Promoting Safe Medication Administration in Massachusetts Nursing Homes

Purpose: As an initial step to promoting safe medication administration in Massachusetts (MA) nursing homes, the UMass Medical School's Center for Health Policy and Research and the MA Board of Registration in Nursing surveyed nurses working in MA nursing homes to determine barriers to medication error reporting, assess patient safety culture and evaluate social desirability of responses. Methods: The survey combined three instruments: the Agency for Healthcare Research and Quality Nursing Home Survey on Patient Safety, Determining Barriers to Medication Error Reporting, and the Marlowe-Crowne social desirability scale. A cluster sampling strategy was used randomly selecting nursing homes stratified by size to reach 25% of MA nursing staff. Results: Of 142 homes contacted, 110 were recruited (recruitment rate: 77.5%). Of 3,300 surveys distributed, 1,274 were completed (response rate: 38.5%). While the majority of nurses (86%) rated the overall patient safety culture as positive, composite scores for four patient safety domains were lower than national benchmarks: “Compliance with Procedures” (57%), “Training and Skills” (64%), “Non-Punitive Responses to Mistakes” (41%), and “Communication Openness” (52%). Perceived barriers to reporting rated as likely modifiable were “Lack of an anonymous reporting system”, “Fear of disciplinary action”, “Lack of recognition that a medication error has occurred”, and “Fear of being blamed”. Conclusions: The results will establish the first statewide nursing home patient safety benchmarks and will advise the development of a non-punitive, facility-based strategy to remediate nursing practice and promote systems change.