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CDA 06-015 – HSR&D Study

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CDA 06-015
Guideline Implementation in Nursing Homes: Targeted Supervisory Feedback
Mary Ellen Dellefield PhD BSN MS
VA San Diego Healthcare System, San Diego, CA
San Diego, CA
Funding Period: October 2008 - September 2012

BACKGROUND/RATIONALE:
Pressure ulcer (PU) prevention and treatment are the focus of The Joint Commission National Patient safety Goal (PSG 14.01.01). While PU prevention and treatment have been linked with patient safety, no studies have demonstrated an association between facility patient safety culture and PU rates. However, some identical organizational variables are associated with both a higher patient safety culture and reduced PU incidence. Promotion of a patient safety culture in nursing homes may be an effective way of sustaining pressure ulcer prevention programs in VA Community Living Centers, previously referred to as nursing home care units.

OBJECTIVE(S):
The immediate aim is to answer two research questions:
a. Is there a significant association of facility and VISN-level average scores of NHSPSC and monthly CLC pressure ulcer incidence and prevalence derived from Advancing Excellence Pressure Ulcer Tracking during the study period?
b. Are there significant associations of facility and VISN-level average sub-score dimensions of teamwork, handoff, feedback, communication openness, and organizational learning of NHSPSC and monthly CLC pressure ulcer incidence and prevalence derived from Advancing Excellence Pressure Ulcer Tracking during the reporting period?
The long-term aim is to: Conduct a larger study of the associations between NHSPSC and short/long stay QMs (these will be available as of October, 2013) based on a theoretical framework, a random sample of VHA's 135 CLCs, and resident-level data

METHODS:
The proposed study is a cross-sectional correlational study. All VISN 22 CLCs will be used as study sites, including VA San Diego Healthcare System (VASDHS), VA Greater Los Angeles Healthcare System (VAGLAHS) including 2 sites, VA Long Beach Healthcare System (VALBHS), and VA Loma Linda Healthcare System (VALLHS). Sample. Two ordered lists of all eligible nursing and inter-professional staff at each CLC. Systematic sampling will be conducted starting randomly with a subject and selecting every second staff member.6 Depending on response rates from systematic sampling, a purposeful convenience sample will be drawn from volunteers among remaining nurses and inter-professional staff. Although the study focus is on nursing and inter-professional team members, it is possible that some nursing and inter-professional staff may be Veterans. We hope to achieve at least a 60% response rate with a targeted sample size of 267 CLC staff.

Descriptive analyses will be used for demographic data, PU outcomes, and NHSPSC information. Multivariate analyses will then be used to examine the association between PUs and each PSC subscale, controlling for facility and respondent characteristics. Demographic data will be aggregated by categories, including NAs and RNAs, LVNs, and RNs (e.g. MDS Nurse Coordinator, advanced practice nurses, certified wound care specialists, and other CLC registered nurses), and 'inter-professional team member' to prevent identification of individuals who are the sole staff member in their job category.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
An association between PU incidence, prevalence, and/or QMs and PSC in NHs has not been demonstrated empirically. However, researchers have found that common variables that are significant for both a stronger PSC and a reduced incidence of PUs include teamwork, communication openness, nursing supervision and leadership, a culture of respect, performance feedback, and higher levels of nurse staffing. If a statistically significant association between high levels of NHPSC and reduced incidence of PUs in CLCs is found, promoting higher levels of NHPSC may be an effective intervention for sustaining PU prevention in CLCs. Examining the subscales may be important, as this could highlight some "actionable" areas for quality improvement.

PUBLICATIONS:

Journal Articles

  1. Dellefield ME, Magnabosco JL. Pressure ulcer prevention in nursing homes: nurse descriptions of individual and organization level factors. Geriatric nursing (New York, N.Y.). 2014 Mar 1; 35(2):97-104.
  2. Dellefield ME, Harrington C, Kelly A. Observing how RNs use clinical time in a nursing home: a pilot study. Geriatric nursing (New York, N.Y.). 2012 Jul 1; 33(4):256-63.
  3. Dellefield ME, Ferrini R. Promoting Excellence in End-of-Life Care: Lessons Learned From a Cohort of Nursing Home Residents With Advanced Huntington Disease. The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses. 2011 Aug 1; 43(4):186-92.
  4. Velez DJ, Dellefield ME. Provide a helping hand to patients with upper extremity prostheses. Nursing. 2011 Jan 1; 41(1):49-52.
  5. Siegel EO, Mueller C, Anderson KL, Dellefield ME. The pivotal role of the director of nursing in nursing homes. Nursing Administration Quarterly. 2010 Apr 1; 34(2):110-21.
  6. Ferrini R, Dellefield ME, Hilleary G, Gibson R, Chu S, Beecham N. Lessons Learned in the Care of Persons with Late-Stage Huntington’s Disease. Annals of Long-Term Care: Clinical Care and Aging. 2009 Aug 1; 17(8):34-38.


DRA: Aging, Older Veterans' Health and Care, Health Systems, Brain and Spinal Cord Injuries and Disorders
DRE: Epidemiology
Keywords: none
MeSH Terms: none

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