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WORKER INJURIES IN NURSING HOMES: IS SAFE PATIENT HANDLING LEGISLATION THE SOLUTION?

ABSTRACT: In 2012, nursing homes were considered the most dangerous workplaces in the United States. While other industries have guidelines that limit manual lifting of stable objects to ?50 pounds, the same is not so in the nursing home industry where residents requiring physical assistance may weigh over 250 pounds and where the prevalence of obesity among residents is increasing. Safe patient handling legislation in nursing homes has been enacted in nine of the United States since 2005 (Hawaii, Illinois, Maryland, Minnesota, New Jersey, New York, Ohio, Rhode Island, and Texas). This paper reviews the problem of worker injuries in nursing homes, describes the legislation passed to address the problem, and reviews the data available on the effectiveness of the legislation. No national studies evaluating the effectiveness of safe patient handling state policies on nursing home injuries exists, although the National Institute on Occupational Safety and Health has recently funded a national evaluation.

SUBMITTER: Lapane KL

PROVIDER: S-EPMC7278261 | biostudies-literature | 2016 Oct

REPOSITORIES: biostudies-literature

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WORKER INJURIES IN NURSING HOMES: IS SAFE PATIENT HANDLING LEGISLATION THE SOLUTION?

Lapane Kate L KL Dubé Catherine E CE Jesdale Bill M BM

The journal of nursing home research sciences 20161001

In 2012, nursing homes were considered the most dangerous workplaces in the United States. While other industries have guidelines that limit manual lifting of stable objects to ≤50 pounds, the same is not so in the nursing home industry where residents requiring physical assistance may weigh over 250 pounds and where the prevalence of obesity among residents is increasing. Safe patient handling legislation in nursing homes has been enacted in nine of the United States since 2005 (Hawaii, Illinoi ...[more]

PMID: 32514490

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Project description:IntroductionSafety climates are perceptions of safety culture shared by staff in organizational units. Measuring staff perceptions of patient safety culture by using safety climate surveys is a possible way of addressing patient safety. Studies have documented that patient safety climates vary significantly between work sites in hospitals. Across-ward variations in the measurements of safety climate factor scores may indicate ward-specific risk of adverse events related to patient care routines, work environment, staff behaviour, and patient results. Variation in patient safety climates has not yet been explored in nursing homes.ObjectivesTo investigate whether the Norwegian translation of the Safety Attitudes Questionnaire-Ambulatory Version is useful to identify significant variation in the patient safety climate factor scores: Teamwork climate, Safety climate, Job satisfaction, Working conditions, Stress recognition, and Perceptions of management, across wards in nursing homes.MethodsFour hundred and sixty three employees from 34 wards in five nursing homes were invited to participate. Cronbach alphas were computed based on individual respondents' scores on the six patient safety climate factor scores. Intraclass correlation coefficients were calculated by multilevel analysis to measure patient safety climate variance at ward level.ResultsTwo hundred and eighty eight (62.2%) returned the questionnaire. At ward level Intraclass correlation coefficients (ICCs) for the factors were 10.2% or higher for the factors Safety climate, Working conditions and Perceptions of management, 2.4% or lower for Teamwork climate, Job satisfaction, and zero for Stress recognition. ICC for variance at nursing home level was zero or less than one per cent for all factor scores.ConclusionsStaff perceptions of Safety climate, Working conditions and Perceptions of management varied significantly across wards. These factor scores may, therefore, be used to identify wards in nursing homes with high and low risk of adverse events, and guide improvement resources to where they are most needed.

Project description:Objective: Determine the accuracy of nursing home self-reported antipsychotic prescribing before and after implementation of a Medicare campaign to reduce use.Methods: Quasi-experimental study comparing trends in self-reported antipsychotic prescribing relative to claims-based prescribing. Setting is a nationwide sample of 11,912 facilities, 2011-2013. Participants are long-stay nursing home residents (n = 586,281) with prescribing data in Medicare Minimum Data Set 3.0 and Medicare Part D claims database. Verified with a pharmacy dispensing database. Main outcomes are the discrepancies in quarterly prevalence of antipsychotic prescribing between nursing home self-reports and claims data and the characteristics of facilities and residents where discrepancies were identified.Results: Nursing homes underreport their antipsychotic prescribing levels, on average, by 1 percentage point per quarter relative to Medicare Part D claims (0.013, 95% confidence interval (CI), 0.012-0.015; p<.001). After the Medicare campaign, the underreporting gap increased by another half a percentage point (0.004, 95% CI .003-.005; p = .012). Nursing home residents with dementia, Alzheimer's disease or bipolar disorders were at the highest risk for underreported antipsychotic prescribing before the campaign (Adjusted Odds ratio (AOR) 1.385, 95% CI: 1.330-1.444; AOR 1.234, 95% CI: 1.172-1.300; AOR 1.574, 95% CI: 1.444-1.716, respectively) and afterwards. After the launch of the Medicare campaign, underreported antipsychotic prescribing occurred most in for-profit nursing homes (AOR 1.088, 95% CI: 1.005-1.178) and facilities in the US South (AOR 1.262, 95% CI: 1.145-1.391). Agreement was high between claims and dispensing data (99.7%).Conclusion: Nursing homes did not identify up to 6,000 residents per calendar quarter as having received antipsychotics despite these prescriptions being paid by Medicare and dispensed by a pharmacy. Nursing home rates of antipsychotic prescribing from self-reported data may be biased.

Dataset Information

WORKER INJURIES IN NURSING HOMES: IS SAFE PATIENT HANDLING LEGISLATION THE SOLUTION?

Publications

WORKER INJURIES IN NURSING HOMES: IS SAFE PATIENT HANDLING LEGISLATION THE SOLUTION?

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