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Patient Safety and Quality

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Shifting from a culture of blame to a culture of safety in nursing homes could help identify and prevent medical errors

Many nursing homes continue to harbor a culture of blame. As long as staff members feel they will be blamed for medical errors they report, patient safety will remain at risk. Creating a culture of safety in nursing homes is complicated by limited resources, overwhelmed leadership, and an educationally diverse workforce. Nevertheless, by improving team communication and participation in decisions, nurse leaders can create an environment in which every team member can contribute to resident safety, asserts Jill Scott-Cawiezell, Ph.D., of the University of Missouri-Columbia. In a study supported by the Agency for Healthcare Research and Quality (HS14281), she and fellow researchers surveyed staff members of five diverse Midwestern nursing homes. The staffers were members of a team whose goal was to improve medication safety practices.

The survey asked nursing home staff how strongly they agreed or disagreed that key safety elements—communication, teamwork, and leadership—were present for medication safety practices to develop and thrive. The study authors also conducted a case study of a nursing home team trying to develop a culture of safety, which nevertheless was stuck in a culture of blame. In this particular case, staff members were assigned a point for every medication error they made. Staff members were disciplined after three points and could even be fired.

The team clearly understood the need to know about errors so that they could improve care, but no one was willing to get others in trouble. Also, the leader of the team often missed meetings due to crises or other problems. To alleviate the leadership void, the research nurse invited the nursing home administrator to the team's regular meetings. The team then became very open about safety issues in the nursing home. They also voiced their frustration with the continued blaming culture, which clearly led to underreporting of errors. The authors conclude that nursing homes must create a climate where everyone feels comfortable identifying and reporting safety concerns in order to shift to a safety culture.

See "Moving from a culture of blame to a culture of safety in the nursing home setting," by Dr. Scott-Cawiezell, Amy Vogelsmeier, M.S.N., Charlotte McKenney, B.S.N., and others, in the July 2006 Nursing Forum 41(3), pp. 133-140.

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