Incidence of adverse incidents in residential aged care
Bella St Clair
A B , Mikaela Jorgensen A and Andrew Georgiou A
A Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia. Email: mikaela.jorgensen@mq.edu.au, andrew.georgiou@mq.edu.au
B Corresponding author. Email: bella.stclair@students.mq.edu.au
Australian Health Review 46(4) 405-413 https://doi.org/10.1071/AH21090
Submitted: 16 March 2021 Accepted: 11 August 2021 Published: 19 October 2021
Journal Compilation © AHHA 2022 Open Access CC BY-NC-ND
Abstract
Objective Adverse incident research within residential aged care facilities (RACFs) is increasing and there is growing awareness of safety and quality issues. However, large-scale evidence identifying specific areas of need and at-risk residents is lacking. This study used routinely collected incident management system data to quantify the types and rates of adverse incidents experienced by residents of RACFs.
Methods A concurrent mixed-methods design was used to examine 3 years of incident management report data from 72 RACFs in New South Wales and the Australian Capital Territory. Qualitative thematic analysis of free-text incident descriptions was undertaken to group adverse incidents into categories. The rates and types of adverse incidents based on these categories were calculated and then compared using incidence rate ratios (IRRs).
Results Deidentified records of 11 987 permanent residents (aged ≥65 years; mean (±s.d.) age 84 ± 8 years) from the facilities were included. Of the 60 268 adverse incidents, falls were the most common event (36%), followed by behaviour-related events (33%), other impacts and injuries (22%) and medication errors (9%). The number of adverse incidents per resident ranged from 0 (42%) to 171, with a median of 2. Women (IRR 0.804; P < 0.001) and residents with low care needs (IRR 0.652; P < 0.001) were significantly less likely to adverse incidents compared with men and residents with high care needs respectively.
Conclusion This study demonstrates that data already collected within electronic management systems can provide crucial baseline information about the risk levels that adverse incidents pose to older Australians living in RACFs.
What is known about the topic? To date, research into aged care adverse incidents has typically focused on single incident types in small studies involving mitigation strategies. Little has been published quantifying the multiple adverse incidents experienced by residents of aged care facilities or reporting organisation-wide rates of adverse incidents.
What does this paper add? This paper adds to the growing breadth of Australian aged care research by providing baseline information on the rates and types of adverse incidents in RACFs across a large and representative provider.
What are the implications for practitioners? This research demonstrates that the wealth of data captured by aged care facilities’ incident management information systems can be used to provide insight into areas of commonly occurring adverse incidents. Better use of this information could greatly enhance strategic planning of quality improvement activities and the care provided to residents.
References
[1] Royal Commission into Aged Care Quality and Safety. Final Report: Care, Dignity and Respect Volume 1 Summary and Recommendations. Canberra: Commonwealth of Australia; 2021.[2] Ibrahim JE. COVID-19 and residential aged care in Australia. Aust J Adv Nurs 2020; 37 1–3.
| COVID-19 and residential aged care in Australia.Crossref | GoogleScholarGoogle Scholar |
[3] Cousins S. Experts criticise Australia’s aged care failings over COVID-19. Lancet 2020; 396 1322–3.
| Experts criticise Australia’s aged care failings over COVID-19.Crossref | GoogleScholarGoogle Scholar |
[4] Larsen LT. Not merely the absence of disease: A genealogy of the WHO’s positive health definition. Hist Human Sci 2021;
| Not merely the absence of disease: A genealogy of the WHO’s positive health definition.Crossref | GoogleScholarGoogle Scholar |
[5] Brady A-M, Redmond R, Curtis E, Fleming S, Keenan P, Malone A-M, et al Adverse events in health care: a literature review. J Nurs Manag 2009; 17 155–64.
| Adverse events in health care: a literature review.Crossref | GoogleScholarGoogle Scholar | 19422173PubMed |
[6] Alvarez Barbosa F, Del Pozo-Cruz B, Del Pozo-Cruz J, Alfonso-Rosa RM, Sanudo Corrales B, Rogers ME. Factors associated with the risk of falls of nursing home residents aged 80 or older. Rehabil Nurs 2016; 41 16–25.
| Factors associated with the risk of falls of nursing home residents aged 80 or older.Crossref | GoogleScholarGoogle Scholar | 26399374PubMed |
[7] Quigley PA, Campbell RR, Bulat T, Olney RL, Buerhaus P, Needleman J. Incidence and cost of serious fall-related injuries in nursing homes. Clin Nurs Res 2012; 21 10–23.
| Incidence and cost of serious fall-related injuries in nursing homes.Crossref | GoogleScholarGoogle Scholar | 21788448PubMed |
[8] Ferrah N, Lovell JJ, Ibrahim JE. Systematic review of the prevalence of medication errors resulting in hospitalization and death of nursing home residents. J Am Geriatr Soc 2017; 65 433–42.
| Systematic review of the prevalence of medication errors resulting in hospitalization and death of nursing home residents.Crossref | GoogleScholarGoogle Scholar | 27870068PubMed |
[9] Tannen A, Dassen T, Halfens R. Differences in prevalence of pressure ulcers between the Netherlands and Germany–associations between risk, prevention and occurrence of pressure ulcers in hospitals and nursing homes. J Clin Nurs 2008; 17 1237–44.
| Differences in prevalence of pressure ulcers between the Netherlands and Germany–associations between risk, prevention and occurrence of pressure ulcers in hospitals and nursing homes.Crossref | GoogleScholarGoogle Scholar | 18416798PubMed |
[10] Howard DL, Taylor YJ. Racial and gender differences in pressure ulcer development among nursing home residents in the Southeastern United States. J Women Aging 2009; 21 266–78.
| Racial and gender differences in pressure ulcer development among nursing home residents in the Southeastern United States.Crossref | GoogleScholarGoogle Scholar | 20183152PubMed |
[11] Cameron ID, Dyer SM, Panagoda CE, Murray GR, Hill KD, Cumming RG, et al Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev 2018; 9 CD005465
| Interventions for preventing falls in older people in care facilities and hospitals.Crossref | GoogleScholarGoogle Scholar | 30191554PubMed |
[12] Francis-Coad J, Etherton-Beer C, Burton E, Naseri C, Hill AM. Effectiveness of complex falls prevention interventions in residential aged care settings: a systematic review. JBI Database System Rev Implement Rep 2018; 16 973–1002.
| Effectiveness of complex falls prevention interventions in residential aged care settings: a systematic review.Crossref | GoogleScholarGoogle Scholar | 29634516PubMed |
[13] Stewart MJ, Georgiou A, Westbrook J. Successfully integrating aged care services: a review of the evidence and tools emerging from a long-term care program. Int J Integr Care 2013; 13 e003
| Successfully integrating aged care services: a review of the evidence and tools emerging from a long-term care program.Crossref | GoogleScholarGoogle Scholar | 23687475PubMed |
[14] Ibrahim JE, Fetherstonhaugh D, Rayner J-A, McAuliffe L, Jain B, Bauer M. Meeting the needs of older people living in Australian residential aged care: A new conceptual model. Australas J Ageing 2020; 39 148–55.
| Meeting the needs of older people living in Australian residential aged care: A new conceptual model.Crossref | GoogleScholarGoogle Scholar | 32274867PubMed |
[15] Georgiou A, Marks A, Braithwaite J, Westbrook JI. Gaps, disconnections, and discontinuities–the role of information exchange in the delivery of quality long-term care. Gerontologist 2013; 53 770–9.
| Gaps, disconnections, and discontinuities–the role of information exchange in the delivery of quality long-term care.Crossref | GoogleScholarGoogle Scholar | 23103520PubMed |
[16] Aged Care Safety and Quality Commission. Serious Incident Response Scheme: Australian Government. 2021, Available at: https://www.agedcarequality.gov.au/sirs. [verified 1 October 2021]
[17] Alexander GL, Georgiou A, Siette J, Madsen R, Livingstone A, Westbrook J, Deroche C. Exploring information technology (IT) sophistication in New South Wales residential aged care facilities. Aust Health Rev 2020; 44 288–96.
| Exploring information technology (IT) sophistication in New South Wales residential aged care facilities.Crossref | GoogleScholarGoogle Scholar | 31248474PubMed |
[18] Davis J, Morgans A, Burgess S. Information management in the Australian aged care setting. Health Inf Manag 2017; 46 3–14.
| 27105477PubMed |
[19] Douglas HE, Georgiou A, Tariq A, Prgomet M, Warland A, Armour P, Westbrook J. Implementing information and communication technology to support community aged care service integration: Lessons from an Australian aged care provider. Int J Integr Care 2017; 17 1–13.
| Implementing information and communication technology to support community aged care service integration: Lessons from an Australian aged care provider.Crossref | GoogleScholarGoogle Scholar |
[20] Creswell JW. Research design: Qualitative, quantitative, and mixed methods approaches – Third Edition, Thousand Oaks, CA: SAGE Publications; 2009.
[21] Crabtree BF, Miller WL. Doing Qualitative Research – Second Edition. Thousand Oaks, CA: SAGE Publications; 1999.
[22] Department of Health. The Aged Care Funding Instrument (ACFI). Australian Government. 2021. Available at: https://www.health.gov.au/initiatives-and-programs/residential-aged-care/funding-for-residential-aged-care/the-aged-care-funding-instrument-acfi [verified 1 October 2021].
[23] Department of Social Services. Removal of low care – high care distinction in permanent residential aged care from 1 July 2014. Australian Government. 2014. Available at: https://www.dss.gov.au/sites/default/files/documents/05_2014/level_3_-_acr_-_rbt_-_resi_-_hi-low_att_d.pdf [verified 1 October 2021]
[24] Australian Institute of Health and Welfare. GEN data: People using aged care services, 30 June 2016-2017. Australian Government. 2021. Available at: https://gen-agedcaredata.gov.au/Resources/Access-data/2020/March/GEN-data-People-using-aged-care. [verified 1 October 2021].
[25] Sluggett JK, Lalic S, Hosking SM, Ilomäki J, Shortt T, McLoughlin J, Yu S, Cooper T, et al Root cause analysis of fall-related hospitalisations among residents of aged care services. Aging Clin Exp Res 2020; 32 1947–57.
| Root cause analysis of fall-related hospitalisations among residents of aged care services.Crossref | GoogleScholarGoogle Scholar | 31728845PubMed |
[26] Church J, Goodall S, Norman R, Haas M. An economic evaluation of community and residential aged care falls prevention strategies in NSW. N S W Public Health Bull 2011; 22 60–8.
| An economic evaluation of community and residential aged care falls prevention strategies in NSW.Crossref | GoogleScholarGoogle Scholar | 21632001PubMed |
[27] Hartholt KA, Lee R, Burns ER, van Beeck EF. Mortality from falls among US adults aged 75 years or older, 2000–2016. JAMA 2019; 321 2131–3.
| Mortality from falls among US adults aged 75 years or older, 2000–2016.Crossref | GoogleScholarGoogle Scholar | 31162561PubMed |
[28] Agency for Healthcare Research and Quality. How do you measure fall rates and fall prevention practices? Rockville, MD: U.S. Department of Health & Human Services. 2013. Available at: https://www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/measure-fall-rates.html. [verified 1 October 2021]
[29] Australian Institute of Health and Welfare. Trends in hospitalised injury due to falls in older people 2007–08 to 2016–17. Australian Government. 2019. Available at: https://www.aihw.gov.au/reports/injury/trends-in-hospitalised-injury-due-to-falls/report-editions [verified 1 October 2021]
[30] Wilson L, Kapp S, Santamaria N. The direct cost of pressure injuries in an Australian residential aged care setting. Int Wound J 2019; 16 64–70.
| The direct cost of pressure injuries in an Australian residential aged care setting.Crossref | GoogleScholarGoogle Scholar | 30240127PubMed |
[31] Khadka J, Lang C, Ratcliffe J, Corlis M, Wesselingh S, Whitehead C, et al Trends in the utilisation of aged care services in Australia, 2008–2016. BMC Geriatr 2019; 19 213
| Trends in the utilisation of aged care services in Australia, 2008–2016.Crossref | GoogleScholarGoogle Scholar | 31387533PubMed |
[32] Lachs MS, Teresi JA, Ramirez M, van Haitsma K, Silver S, Eimicke JP, Boratgis G, Sukha G, et al The prevalence of resident-to-resident elder mistreatment in nursing homes. Ann Intern Med 2016; 165 229–36.
| The prevalence of resident-to-resident elder mistreatment in nursing homes.Crossref | GoogleScholarGoogle Scholar | 27295575PubMed |
[33] Murphy B, Bugeja L, Pilgrim J, Ibrahim JE. Deaths from resident-to-resident aggression in Australian nursing homes. J Am Geriatr Soc 2017; 65 2603–9.
| Deaths from resident-to-resident aggression in Australian nursing homes.Crossref | GoogleScholarGoogle Scholar | 29131309PubMed |
[34] Rodney V. Nurse stress associated with aggression in people with dementia: its relationship to hardiness, cognitive appraisal and coping. J Adv Nurs 2000; 31 172–80.
| Nurse stress associated with aggression in people with dementia: its relationship to hardiness, cognitive appraisal and coping.Crossref | GoogleScholarGoogle Scholar | 10632806PubMed |
[35] Arah OA, Westert GP, Hurst J, Klazinga NS. A conceptual framework for the OECD Health Care Quality Indicators Project. Int J Qual Health Care 2006; 18 5–13.
| A conceptual framework for the OECD Health Care Quality Indicators Project.Crossref | GoogleScholarGoogle Scholar | 16954510PubMed |
[36] Caughey GE, Lang CE, Bray SC, Moldovan M, Jorissen RN, Wesselingh S, et al. International and National Quality and Safety Indicators for Aged Care. Report for the Royal Commission into Aged Care Quality and Safety. Adelaide: South Australian Health and Medical Research Institute, 2020.
[37] Hibbert P, Wiles L, Cameron I, Kitson A, Reed R, Georgiou A, et al CareTrack Aged: the appropriateness of care delivered to Australians living in residential aged care facilities: a study protocol. BMJ Open 2019; 9 e030988
| CareTrack Aged: the appropriateness of care delivered to Australians living in residential aged care facilities: a study protocol.Crossref | GoogleScholarGoogle Scholar | 31243038PubMed |
[38] Woolford MH, de Lacy-Vawdon C, Bugeja L, Weller C, Ibrahim JE. Applying dignity of risk principles to improve quality of life for vulnerable persons. Int J Geriatr Psychiatry 2020; 35 122–30.
| Applying dignity of risk principles to improve quality of life for vulnerable persons.Crossref | GoogleScholarGoogle Scholar | 31647586PubMed |
[39] Eagar K, Gordon R, Snoek MF, Loggie C, Westera A, Samsa PD, et al The Australian National Aged Care Classification (AN-ACC): a new casemix classification for residential aged care. Med J Aust 2020; 213 359–63.
| The Australian National Aged Care Classification (AN-ACC): a new casemix classification for residential aged care.Crossref | GoogleScholarGoogle Scholar | 32720326PubMed |
[40] McNammee J, Poulos C, Seraji H, Kobel C, Duncan C, Westera A, et al. Alternative Aged Care Assessment, Classification System and Funding Models: Final Report. Wollongong: Australian Health Services Research Institute, University of Wollongong; 2017.
