Summary of relevance
- •Issue: Quality of care is an ongoing issue in Australian residential aged care homes, with repeated reviews highlighting that workforce is a key aspect of neglect and poor resident outcomes.
- •What is already known: International residential aged care and Australian hospital evidence demonstrates more nurse staffing hours leads to lower rates of adverse events, but evidence specific to Australian aged care is lacking.
- •What this paper adds: Resident access to more registered nursing hours at night and on weekends decreased the chance of pressure injuries/skin tears or falls. Size of homes often determine nursing hours available.
ABSTRACT
Background
People living in residential aged care homes are entitled to a safe environment 24
hours a day, 7 days a week. Unfortunately, past evidence tells us this is not always
the case and that our most vulnerable population experience high rates of adverse
events.
Aim
To determine whether after-hours shifts are associated with number of adverse events,
independent of registered nurse staffing levels and residential aged care home size.
Methods
Retrospective cohort design with multilevel modelling. Adverse events, registered
nurse staffing and facility size were collected via routine reporting from ten homes
(1020 beds) in one Australian state for three months in 2017.
Findings
Residents records (n = 1560) of adverse events were collected from ten Residential
Aged Care Homes with 1020 beds. An adverse event was reported, on average, every second
shift per home. During afterhours shifts, there was an inverse association between
nurse staffing and adverse events, such that lower nurse staffing was associated with
higher rates of adverse events, specifically for falls and pressure injuries/skin
tears. During day shifts, this effect was not seen.
Discussion
The findings support statements made at the Royal Commission into Aged Care Quality
and Safety regarding the lack of adequacy of nurse staffing supervision during and
after hours and may contribute to considerations of upcoming mandated registered nursing
contact hours for 16 of the 24 hours in a day.
Conclusion
During after-hour shifts, but not day shifts, having fewer nurses is associated with
more likelihood of adverse event occurrences in Australian residential aged care homes.
More research, in more sites and across more organisations, with better granulation
across day, evening, night and weekend/public holiday shifts will improve understanding
and responsiveness to the phenomena. Future research examining falls should include
staffing levels.
Keywords
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Article info
Publication history
Published online: October 19, 2022
Accepted:
September 27,
2022
Received in revised form:
August 11,
2022
Received:
April 21,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Published by Elsevier Ltd on behalf of Australian College of Nursing Ltd.
