Patient safety culture in care homes for older people: a scoping review

Emily Gartshore,Stephen Timmons,Justin Waring

doi:10.1186/s12913-017-2713-2

Abstract

BackgroundIn recent years, there has been an increasing focus on the role of safety culture in preventing incidents such as medication errors and falls. However, research and developments in safety culture has predominantly taken place in hospital settings, with relatively less attention given to establishing a safety culture in care homes. Despite safety culture being accepted as an important quality indicator across all health and social care settings, the understanding of culture within social care settings remains far less developed than within hospitals. It is therefore important that the existing evidence base is gathered and reviewed in order to understand safety culture in care homes.MethodsA scoping review was undertaken to describe the availability of evidence related to care homes’ patient safety culture, what these studies focused on, and identify any knowledge gaps within the existing literature. Included papers were each reviewed by two authors for eligibility and to draw out information relevant to the scoping review.ResultsTwenty-four empirical papers and one literature review were included within the scoping review. The collective evidence demonstrated that safety culture research is largely based in the USA, within Nursing Homes rather than Residential Home settings. Moreover, the scoping review revealed that empirical evidence has predominantly used quantitative measures, and therefore the deeper levels of culture have not been captured in the evidence base.ConclusionsSafety culture in care homes is a topic that has not been extensively researched. The review highlights a number of key gaps in the evidence base, which future research into safety culture in care home should attempt to address.

Highlights

In recent years, there has been an increasing focus on the role of safety culture in preventing incidents such as medication errors and falls
Due to the limited availability of articles, four relevant papers that explored validation of safety culture surveys were included to provide a broader overview of the available validation studies. 23 papers were included at this stage, and the full texts were screened to identify additional relevant papers (n = 7), that were again reviewed by two authors (EG and ST) to identify 2 further texts for inclusion
The identified studies were found to not be representative of care home settings globally. This appeared to be due to the dominance of studies from the United States of America (USA) (n = 18), which reflected the prevalence of Nursing Homes across the USA care home sector

Summary

Introduction

There has been an increasing focus on the role of safety culture in preventing incidents such as medication errors and falls. Despite safety culture being accepted as an important quality indicator across all health and social care settings, the understanding of culture within social care settings remains far less developed than within hospitals. It is important that the existing evidence base is gathered and reviewed in order to understand safety culture in care homes. Organisational ‘culture’ is often related to the organisational ‘climate’ and both terms are often described as necessary components for quality and safety within healthcare [13, 14]. These terms are often referred to in the literature without clear distinction. ‘culture’ studies often attempt to look at deeper levels than ‘climate’ studies, which

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