey, nursing home staff scored significantly worse than hospital staff benchmarks in 5 of the 12 patient safety culture dimensions. These significant differences were reported in nonpunitive response to error, teamwork within units, communication openness, feedback and communication about errors, and organizational learning.

"Nursing homes are an important area of health care being overlooked in the effort to improve patient safety. The reality is that there are approximately 16,500 nursing homes providing care for 1.6 million residents in the U.S. There are more nursing home beds than the total number of hospital beds in the country, and 6.7 percent of health care expenditures support nursing home costs. Individuals over the age of 65 have a nearly 50 percent chance of being placed in a nursing home during their lifetime. We need to identify targets for interventions to improve the patient safety culture, which may in turn improve staff and resident outcomes," Handler notes.

From May through July 2005, a paper-based version of the AHRQ survey was administered to 151 physicians, pharmacists, nursing staff, and advanced practitioners at four nursing homes in southwest Pennsylvania. To improve participation, Handler visited the sites, and individuals completing the survey were offered a small monetary incentive. The effort yielded a 69 percent response rate. The average responder had 10 years' experience working in the nursing home industry and more than 5 years' tenure at their current facilities.

To adapt the survey from its validated use in the acute care setting to the nursing home setting, Handler made appropriate changes to the original survey questions, such as changing "hospital work area/unit" to "nursing home work area/unit." In addition, he provided definitions to terminology such as "patient safety" and "event reporting" to orient the nursing home staff. Questions about demographics were also included.

"It is my hope that this study will demonstrate the need for the establishment of benchmarks based on responses from the nursing home setting. It is clear that this data will be useful to help improve the patient safety culture in nursing homes, as well as eventually to serve as useful criteria for consumers when choosing a nursing home for a loved one," Handler says.