Chartbook on Patient Safety

Patient Safety in the Nursing Home Setting

• More than 3 million people receive care in U.S. nursing homes and skilled nursing facilities each year (CDC).
• For nursing home residents, optimal care seeks to maximize quality of life and minimize unintended complications.
• Measures include:
  • Nursing home residents experiencing urinary tract infections.
  • Nursing home residents experiencing use of restraints.
  • Pooled mean rate of healthcare-associated infections per 1,000 resident days in Pennsylvania nursing homes.

Nursing Home Residents With Urinary Tract Infections

Long-stay nursing home residents experiencing urinary tract infections, by sex, age, and race/ethnicity, 2011-2012

Key: NHOPI = Native Hawaiian or Other Pacific Islander; AI/AN = American Indian or Alaska Native.

Source: Centers for Medicare & Medicaid Services, Minimum Data Set 3.0, 2014.

Denominator: Long-stay residents, who are defined as having a cumulative stay greater than 100 days.

Note: For this measure, lower rates are better. The measure was calculated as follows: Percentage of long-stay residents with a urinary tract infection within the 30 days prior to assessment. In 2011, the top 5 State achievable benchmark for UTIs was 6.1. The States that contributed to the achievable benchmark were Connecticut, Hawaii, Minnesota, North Dakota, and Pennsylvania. 

• Importance: Urinary tract infections (UTIs) can spread and become more serious or cause further complications, such as delirium.
• Overall Rate: In 2012, the percentage of long-stay nursing home residents with a UTI was 7.3%.
• Groups With Disparities:
  • In 2011 and 2012, higher percentages of long-stay residents age 65 and over had UTIs compared with those under 65. A higher percentage of female long-stay residents had UTIs compared with their male counterparts in both years.
  • In 2012, compared with White residents, other racial and ethnic groups had lower rates of UTIs.
• Achievable Benchmark: Residents under age 65, males, and Blacks, Asians, and Native Hawaiians and Other Pacific Islanders achieved the benchmark.

Nursing Home Residents in Restraints

Long-stay nursing home residents experiencing use of restraints, by sex, age, and race/ethnicity, 2011-2012

Key: NHOPI = Native Hawaiian or Other Pacific Islander; AI/AN = American Indian or Alaska Native.

Source: Centers for Medicare & Medicaid Services, Minimum Data Set 3.0, 2014.

Denominator: Long-stay residents, who are defined as having a cumulative stay greater than 100 days.

Note:  For this measure, lower rates are better. The measure was calculated as follows: Percentage of long-stay residents who are physically restrained on a daily basis. In 2011, the top 5 State achievable benchmark for restraint use was 0.7 percent. The States that contributed to the achievable benchmark were Kansas, Maine, Nebraska, New Hampshire, and Vermont. 

• Importance: Residents who are restrained daily can become weak, lose their ability to go to the bathroom by themselves, and develop pressure ulcers or other medical conditions.
• Overall Rate: In 2012, the percentage of long-stay nursing home residents who were physically restrained on a daily basis was 1.9%.
• Groups With Disparities:
  • In 2011 and 2012, a lower percentage of residents ages 65-74 years were held in restraints on a daily basis compared with residents younger than 65 years.
  • In 2012, compared with Whites, Asians, Native Hawaiians and Other Pacific Islanders, and Hispanics had higher rates of daily restraint use; Blacks and American Indians and Alaska Natives had lower rates of daily restraint use compared with Whites.
• Achievable Benchmark: No group has achieved the benchmark

Healthcare-Associated Infections in Nursing Homes

Pooled mean rate of healthcare-associated infections per 1,000 resident days in Pennsylvania nursing homes, by gender, 2010-2013 (combined)

Key: RTI = respiratory tract infection, including pneumonia and influenza-like illness; GI = gastrointestinal infection, including Clostridium difficile and norovirus; UTI = urinary tract infection in resident without indwelling urinary catheter; Cellulitis = skin and soft tissue infection; Other = intra-abdominal infection, meningitis, viral hepatitis, osteomyelitis, and primary bloodstream infection.

Source: Pennsylvania Patient Safety Authority data, 2010-2013.

Note:  For this measure, lower rates are better. Rate calculation = (number of infections divided by number of resident days) x 1,000. Factors affecting infection rates include the prevalence of underlying risk factors as well as awareness and surveillance efforts.

• Importance: Infections are a major cause of harm in nursing homes. Respiratory tract, gastrointestinal, urinary tract, and skin and soft tissue infections are the most common conditions in this care setting.
• Groups With Disparities: Pooled mean rates of infection among Pennsylvania nursing home residents were higher among men than women for RTI, UTI, and other infections.

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