Institute of Applied Health Research, University of Birmingham, Edgbaston, West Midlands B15 2TT, UK.
Int J Environ Res Public Health. 2021 Jul 16;18(14):7581. doi: 10.3390/ijerph18147581.
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 ( = 0.0006), severe pressure ulcers ( = 0.014), UTIs ( = 0.001) and 'any' events ( = 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.
居住在养老院的老年人面临可避免伤害的风险，这可能需要住院治疗。本文描述了一项针对一项大型质量改进（QI）计划的混合方法评估，该计划为英国西米德兰兹地区的 29 家养老院的员工提供技能培训和支持。使用安全态度问卷（SAQ）评估护理院安全氛围在基线和 24 个月计划结束时的变化。我们使用常规收集的数据来评估计划前后的可避免伤害和住院率。还对四个案例研究中的计划经理（n = 18）和员工（n = 49）进行半结构化访谈，以评估对计划实施的看法。我们的结果表明，安全氛围评分提高了 1.4 分。跌倒（ = 0.0006）、严重压疮（ = 0.014）、尿路感染（ = 0.001）和“任何”事件（ = 0.0003）的发生率显著降低。急诊住院人数减少，但入院人数增加。访谈参与者报告称，团队合作、工作实践、信息共享、知识和技能有所改善。提高养老院员工的技能可以改善工作实践和对居民安全和护理质量的态度，这可能与可避免伤害率的显著降低有关。护理人员的离职率很高，这可能会影响到观察到的变化的长期可持续性。
