Unsafe care in residential settings for older adults. A content analysis of accreditation reports

Hibbert, Peter D., Ash, Ruby, Molloy, Charlotte J., Westbrook, Johanna, Cameron, Ian D., Carson-Stevens, Andrew ORCID: https://orcid.org/0000-0002-7580-7699, Gray, Leonard C., Reed, Richard L., Kitson, Alison and Braithwaite, Jeffrey 2023. Unsafe care in residential settings for older adults. A content analysis of accreditation reports. International Journal for Quality in Health Care 35 (4) , mzad085. 10.1093/intqhc/mzad085

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Abstract

Background Residents of aged care services can experience safety incidents resulting in preventable serious harm. Accreditation is a commonly used strategy to improve the quality of care; however, narrative information within accreditation reports is not generally analysed as a source of safety information to inform learning. In Australia, the Aged Care Quality and Safety Commission (ACQSC), the sector regulator, undertakes over 500 accreditation assessments of residential aged care services against national standards every year. From these assessments, the ACQSC generates detailed Site Audit Reports. In over one-third (37%) of Site Audit Reports, standards relating to Personal and Clinical Care (Standard 3) are not being met. The aim of this study was to identify the types of resident Safety Risks that relate to Personal and Clinical Care Standards not being met during accreditation or re-accreditation. These data could inform priority setting at policy, regulatory and service levels. Methods An analytical framework was developed based on the World Health Organization’s International Classification for Patient Safety (ICPS) and other fields including Clinical Issue (the issue related to the incident impacting on the resident e.g., wound/skin or pain). Information relating to safety incidents in the Site Audit Reports was extracted and a content analysis undertaken using the analytical framework. Clinical Issue and the ICPS-based classification were combined to describe a clinically intuitive category (“Safety Risks”) to describe ways in which residents could experience unsafe care e.g., diagnosis/assessment of pain. The resulting data were descriptively analysed. Results The analysis included 65 Site Audit Reports that were undertaken between September 2020 – March 2021. There were 2,267 incidents classified into 274 types of resident Safety Risks. The twelve most frequently occurring Safety Risks account for only 32.3% of all incidents. Relatively frequently occurring Safety Risks were organisation management of infection control; diagnosis/assessment of pain, restraint, resident behaviours, falls; and multiple stages of wounds/skin management e.g., diagnosis/assessment, documentation, treatment, and deterioration. Conclusion The analysis has shown that accreditation reports contain valuable data that may inform prioritisation of resident Safety Risks in the Australian residential aged care sector. A large number of low frequency resident Safety Risks were detected in the accreditation reports. To address these, organisations may use implementation science approaches to facilitate evidence-based strategies to improve the quality of care delivered to residents. Improving the aged care workforces’ clinical skills base may address some of the Safety Risks associated with diagnosis/assessment and wound management.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Publisher:	Oxford University Press
ISSN:	1353-4505
Date of First Compliant Deposit:	24 October 2023
Date of Acceptance:	29 September 2023
Last Modified:	18 Dec 2023 12:11
URI:	https://orca.cardiff.ac.uk/id/eprint/163463

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