Nursing Home Survey on Patient Safety Culture Feedback Results: Evalua

Appendix A: Nursing Home Survey on Patient Safety

This document contains references to Web sites that provide practical resources nursing homes can use to implement changes to improve patient safety culture and patient safety.

Appendix A: Nursing Home Survey on Patient Safety

In this survey, "resident safety" means preventing resident injuries, incidents, and harm to residents in the nursing home.

This survey asks for your opinions about resident safety issues in your nursing home.
It will take about 15 minutes to complete.

To mark your answer, just put an X or a check in the box.

If a question does not apply to your job or you do not know the answer, please mark the box in the last column. If you do not wish to answer a question, you may leave your answer blank.

Section A: Working in This Nursing Home

How much do you agree or disagree with the following statements?Strongly DisagreeDisagreeNeither Agree
nor Disagree
AgreeStrongly AgreeDoes Not Apply
or Don't Know
1. Staff in this nursing home treat each other with respect___ 1___ 2___ 3___ 4___ 5___ 9
2. Staff support one another in this nursing home___ 1___ 2___ 3___ 4___ 5___ 9
3. We have enough staff to handle the workload___ 1___ 2___ 3___ 4___ 5___ 9
4. Staff follow standard procedures to care for residents___ 1___ 2___ 3___ 4___ 5___ 9
5. Staff feel like they are part of a team___ 1___ 2___ 3___ 4___ 5___ 9
6. Staff use shortcuts to get their work done faster___ 1___ 2___ 3___ 4___ 5___ 9
7. Staff get the training they need in this nursing home___ 1___ 2___ 3___ 4___ 5___ 9
8. Staff have to hurry because they have too much work to do___ 1___ 2___ 3___ 4___ 5___ 9
9. When someone gets really busy in this nursing home, other staff help out___ 1___ 2___ 3___ 4___ 5___ 9
10. Staff are blamed when a resident is harmed___ 1___ 2___ 3___ 4___ 5___ 9
11. Staff have enough training on how to handle difficult residents___ 1___ 2___ 3___ 4___ 5___ 9
12. Staff are afraid to report their mistakes___ 1___ 2___ 3___ 4___ 5___ 9
13. Staff understand the training they get in this nursing home___ 1___ 2___ 3___ 4___ 5___ 9
14. To make work easier, staff often ignore procedures___ 1___ 2___ 3___ 4___ 5___ 9
15. Staff are treated fairly when they make mistakes___ 1___ 2___ 3___ 4___ 5___ 9
16. Residents' needs are met during shift changes___ 1___ 2___ 3___ 4___ 5___ 9
17. It is hard to keep residents safe here because so many staff quit their jobs___ 1___ 2___ 3___ 4___ 5___ 9
18. Staff feel safe reporting their mistakes___ 1___ 2___ 3___ 4___ 5___ 9

Section B: Communications

How often do the following things happen in your nursing home?NeverRarelySometimesMost of the timeAlwaysDoes Not Apply
or Don't Know
1. Staff are told what they need to know before taking care of a resident for the first time___ 1___ 2___ 3___ 4___ 5___ 9
2. Staff are told right away when there is a change in a resident's care plan___ 1___ 2___ 3___ 4___ 5___ 9

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Appendix B

Nursing Home Recommendation

This image is a bar graph depicting the percent of responses to the survey item 'I would tell friends that this is a safe nursing home for their family. (Survey Item E1)' In this example, 60% responded 'yes', 28% responded 'maybe', and 12% responded 'no'.

Overall rating on resident safety

This image is a bar graph depicting the percent of responses to the survey item 'Please give this nursing home an overall rating on resident safety. (Survey Item E2)' In this example, 12% responded 'Excellent', 29% responded 'Very Good', 40% responded 'Good', 13% responded 'Fair', and 7% responded 'Poor'.

Comparison with 40 Pilot Study Nursing Homes

I would tell friends that this is a safe nursing home for their family. (Survey Item E1)

This image is a bar graph depicting the percent of responses to the survey item 'I would tell friends that this is a safe nursing home for their family. (Survey Item E1)' It shows the comparison of your nursing home alongside the 40 pilot study nursing homes. In this example, 81% responded 'yes' in the pilot compared to 60% responded 'yes' in your nursing home; 15% responded 'maybe' in the pilot compared to 28% responded 'maybe' in your nursing home; and 3% responded 'no' in the pilot compared to 12% responded 'no' in your nursing home.

Please give this nursing home an overall rating on resident safety. (Survey item E2)

This image is a bar graph depicting the percent of responses to the survey item 'Please give this nursing home an overall rating on resident safety. (Survey Item E2)' It shows results from the pilot study of 40 nursing homes compared to your nursing home. In this example, 29% responded 'Excellent' in the pilot and 12% responded 'Excellent' in your nursing home; 39% responded 'Very Good' in the pilot and 29% responded 'Very Good' in your nursing home; 23% responded 'Good' in the pilot and 40% repsonded 'Good' in your nursing home; 8% responded 'Fair' in the pilot and 13% responded 'Fair' in your nursing home; and 1% responded 'Poor' in the pilot and 7% responded 'Poor' in your nursing home.

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Appendix C

Positively Worded Items

This is an example of a positively worded item. For this item, the percentage who answered "Strongly Agree/Agree" is shown in green (positive response), "Neither" in yellow, and "Strongly Disagree/Disagree" (negative response) in red.

This image shows a survey item along with the accompanying 3-point bar chart to explain how percentages are calculated for positively worded items. For the survey item: 'we have enough staff to handle the workload. (A3)', the first point of the 3-point bar chart shows the percent positive score which represents most positive answers (better survey results). In this example, it is 50% positive response. In the middle of the 3-point bar chart, the percent neutral is displayed which represents the in-between answers. In this example, it is 30%. Lastly, the percent negative is displayed at the right end of the 3-point bar chart which displays the least positive answers (worse survey results). In this example, the percent negative response is 20%.

Negatively Worded Items

This is an example of a negatively worded item. The percentage who answered "Strongly Disagree/Disagree" is shown in green (positive response), "Neither" in yellow, and "Strongly Agree/Agree" (negative response) in red.

This image shows a survey item along with the accompanying 3-point bar chart to explain how percentages are calculated for negatively worded items. In this example, the survey item is negatively worded: 'Staff have to hurry because they have too much work to do. (A8R)'. Therefore, the responses are reverse coded so that the percent who strongly disagree/disagree show up as percent positive responses; the neither remain as percent neutral, and the strongly agree/agree responses show up as the percent negative response. The first section of the 3-point bar chart is the percent positive response which, in this example, it is 60% positive response. In the middle of the 3-point bar chart, the percent neutral is displayed which represents the in-between answers. In this example, it is 20%. Lastly, the percent negative is displayed at the right end of the 3-point bar chart which displays the least positive answers (worse survey results). In this example, the percent negative response is 20%.

 

Series of bar charts showing results from the survey. The topic areas are: Overall Perceptions of Resident Safety, Feedback & Communication About Incidents, and Supervisor Expectations & Actions Promotion Resident Safety. Series of bar charts showing results from the survey. The topic areas are: Organizational Learning, Management Support for Resident Safety and Training & Skills. Series of bar charts showing results from the survey. The topic areas are: Compliance with Procedures, Teamwork, and Handoffs. Series of bar charts showing results from the survey. The topic areas are: Communication Openness, Nonpunitive Response to Mistakes, and Staffing.

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Appendix D

Participants' Comments
10% of respondents provided comments

1. Respondent Comments Here

This material was prepared by GMCF, the Medicare Quality Improvement Organization for Georgia, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. 9SOW-GA-PSF-10-18

*Comments appear as written on the survey. No changes have been made.

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Page last reviewed October 2010
Internet Citation: Nursing Home Survey on Patient Safety Culture Feedback Results: Evalua: Appendix A: Nursing Home Survey on Patient Safety. October 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/nursing-home/resources/sampevalapp.html